Winning Idea: Ohio Vaccine Lottery Shows Some Incentives May Work

Damian McNamara

May 18, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

For some residents of Ohio, the prospect of winning $1 million is enough of an incentive to roll up their sleeves and get vaccinated against COVID-19. In fact, since Governor Mike DeWine's office announced the five weekly drawings of $1 million each, the number of people signing up has increased.

"Friday saw more vaccines than any day in the last three weeks. We have seen increases in teenagers getting vaccinated as well as adults 30 to 74," Dan Tierney, press secretary for the office of Ohio Governor Mike DeWine, told Medscape Medical News.

"This is truly changing the downward trends in vaccine uptake," he added. "We are pleased that this has helped draw attention to the power of the vaccine and encouraged people to get vaccinated."

Like other recently announced COVID-19 vaccine incentives, the goal is to reach the people amenable to getting vaccinated but who need a nudge to act. This "moveable middle" group lies somewhere between the vaccine enthusiasts and people who report they will never get vaccinated.

The vaccine incentive programs are not without controversy. Some Ohio officials criticized the use of federal COVID-19 relief money to fund the incentive, for example. But DeWine, who came up with the idea for the lottery, appears unswayed.

The "Ohio Vax-a-Million" drawings are planned for 5 consecutive Wednesdays starting May 26. At the same time, a second drawing for full scholarships to a 4-year state college will be held for residents 12 to 17 years old who get vaccinated. 

The Ohio lottery may be getting the most attention, but it is not alone. Other states and retailers are encouraging the "moveable middle" through giveaways of donuts, beer, baseball tickets, and more. West Virginia announced a $100 savings bond incentive for residents, one that requires more patience because the bonds will not mature for years.

Although some have criticized Ohio for such a high-dollar incentive, West Virginia Governor Jim Justice estimated their program would cost $27.5 million if the state vaccinated every resident 16 to 35 years old.

He described the amount as a "small price" compared with the $75 million the state has already spent on COVID-19 testing.

Predicting Who Will Be Swayed

One goal all the incentive programs share is motivating people "on the fence" about COVID-19 vaccines. Research on the demographics or personas of people most likely to land within this group or respond to targeted messaging can be helpful, but it's likely just a starting point, experts point out.

"We are targeting all eligible Ohioans, but we are also making efforts to make sure underserved communities and older Ohioans are included," Tierney said.

Dr Robert Bednarczyk

Public health officials often classify groups of people who may be more or less likely to get vaccinated versus others. "We think through who's getting vaccinated, who's not, and who may have intentions to get vaccinated," Robert Bednarczyk, PhD, assistant professor, Hubert Department of Global Health and Department of Epidemiology at Rollins School of Public Health at Emory University in Atlanta, Georgia, said during a May 18 media briefing sponsored by Emory.

"I think that some of those categories that we oftentimes look at tend to be very singularly focused" he said, so they do not account for the diversity of individuals within a certain group.

"Some of that research is useful for an initial look at who is intending to get vaccinated and who is not, but that doesn't give us all of the answers."

Instead, understanding on a person-by-person or small-group basis who may be amenable to some of vaccine incentive programs remains essential. "We can't paint everyone who we identify with particular demographic characteristics to all have the same attitudes and the same perceptions," he added.

On a Persona Level

Instead of grouping people by age, sex, race, or ethnicity when predicting the effectiveness of vaccine incentives, looking at personas might help. It would be similar to a customer-based approach to advertising or messaging that companies can employ.

There are five main persona types when it comes to willingness to get vaccinated for COVID-19, a nationally representative survey of 2747 US adults reveals:

  • The enthusiasts

  • The watchful

  • The cost-anxious

  • The system distrusters

  • The conspiracy believers

Excluding the 40% of enthusiasts and the 17% of conspiracy believers, the survey group Surgo Ventures noted that means 43% of Americans fall into one of the persuadable groups.

A Surgo analysis of the findings aligns with Bednarczyk's take on classifying people. "Certain subgroups — women, Republicans, essential workers, Black individuals, rural residents, and those with lower incomes and education levels — tend to express lower likelihood of taking the vaccine, but these groups are not a monolith."

Instead, they report that addressing barriers by persona could be helpful. For example, the key barrier for the "watchful" group is community norms — they tend to wait and watch others go first.

The "cost-anxious" are, like the name suggests, more concerned about time and money — so an incentive for employees to take paid time off to get vaccinated might resonate with them.

The "system distrusters" include people who might believe COVID-19 vaccines have not been fully evaluated for safety in their racial or ethnic group and/or who have a general distrust of the healthcare system. Reaching this group might require promoting data on racial vaccination disparities or setting up vaccination clinics in local communities.

What's In It for Me?

So once officials identify the type of person they need to reach, what other considerations are important? Messaging that highlights the benefits for an individual can be more effective than altruistic or population-based advantages associated with COVID-19 vaccination, research shows.

For example, investigators in the United Kingdom assessed 15,014 for vaccine hesitancy. Within this group, 66% were willing, 16% doubtful, and 18% were strongly hesitant to get a COVID-19 vaccine.

Although the type of information offered did not significantly change vaccine hesitancy among those willing or doubtful, it did have a significant effect on those strongly hesitant.

Vaccine hesitancy rates dropped among the strongly hesitant more when information focused on not getting personally ill compared with the collective benefit of lowering transmission of the virus, investigators reported May 12, 2021, in The Lancet Public Health.

Not a Substitute for Public Health Outreach

During the media briefing, a reporter asked Bednarczyk how long it will likely take to gauge the success of the Ohio COVID-19 lottery and other recent incentives.

"I don't know if there's a clear number that we're looking at or a clear rate that we're looking at that would indicate that this is working," he said. "What we're really paying attention to is: are the numbers just continuing to go up?"

The recent expansion of vaccine eligibility to include 12- to 15-year-olds could also increase the number of vaccinations, he added.

Ultimately, vaccine access and community outreach are more essential than incentive programs, Bednarczyk said.

"For individuals who don't have confidence in the vaccine or in the vaccination program, these giveaways are not likely to overcome these concerns," he said. "We still need to work with our communities to understand their concerns" and help answer their questions.

"I worry that while we may see some people getting vaccinated because of these incentive programs and because of these giveaways, that these more flashy types of programs may distract from that day-to-day, on-the-ground work that our public health practitioners are doing."

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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