Nearly 50 percent of Americans have been at least partially vaccinated as of this week, a major milestone that, not long ago, felt out of reach. But with some states still far behind a majority-vaccinated population, many have turned to a reliably alluring proposition: financial incentives.
Ohio was the first state to try this approach with its Vax-A-Million program, a campaign that offers five $1 million prizes to vaccinated adults in the state and four full-ride scholarships to Ohio state schools for 12 to 17-year-olds. The program was an instant success, prompting a 28 percent increase in vaccinations the weekend after the announcement. In total, 2.7 million Ohioans have now signed up for the state's vaccine lottery, roughly 23 percent of its entire population.
As the success of Ohio's program became evident, more states followed suit. Oregon launched a similar million-dollar lottery last week — which also includes free tuition to state colleges — so did New York, Colorado and Maryland. Maine started offering prizes such as free fishing licenses and L.L. Bean gift cards while New Jersey began offering a free beer. Even the federal government has gotten involved, commending states for getting creative with their vaccination campaigns.
"From the data we’ve seen, they appear to be working," Andy Slavitt, White House senior adviser on the national COVID-19 response, said on Tuesday. "I think the reason they work is because the vast number of people who are not yet vaccinated are actually not opposed to getting vaccinated; they’re just not prioritizing it very high ... and so things that draw attention to it, like the lotteries in those states you mentioned, are not surprisingly very effective, and so we’re enthusiastic."
So what is it about incentives that encourage people to get vaccinated — and does any type of reward work? Dr. David Asch, executive director of the Penn Medicine Center for Health Care Innovation, is well-versed in the world of incentives. Asch is an expert in a field known as "behavioral economics," the study of — among other things — how various psychological, cultural and social factors impact decision-making.
Asch points out that, despite how novel the vaccine lotteries and prizes seem, incentives in the healthcare world are nothing new. "Look at your health insurance plan," Asch tells Yahoo Life. "It's all these co-payments and deductibles and out-of-pocket maximums and in and out-of-network things, every single one of those is a financial incentive directed at you, the health insurance plan member to get you to direct your healthcare in a certain way."
But not all vaccine rewards are created equal. "If someone claims that we're going to use incentives to promote vaccination, my question is what kind?" says Asch. Offering things like free beer or $100 savings bonds (which West Virginia is now doing) may be too "transactional" to have a big impact, he says. "They can be effective, but they're not likely to have a major effect on vaccination rates."
Lotteries, on the other hand, tap into people's emotional side and offer an "exciting" opportunity. "Let's face it, buying a lottery ticket is a fairly bad idea as an investment return — only pennies on the dollar," Asch says. "But lotteries offer the chance to win a huge prize and people are much more likely to focus on the big prize than on the small chance of winning that prize."
One way to look at this is what one psychologist called "unrealistic optimism," but another explanation is simply that as humans, we can't fully grasp how unlikely it is that we will win. "It's a psychological phenomenon that we tend to focus more on the prize and have a hard time understanding the implications of small probabilities," says Asch. "A typical person doesn't understand the difference between a one in 100 chance and a one in 10,000 chance. They both seem small, but one is a hundred times larger than the other. You'd think that would make a difference, but it doesn't. We just can't comprehend it."
Robert Williams, a clinical psychologist at the University of Lethbridge who has studied the psychology of lotteries, explained it in a similar way to science magazine Nautilus. "People just aren’t able to grasp 1 in 175 million,” said Williams. “It’s just beyond our experience—we have nothing in our evolutionary history that prepares us or primes us, no intellectual architecture, to try and grasp the remoteness of those odds.”
Asch agrees. "It's not our fault, we're just wired that way," he says. "Lotteries take advantage of our focus on the prize; it gives them some of the emotional appeal — that emotional punch." The good news for states unwilling to shell out millions is that it doesn't necessarily have to be a traditional lottery to have that same effect. "New Jersey is giving away passes to state parks and also a chance to have dinner with the governor and his wife. That's really cool. I'd like to have dinner with the governor and his wife, so that's got more of a lottery feel," Asch says. "If I really want to go to the state park, I can buy a pass to the state park. That doesn't have the same emotional appeal."
In terms of who these lotteries may impact positively, Asch says it's more likely to be individuals who trusted the science of the vaccine but simply hadn't planned to get one. Adding money to the equation may actually make individuals who have concerns about its safety become more distrustful of the vaccine and the intentions behind it.
"If you're pretty much of the view that the vaccine is bad, you will interpret most information as corroborating that view. We have what is called confirmation bias, which means not only do we seek out information that tends to confirm our prior beliefs, but we interpret information so as to make it confirm our prior beliefs," Asch says. "So someone who was really eager to get vaccinated will see $100 and say, 'This is great.' And someone who is really concerned about the safety of vaccines will see the same $100 and say, 'Well, they certainly wouldn't be offering $100 if it was safe.'"
Overall, Asch says he's not opposed to any incentives regarding vaccination, he simply hopes that states will consider their effectiveness before launching them. "Our goal is to get vaccination rates up so we should not rely on any one strategy to do that," he says. "Each of these things is part of a campaign where some strategies work better with some people and others with other people."
But in his opinion, the incentives that play on our imaginations will always work the best. "Prizes that allow you to dream, they harness our passions," he says. "I don't think a Krispy Kreme doughnut a day, that doesn't meet any one of my passions — no disrespect to Krispy Kreme."
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