Ohio Vaccine Lottery Boosted Vaccinations in Low-Income Counties

By Ronnie Cohen

September 03, 2021

(Reuters Health) - Ohio's Vax-a-Million lottery program helped convince an additional 109,000 of the state's residents to get COVID-19 vaccinations, a new analysis suggests.

Most of those people lived in counties where uptake of the vaccines had been low, researchers said.

Nearly 3.5 million adults and 155,000 adolescents who received at least one COVID-19 vaccine entered the Vax-a-Million lottery. Drawings for $1 million prizes for adults and full scholarships for 12 to 17 year olds were held five times in May and June.

The program cost the state approximately $6 million, or about $55 for each additional vaccine started, according to a report in the American Journal of Emergency Medicine.

The greatest benefits accrued in low-income counties, where residents had been less likely to get vaccinated than in high-income counties. Those counties saw an increase of an additional 25 vaccinations a day during the lottery.

"The overall benefits of the program were very positive," said lead author Peter J. Mallow, director of health economics and clinical outcomes research at Xavier University in Cincinnati.

"The question is whether there are better programs," he told Reuters Health in a phone interview. "We just don't know."

Mallow's team did not analyze the effects of the vaccines in their study. Based on Ohio's published COVID-19 data, however, they speculate that the lottery may have prevented 46 SARS-CoV-2 infections and four hospitalizations, and saved one life.

Ohio Governor Mike DeWine unveiled the lottery incentive in May a few days after the Food and Drug Administration expanded its Emergency Use Authorization for the Pfizer-BioNTech vaccine to include adolescents from 12 to 15 years old.

DeWine hailed the lottery as a "resounding success." Research into the value of the program, however, showed more mixed results.

Two previous studies reached conflicting conclusions about the lottery's effectiveness. Researchers used Centers for Disease Control and Prevention data in the prior studies, while the current study used Ohio Department of Health data.

A prior analysis in the American Journal of Medicine found a statistically significant increase in first vaccinations in Ohio compared to a matched synthetic control. It estimated that nearly 115,000 additional Ohioans received shots at a cost of $49 each. (https://bit.ly/2WDVCyh)

But a research letter in JAMA Network Open found no evidence that the lottery increased the number of adults getting the shots. (https://bit.ly/3Bq15HA)

Before the lottery, the number of people starting to get vaccinated had declined throughout the U.S. as well as in Ohio. When the FDA approved the vaccine for 12 to 15 year olds, the rate of decline in vaccinations slowed. But, researchers found, the rate slowed more in the U.S. as a whole than in Ohio.

Because the new study evaluated vaccine trends only in Ohio, it remains unclear if the observed vaccine bump resulted from the lottery or from increased vaccinations among adults as a result of expanded availability to adolescents, said Dr. Allan J. Walkey, lead author of the JAMA Network Open study and a professor of medicine and public health at Boston University.

"Our study suggested that there may have been a similar sized bump in adult vaccinations in Ohio and in U.S. states that did not offer a lottery, coinciding with the expansion of the vaccine to adolescents," Walkey said in an email. "Thus, we could not attribute changes in vaccine rates to the lottery."

Walkey, who was not involved with the new study, said he would have liked it to include a control group to account for underlying vaccination trends across the rest of the nation.

Mallow acknowledged that his study was unable to differentiate between an increase as a result of adults getting vaccinated along with their teenagers compared to adults getting vaccinated to enter the lottery.

He also lamented the difficulty in obtaining vaccines in Ohio. When his daughter turned 12 recently and became eligible for her first shot, the logistics of locating one, reserving a spot and driving her the 20 minutes there and back twice proved challenging for Mallow and his family.

"It was no small effort to do this for my daughter," he said. "It was that difficult for a household that had all the means in the world. At least in the Ohio area, there are still a lot of burdens that need to be addressed in terms of accessibility."

SOURCE: https://bit.ly/3DqML3f American Journal of Emergency Medicine, August 26, 2021.