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Fu W, Wang LS, Chou SY. A single dose for me, A wealth of protection for us: The public health cost of individualism in the rollout of COVID-19 vaccine. Soc Sci Med 2024; 348:116849. [PMID: 38581815 DOI: 10.1016/j.socscimed.2024.116849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE This study examines whether individualism weakens the effectiveness of the COVID-19 vaccine eligibility expansions in the United States in 2021, and assesses the associated social benefits or costs associated with individualism. METHODS We construct a county-level composite individualism index as a proxy of culture and the fraction of vaccine eligible population as a proxy of vaccination campaign (mean: 41.34%). We estimate whether the COVID-19 vaccine eligibility policy is less effective in promoting vaccine coverage, reducing in COVID-19 related hospitalization and death using a linear two-way fixed effect model in a sample of 2866 counties for the period between early December 2020 and July 1, 2021. We also test whether individualism shapes people's attitudes towards vaccine using a linear probability model in a sample of 625,308 individuals aged 18-65 (mean age: 43.3; 49% male; 59.1% non-Hispanic white, 19.1% Hispanic, 12% African American; 5.9% Asian) from the Household Pulse Survey. RESULTS The effects of expanded vaccine eligibility are diminished in counties with greater individualism, as evidenced by lower effectiveness in increasing vaccination rates and reducing outpatient doctor visits primarily for COVID-related symptoms and COVID deaths. Moreover, our results show that this cultural influence on attitudes towards vaccine is more pronounced among the less educated, but unrelated to race. CONCLUSION Assuming an average level of vaccine eligibility policies and an average intensity of individualism across the nation, we calculate that the average social cost associated with an individualistic culture amid the pandemic is approximately $50.044 billion, equivalent to 1.32% of the total U.S. health care spending in 2019. Our paper suggests that strategies to promote public policy compliance should be tailored to accommodate cultural and social contexts.
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Affiliation(s)
- Wei Fu
- Department of Health Management and Systems Sciences, University of Louisville, USA.
| | - Li-San Wang
- Penn Neurodegeneration Genomics Center (PNGC), Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, USA
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2
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Reddinger JL, Charness G, Levine D. Vaccination as personal public good provision. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2022.04.21.22274110. [PMID: 35923323 PMCID: PMC9347278 DOI: 10.1101/2022.04.21.22274110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vaccination against infectious diseases has both private and public benefits. We study whether social preferences-concerns for the well-being of other people-are associated with one's decision regarding vaccination. We measure these social preferences for 549 online subjects with a public-good game and an altruism game. To the extent that one gets vaccinated out of concern for the health of others, contribution in the public-good game is analogous to an individual's decision to obtain vaccination, while our altruism game provides a different measure of altruism, equity, and efficiency concerns. We proxy vaccine demand with how quickly a representative individual voluntarily took the initial vaccination for COVID-19 (after the vaccine was widely available). We collect COVID-19 vaccination history separately from the games to avoid experimenter-demand effects. We find a strong result: Contribution in the public-good game is associated with greater demand to voluntarily receive a first dose, and thus also to vaccinate earlier. Compared to a subject who contributes nothing, one who contributes the maximum ($4) is 58% more likely to obtain a first dose voluntarily in the four-month period that we study (April through August 2021). In short, people who are more pro-social are more likely to take a voluntary COVID-19 vaccination. Behavior in our altruism game does not predict vaccination. We recommend further research on the use of pro-social preferences to help motivate individuals to vaccinate for other transmissible diseases, such as the flu and HPV.
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3
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Bade V, Schmitz H, Tawiah BB. Regional variations in vaccination against COVID-19 in Germany. PLoS One 2024; 19:e0296976. [PMID: 38635523 PMCID: PMC11025766 DOI: 10.1371/journal.pone.0296976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 12/25/2023] [Indexed: 04/20/2024] Open
Abstract
Vaccination willingness against COVID-19 is generally perceived as low. Moreover, there is large heterogeneity across and within countries. As a whole, Germany has average vaccination rates compared to other industrialized countries. However, vaccination rates in the 16 different German federal states differ by more than 20 percentage points. We describe variation in vaccination rates on the level of the 400 German counties using data on all vaccinations carried out until December 2022. Around 52-72% of that variation can be explained by regional differences in demographic characteristics, housing, education and political party preferences. We find indications that the remaining part may be due to differences in soft factors such as risk aversion, trust in the German government, trust in science, and beliefs in conspiracy theories regarding the origins of the Corona virus. We conclude that improving the trust in science and the fight against conspiracy theories may possibly be effective tools to improve vaccination rates and effectively fight pandemics.
