Guaranteed financial incentives for COVID-19 vaccination increase vaccine uptake

North Carolina's $25 Summer Card Pilot program successfully encouraged more adults to get a COVID-19 vaccine at a time when the pace of vaccination in North Carolina was slowing.

The North Carolina Department of Health and Human Services authored a research letter in JAMA Internal Medicine along with researchers at North Carolina Central University and the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, about the program. The report is one of the first to provide data on guaranteed financial incentives for COVID-19 vaccination.

Within a week, this well-designed incentive program halved the drop in COVID-19 vaccination that North Carolina was experiencing. Using guaranteed cash incentives is a best practice, recommended by the U.S. Centers for Disease Control. It builds on 70 years of psychological research showing that rewards are most effective when delivered immediately after the behavior."

Noel T. Brewer, co-author, professor of health behavior, UNC Gillings School of Global Public Health

During the one-week review period, COVID-19 vaccinations declined by just 26% at clinics in Mecklenburg, Guilford, Rowan and Rockingham counties offering the $25 cards, but declined by 51% at other clinics in the four counties. During the same period, the rate of vaccinations decreased statewide by 49%.

The incentive study guaranteed a $25 card to adults who either received their first dose of COVID-19 vaccine or drove someone to providers participating in the pilot program.

The program distributed 2,890 cards to vaccine recipients and 1,374 to drivers. The $25 Summer Card program switched to providing $100 cards after this evaluation was conducted, and data on the $100 Summer Card program are not included in the authors' review.

"Providing guaranteed small financial incentives is a promising strategy to increase COVID-19 vaccination uptake," said Charlene Wong, the chief health policy officer for COVID-19 at the NCDHHS. "The design of our $25 incentive pilot program in North Carolina helped alleviate transportation and other cost barriers to vaccination, particularly for low-income, Latinx and Black individuals."

"North Carolina Central University was pleased to be a key partner in North Carolina's effort to increase COVID-19 vaccination rates through incentive vaccination clinics," said William Pilkington, H.O.P.E co-program director at Julius L. Chambers Biomedical Biotechnology Research Institute at NCCU. "The university's staff developed and administered surveys at the clinics that produced results clearly demonstrating the value of incentives to promote more equitable distribution of the COVID-19 vaccinations."

Of 401 vaccine recipients surveyed, 41% reported the $25 card was an important reason why they decided to get vaccinated. The cards were more important to respondents who were not white as well as respondents with lower incomes.

Additionally, "someone driving me here today" was an important reason for 49% of respondents, more commonly among Black, Hispanic and lower-income respondents. Lower-income and older individuals, especially, were more likely to have been brought by a driver who received a cash card.