Public Health Watch: Monetary Incentives Boost Vaccination Rates


Pilot program benefits those in need most, covering potential costs associated with vaccination.

cash incentive

Vaccine hesitancy comes in many flavors.

There are those who deny or dispute the science behind the injections—and that’s hardly new. That issue long predates COVID-19, and the vaccines designed specifically for the virus that causes it.

However, there are others who are reluctant to get vaccinated for other reasons, many of which are related to economics and accessibility.

For those that fall into this latter group, evidence suggests that financial incentives can help them overcome these barriers to vaccination and compel them to get inoculated. That is the key message of a study published on October 25 by JAMA Internal Medicine.

“What we’ve seen since the COVID-19 vaccines first became available is that there are many people who want to get vaccinated but face challenges in being able to do so,” study coauthor Charlene A. Wong, MD, MSHP, chief health policy officer for COVID-19 with the North Carolina Department of Health and Human Services (NCDHHS)in Raleigh. “These include problems with transportation to vaccine clinics and lost wages due to missed work time.”

To address these issues, Wong and her colleagues at NCDHHS created a program that “provided smaller but guaranteed financial incentives.” The program guaranteed a $25 cash card to adults who either received their first dose of COVID-19 vaccine at, or drove someone to, participating providers in four North Carolina counties. At 4 events held in April, May, and June the pilot program distributed 2890 cards to vaccine recipients and 1374 to drivers who transported others to vaccine distribution sites.

This is not the same as entering people who get vaccinated into “lotteries” with prizes as high as $1 million, as some states have done. Research suggests that these types of inducements may be ineffective.

Rather, this is about providing people who may have limited financial resources with a means of offsetting, at least partially, any costs they may incur in simply getting vaccinated. And, importantly, it does so without stigmatizing them in any way. Participants in the pilot program did not need to “apply” for a cash card, nor did they have to demonstrate or prove financial need. Everyone who got vaccinated, or help transport others to a vaccination site, received a cash card—though, interestingly, people with lower household incomes were about twice as likely to participate in the program compared with wealthier people, which suggests the incentives reached those who stood to benefit most.

Notably, COVID-19 vaccine initiation increased by 46% in the intervention clinics. In addition, of 401 vaccine recipients surveyed, 41% reported the cash card was an important reason they decided to get vaccinated, according to the researchers. The program was so successful that the program switched to providing $100 cards after the study was conducted.

“Financial incentives to encourage people to participate in a public health program are nothing new—insurance companies have been doing this for years, to get members to undergo cancer screening, for example,” Wong said. “For us, the incentives weren’t just part of a research effort, but a need to get the people of North Carolina vaccinated. We realized that if we could get people to get their first dose of the COVID-19 vaccine, and they had a positive experience, it would build confidence in the vaccine and its distribution.”

And that can only help.

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