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Affiliation(s)
| | - Hendrik Schmitz
- Paderborn University, Paderborn, Germany
- RWI – Leibniz Institute for Economic Research, Essen, Germany
- Leibniz Science Campus Ruhr, Essen, Germany
| | - Beatrice Baaba Tawiah
- Munich Research Institute for the Economics of Aging ans SHARE Analyses, Munich, Germany
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4
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Steinmayr A, Rossi M. Vaccine-skeptic physicians and patient vaccination decisions. HEALTH ECONOMICS 2024; 33:509-525. [PMID: 38015034 DOI: 10.1002/hec.4781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
What is the role of general practitioners (GPs) in supporting or hindering public health efforts? We investigate the influence of vaccine-skeptic GPs on their patients' decisions to get a COVID-19 vaccination. We identify vaccine-skeptic GPs from the signatories of an open letter in which 199 Austrian physicians expressed their skepticism about COVID-19 vaccines. We examine small rural municipalities where patients choose a GP primarily based on geographic proximity. These vaccine-skeptic GPs reduced the vaccination rate by 5.6 percentage points. This estimate implies that they discouraged 7.9% of the vaccinable population. The effect appears to stem from discouragement rather than rationing vaccine access.
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5
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Krajewski T, Hudgens M. The augmented synthetic control method in public health and biomedical research. Stat Methods Med Res 2024; 33:376-391. [PMID: 38320801 PMCID: PMC10981189 DOI: 10.1177/09622802231224638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Estimating treatment (or policy or intervention) effects on a single individual or unit has become increasingly important in health and biomedical sciences. One method to estimate these effects is the synthetic control method, which constructs a synthetic control, a weighted average of control units that best matches the treated unit's pre-treatment outcomes and other relevant covariates. The intervention's impact is then estimated by comparing the post-intervention outcomes of the treated unit and its synthetic control, which serves as a proxy for the counterfactual outcome had the treated unit not experienced the intervention. The augmented synthetic control method, a recent adaptation of the synthetic control method, relaxes some of the synthetic control method's assumptions for broader applicability. While synthetic controls have been used in a variety of fields, their use in public health and biomedical research is more recent, and newer methods such as the augmented synthetic control method are underutilized. This paper briefly describes the synthetic control method and its application, explains the augmented synthetic control method and its differences from the synthetic control method, and estimates the effects of an antimalarial initiative in Mozambique using both the synthetic control method and the augmented synthetic control method to highlight the advantages of using the augmented synthetic control method to analyze the impact of interventions implemented in a single region.
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Affiliation(s)
- Taylor Krajewski
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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6
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Robertson DA, Timmons S, Lunn PD. Behavioural evidence on COVID-19 vaccine uptake. Public Health 2024; 227:49-53. [PMID: 38104419 DOI: 10.1016/j.puhe.2023.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The World Health Organization has declared that COVID-19 is no longer a public health emergency of international concern. Nevertheless, it remains a public health issue, and seasonal vaccinations, at the same time of year as influenza vaccinations, will be necessary. When the first vaccines were administered in 2020, decision-makers had to make assumptions about the best methods to communicate and administer vaccines to increase uptake. Now, a body of evidence can inform these decisions. STUDY DESIGN A narrative review written by three behavioural scientists who design research for policy. METHODS We searched the PubMed database for: (i) reviews of interventions to increase uptake of COVID-19 or influenza vaccines and (ii) empirical studies on uptake of COVID-19 and influenza vaccines. In addition, registered trials gathered by a Cochrane scoping review of interventions to increase uptake of COVID-19 vaccines were searched for updated results. RESULTS Results centre around two aspects of a vaccination campaign of interest to policymakers: communication and administration. Results suggest that communications highlighting the personal benefits of vaccination are likely to be more effective than those highlighting collective benefits. The efficacy of vaccination may be underestimated and stressing efficacy as a strong personal benefit may increase uptake. Keeping vaccines free, sending personalised messages, reminders and prebooked appointment times may also increase uptake. CONCLUSIONS There is now a body of evidence from behavioural science that suggests how vaccination campaigns for COVID-19 can be structured to increase uptake. These recommendations may be useful to policymakers considering seasonal vaccination campaigns and to researchers generating hypotheses for country-specific trials.
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Affiliation(s)
- D A Robertson
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland.
| | - S Timmons
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - P D Lunn
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; Department of Economics, Trinity College Dublin, Dublin, Ireland
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7
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Hernández-García I, Rodríguez-Montolio J, Almeida-Zurita M, Cheli-Gracia D, Sahuquillo BDM, Aibar-Remón C, Garcés-Redondo M. COVID-19 Vaccination Coverage and Associated Factors in Patients with Multiple Sclerosis. Vaccines (Basel) 2024; 12:126. [PMID: 38400109 PMCID: PMC10893319 DOI: 10.3390/vaccines12020126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Our objective was to know the COVID-19 vaccination coverage in multiple sclerosis (MS) patients and its factors associated. A retrospective cohort study was carried out. Patients seen at the MS unit of the University Clinical Hospital of Zaragoza between 2017 and 2021 were included. Variables were obtained by reviewing the specialized and primary care records. Associations between receiving COVID-19 full primo-vaccination, as well as one booster dose since autumn 2022, and the other variables were analyzed using bivariate analysis and multiple logistic regression models. Of the 359 included patients, 90.3% received the COVID-19 full primo-vaccination. Having been born in Spain (aOR = 3.40) and having received the 2020-2021 influenza vaccine (aOR = 6.77) were associated with receiving the COVID-19 full primo-vaccination. Vaccination with a COVID-19 booster dose was detected in 141 patients (39.3%). Sex (man) (aOR = 2.36), age (60 years or over) (aOR = 6.82), type of MS (Primary Progressive/Secondary Progressive) (aOR = 3.94), and having received the 2022-2023 influenza vaccine (aOR = 27.54) were associated with receiving such a booster dose. The COVID-19 booster dose was administered at the same time as the 2022-2023 influenza vaccine in 57.8% (67/116) of the patients vaccinated with both vaccines. The COVID-19 full primo-vaccination coverage is higher than in other countries. However, the decrease in vaccination coverage with the booster dose makes it necessary to develop strategies to improve it that are not limited to administering the flu vaccine together with the COVID-19 booster dose. Such strategies should be in focus, especially for women under 60 years of age.
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Affiliation(s)
- Ignacio Hernández-García
- Department of Preventive Medicine and Public Health, Lozano Blesa University Clinical Hospital of Zaragoza, Calle San Juan Bosco 15, 50009 Zaragoza, Spain
- Health Services Research Group of Aragon (GRISSA), Aragon Institute for Health Research (IISA), Calle San Juan Bosco 15, 50009 Zaragoza, Spain;
| | - Joana Rodríguez-Montolio
- Department of Neurology, Lozano Blesa University Clinical Hospital of Zaragoza, Calle San Juan Bosco 15, 50009 Zaragoza, Spain; (J.R.-M.); (M.A.-Z.); (D.C.-G.); (B.d.M.S.); (M.G.-R.)
| | - Monserrath Almeida-Zurita
- Department of Neurology, Lozano Blesa University Clinical Hospital of Zaragoza, Calle San Juan Bosco 15, 50009 Zaragoza, Spain; (J.R.-M.); (M.A.-Z.); (D.C.-G.); (B.d.M.S.); (M.G.-R.)
| | - Dionisio Cheli-Gracia
- Department of Neurology, Lozano Blesa University Clinical Hospital of Zaragoza, Calle San Juan Bosco 15, 50009 Zaragoza, Spain; (J.R.-M.); (M.A.-Z.); (D.C.-G.); (B.d.M.S.); (M.G.-R.)
| | - Belén del Moral Sahuquillo
- Department of Neurology, Lozano Blesa University Clinical Hospital of Zaragoza, Calle San Juan Bosco 15, 50009 Zaragoza, Spain; (J.R.-M.); (M.A.-Z.); (D.C.-G.); (B.d.M.S.); (M.G.-R.)
| | - Carlos Aibar-Remón
- Health Services Research Group of Aragon (GRISSA), Aragon Institute for Health Research (IISA), Calle San Juan Bosco 15, 50009 Zaragoza, Spain;
- Department of Microbiology, Pediatrics, Radiology and Public Health, University of Zaragoza, Calle de Pedro Cerbuna 12, 50009 Zaragoza, Spain
| | - Moisés Garcés-Redondo
- Department of Neurology, Lozano Blesa University Clinical Hospital of Zaragoza, Calle San Juan Bosco 15, 50009 Zaragoza, Spain; (J.R.-M.); (M.A.-Z.); (D.C.-G.); (B.d.M.S.); (M.G.-R.)
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8
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Serrano-Alarcón M, Mckee M, Palumbo L, Salvi C, Johansen A, Stuckler D. How to increase COVID-19 vaccination among a population with persistently suboptimal vaccine uptake? Evidence from the North Macedonia mobile vaccination and public health advice caravan. Health Policy 2024; 139:104966. [PMID: 38101148 PMCID: PMC10788482 DOI: 10.1016/j.healthpol.2023.104966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
Over three years since the first COVID-19 vaccine was approved, many countries still have suboptimal vaccination rates despite holding great amounts of vaccines. Overall, there is little evidence on which policies are more effective to encourage vaccination, particularly in countries where a large share of the population remains unvaccinated. In this study, we examine the effectiveness of a community-based intervention carried out in March 2022 in North Macedonia, a country with a large and persistent share of the population that remains unvaccinated. The intervention, spearheaded by the Ministry of Health and supported by the World Health Organization and UNICEF, consisted of a mobile caravan offering vaccination and public health advice to different locations across the country on different days. Results from our staggered difference-in-difference model show that the mobile vaccination caravan increased daily vaccination rates by 7.7 vaccines per 100,000 inhabitants during the three weeks after the day of the caravan visit. This corresponds to a 35 % increase with respect to pre-intervention vaccination rates. We estimate a cost-effectiveness of 25.4 US dollars (USD) per additional vaccination induced. These results point to mobile caravan vaccines as an effective and cost-effective strategy to increase COVID-19 vaccination rates, even in a context of persistently suboptimal uptake.
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Affiliation(s)
- Manuel Serrano-Alarcón
- European Commission, Joint Research Centre (JRC), Ispra, Italy; Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy.
| | - Martin Mckee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | | | | | | | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy; Department of Social & Political Sciences, Bocconi University, Milano, Italy
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9
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Erdem O, Erdem S, Monson K. Children, vaccines, and financial incentives. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:537-552. [PMID: 36853572 PMCID: PMC9973241 DOI: 10.1007/s10754-023-09343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Recent studies have been analyzing and measuring the efficacy of the use of financial incentives to increase the Covid-19 vaccine uptake. To the best of our knowledge, this paper is the only study available in the literature that aims to measure the effect of financial incentives on vaccine rates among children. This paper explores the effects of a specific financial incentive on parents' vaccination decisions for their children. Using data from a regional practice, where students aged 12 and older received $50 gift cards per Covid-19 vaccination dose, we use various methodologies (synthetic control, linear regression, and difference-in-differences) to approximate the effects of financial incentives on vaccine rates. Our analysis reveals that gift cards increase vaccination rates by 2.64-4.23 percentage points from a baseline rate of 38 percent, concluding that financial incentives, in conjunction with other incentives and policies, can be considered to increase the rate of vaccines for 12- to 17-year-olds.
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Affiliation(s)
- Orhan Erdem
- Puri School of Business, Rockford University, 5100 E State St., Rockford, IL, 61108, USA.
| | - Sukran Erdem
- University of Illinois College of Medicine Rockford, 1601 Parkview Ave, Rockford, IL, 61107, USA
| | - Kelly Monson
- Department of Education, Rockford University, 5050 E State St., Rockford, IL, 61108, USA
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10
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Knox M, Hernandez EA, Brown DM, Ahern J, Fleming MD, Guo C, Brewster AL. Greater Covid-19 vaccine uptake among enrollees offered health and social needs case management: Results from a randomized trial. Health Serv Res 2023. [PMID: 37775953 DOI: 10.1111/1475-6773.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE To investigate Covid-19 vaccination as a potential secondary public health benefit of case management for Medicaid beneficiaries with health and social needs. DATA SOURCES AND STUDY SETTING The CommunityConnect case management program for Medicaid beneficiaries is run by Contra Costa Health, a county safety net health system in California. Program enrollment data were merged with comprehensive county vaccination records. STUDY DESIGN Individuals with elevated risk of hospital and emergency department use were randomized each month to a case management intervention or usual care. Interdisciplinary case managers offered coaching, community referrals, healthcare connections, and other support based on enrollee interest and need. Using survival analysis with intent-to-treat assignment, we assessed rates of first-dose Covid-19 vaccination from December 2020 to September 2021. In exploratory sub-analyses we also examined effect heterogeneity by gender, race/ethnicity, age, and primary language. DATA COLLECTION AND EXTRACTION METHODS Data were extracted from county and program records as of September 2021, totaling 12,866 interventions and 25,761 control enrollments. PRINCIPAL FINDINGS Approximately 58% of enrollees were female and 41% were under age 35. Enrollees were 23% White, 12% Asian/Pacific Islander, 20% Black/African American, and 36% Hispanic/Latino, and 10% other/unknown. Approximately 35% of the intervention group engaged with their case manager. Approximately 56% of all intervention and control enrollees were vaccinated after 9 months of analysis time. Intervention enrollees had a higher vaccination rate compared to control enrollees (adjusted hazard ratio [aHR]: 1.06; 95% confidence interval [CI]: 1.02-1.10). In sub-analyses, the intervention was associated with stronger likelihood of vaccination among males and individuals under age 35. CONCLUSIONS Case management infrastructure modestly improved Covid-19 vaccine uptake in a population of Medicaid beneficiaries that over-represents social groups with barriers to early Covid-19 vaccination. Amidst mixed evidence on vaccination-specific incentives, leveraging trusted case managers and existing case management programs may be a valuable prevention strategy.
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Affiliation(s)
- Margae Knox
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | | | - Jennifer Ahern
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Mark D Fleming
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Crystal Guo
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Amanda L Brewster
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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11
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Zhang X, Lane T. The backfiring effects of monetary and gift incentives on Covid-19 vaccination intentions. CHINA ECONOMIC REVIEW 2023; 80:102009. [PMID: 37351337 PMCID: PMC10270730 DOI: 10.1016/j.chieco.2023.102009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
We provide evidence that material inducements for Covid-19 vaccination may backfire. Results from a hypothetical survey experiment in China (N = 1365) show incentives of 8-125 USD reduce vaccine uptake intentions compared to simply offering vaccination for free. Ours is the first Covid-19 vaccine study to separately consider and directly compare the effects of monetary and goods-based incentives, both of which have been widely employed by countries seeking to increase uptake; we demonstrate that both types backfire equally. Results are compared against the burgeoning literature on Covid-19 vaccine incentives.
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Affiliation(s)
- Xinrui Zhang
- School of Economics, University of Nottingham Ningbo China, China
| | - Tom Lane
- School of Economics, University of Nottingham Ningbo China, China
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12
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Larsen BJ, Ryan TJ, Greene S, Hetherington MJ, Maxwell R, Tadelis S. Counter-stereotypical messaging and partisan cues: Moving the needle on vaccines in a polarized United States. SCIENCE ADVANCES 2023; 9:eadg9434. [PMID: 37467319 PMCID: PMC10355821 DOI: 10.1126/sciadv.adg9434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 07/21/2023]
Abstract
This paper reports results from a large-scale randomized controlled trial assessing whether counter-stereotypical messaging and partisan cues can induce people to get COVID-19 vaccines. The study used a 27-s video compilation of Donald Trump's comments about the vaccine from Fox News interviews and presented the video to millions of U.S. YouTube users through a $100,000 advertising campaign in October 2021. Results indicate that the number of vaccines increased in the average treated county by 103 (with a one-tailed P value of 0.097). Based on this average treatment effect and totaling across our 1014 treated counties, the total estimated effect was 104,036 vaccines.
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Affiliation(s)
- Bradley J. Larsen
- Washington University in St. Louis, St. Louis, MO, and NBER, Cambridge, MA
| | - Timothy J. Ryan
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Steven Tadelis
- The University of California at Berkeley, Berkeley, CA, and NBER, Cambridge, MA
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13
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Terrell R, Alami A, Krewski D. Interventions for COVID-19 Vaccine Hesitancy: A Systematic Review and Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6082. [PMID: 37372669 DOI: 10.3390/ijerph20126082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Vaccines effectively protect against COVID-19, but vaccine hesitancy and refusal hinder vaccination rates. This systematic review aimed to (1) review and describe current interventions for addressing COVID-19 vaccine hesitancy/refusal and (2) assess whether these interventions are effective for increasing vaccine uptake. The protocol was registered prospectively on PROSPERO and comprehensive search included Medline, Embase, CINAHL, PsycInfo, and Web of Science databases. Only studies that evaluated the effectiveness of non-financial interventions to address COVID-19 vaccine hesitancy were included, while those focusing intentions or financial incentive were excluded. Risk of bias for all included studies was evaluated using Cochrane risk of bias tools. In total, six articles were included in the review (total participants n = 200,720). A narrative synthesis was performed due to the absence of common quantitative metrics. Except for one randomized controlled trial, all studies reported that interventions were effective, increasing COVID-19 vaccination rates. However, non-randomized studies were subject to confounding biases. Evidence on the effectiveness of COVID-19 vaccine hesitancy interventions remains limited and further evidence is needed for the development of clear guidance on effective interventions to increase vaccine uptake.
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Affiliation(s)
- Rowan Terrell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
| | - Abdallah Alami
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
| | - Daniel Krewski
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
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14
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Stamm TA, Partheymüller J, Mosor E, Ritschl V, Kritzinger S, Alunno A, Eberl JM. Determinants of COVID-19 vaccine fatigue. Nat Med 2023; 29:1164-1171. [PMID: 36973410 DOI: 10.1038/s41591-023-02282-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
There is growing concern that Coronavirus Disease 2019 (COVID-19) vaccine fatigue will be a major obstacle in maintaining immunity in the general population. In this study, we assessed vaccine acceptance in future scenarios in two conjoint experiments, investigating determinants such as new vaccines, communication, costs/incentives and legal rules. The experiments were embedded in an online survey (n = 6,357 participants) conducted in two European countries (Austria and Italy). Our results suggest that vaccination campaigns should be tailored to subgroups based on their vaccination status. Among the unvaccinated, campaign messages conveying community spirit had a positive effect (0.343, confidence interval (CI) 0.019-0.666), whereas offering positive incentives, such as a cash reward (0.722, CI 0.429-1.014) or voucher (0.670, CI 0.373-0.967), was pivotal to the decision-making of those vaccinated once or twice. Among the triple vaccinated, vaccination readiness increased when adapted vaccines were offered (0.279, CI 0.182-0.377), but costs (-0.795, CI -0.935 to -0.654) and medical dissensus (-0.161, CI -0.293 to -0.030) reduced their likelihood to get vaccinated. We conclude that failing to mobilize the triple vaccinated is likely to result in booster vaccination rates falling short of expectations. For long-term success, measures fostering institutional trust should be considered. These results provide guidance to those responsible for future COVID-19 vaccination campaigns.
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Affiliation(s)
- Tanja A Stamm
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.
| | | | - Erika Mosor
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | | | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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15
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Digital public health interventions at scale: The impact of social media advertising on beliefs and outcomes related to COVID vaccines. Proc Natl Acad Sci U S A 2023; 120:e2208110120. [PMID: 36701366 PMCID: PMC9945974 DOI: 10.1073/pnas.2208110120] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Public health organizations increasingly use social media advertising campaigns in pursuit of public health goals. In this paper, we evaluate the impact of about $40 million of social media advertisements that were run and experimentally tested on Facebook and Instagram, aimed at increasing COVID-19 vaccination rates in the first year of the vaccine roll-out. The 819 randomized experiments in our sample were run by 174 different public health organizations and collectively reached 2.1 billion individuals in 15 languages. We find that these campaigns are, on average, effective at influencing self-reported beliefs-shifting opinions close to 1% at baseline with a cost per influenced person of about $3.41. Combining this result with an estimate of the relationship between survey outcomes and vaccination rates derived from observational data yields an estimated cost per additional vaccination of about $5.68. There is further evidence that campaigns are especially effective at influencing users' knowledge of how to get vaccines. Our results represent, to the best of our knowledge, the largest set of online public health interventions analyzed to date.
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16
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Chen K, Wilson-Barthes M, Harris JE, Galárraga O. Incentivizing COVID-19 vaccination among racial/ethnic minority adults in the United States: $209 per dose could convince the hesitant. HEALTH ECONOMICS REVIEW 2023; 13:4. [PMID: 36629981 PMCID: PMC9832714 DOI: 10.1186/s13561-023-00417-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND More than two years into the coronavirus disease (COVID-19) pandemic, it remains unclear whether financial incentives can reduce vaccine hesitancy and improve uptake among key unvaccinated populations. This study estimated the willingness of racial/ethnic minority adults in the United States to accept financial incentives for COVID-19 vaccination and the minimum amount needed to vaccinate a sufficiently high percentage of this population. METHODS From August through September 2021, we conducted an online survey of 367 Black/African American and Hispanic patients, age ≥ 18 years, from 8 community health centers in Rhode Island. Contingent valuation questions assessed respondents' willingness-to-accept (WTA) incentives for COVID-19 vaccination using random-starting-points and iterative incentive offers of $5 to $50 per dose. Ordered logistic regression models examined associations between respondent characteristics and WTA. Predictive probabilities were modeled using both within-survey range and out-of-survey range incentive offer amounts and compared against vaccination thresholds needed to reach herd immunity. RESULTS Less than 30% of unvaccinated survey respondents were WTA an incentive of $50/dose for vaccination. Models using out-of-survey incentive offer amounts greater than $50 suggested that 85% of respondents would agree $140/dose (95% CI: $43-$236) could convince other people to accept vaccination, while $209/dose (95% CI: -$91-$509) would be needed for 85% of respondents to accept vaccination themselves. CONCLUSIONS Findings from this analysis may inform the design of incentive schemes aiming to reduce racial/ethnic disparities in vaccine and booster uptake, which will continue to be important as new variants of SARS-CoV-2 emerge.
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Affiliation(s)
- Kevin Chen
- Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
| | - Jeffrey E. Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02142 USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02912 USA
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17
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Kim S, Hwang Y, Lee C, Kwak S, Kim J. Estimation of Total Cost Required in Controlling COVID-19 Outbreaks by Financial Incentives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1217. [PMID: 36673975 PMCID: PMC9859412 DOI: 10.3390/ijerph20021217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
In this article, we present a Monte Carlo simulation (MCS) to estimate the total cost required to control the spread of the COVID-19 pandemic by financial incentives. One of the greatest difficulties in controlling the spread of the COVID-19 pandemic is that most infected people are not identified and can transmit the virus to other people. Therefore, there is an urgent need to rapidly identify and isolate the infected people to avoid the further spread of COVID-19. To achieve this, we can consider providing a financial incentive for the people who voluntarily take the COVID-19 test and test positive. To prevent the abuse of the financial incentive policy, several conditions should be satisfied to receive the incentive. For example, an incentive is offered only if the recipients know who infected them. Based on the data obtained from epidemiological investigations, we calculated an estimated total cost of financial incentives for the policy by generating various possible infection routes using the estimated parameters and MCS. These results would help public health policymakers implement the proposed method to prevent the spread of the COVID-19 pandemic. In addition, the incentive policy can support various preparations such as hospital bed preparation, vaccine development, and so forth.
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18
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Schneider FH, Campos-Mercade P, Meier S, Pope D, Wengström E, Meier AN. Financial incentives for vaccination do not have negative unintended consequences. Nature 2023; 613:526-533. [PMID: 36631607 PMCID: PMC9833033 DOI: 10.1038/s41586-022-05512-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/02/2022] [Indexed: 01/13/2023]
Abstract
Financial incentives to encourage healthy and prosocial behaviours often trigger initial behavioural change1-11, but a large academic literature warns against using them12-16. Critics warn that financial incentives can crowd out prosocial motivations and reduce perceived safety and trust, thereby reducing healthy behaviours when no payments are offered and eroding morals more generally17-24. Here we report findings from a large-scale, pre-registered study in Sweden that causally measures the unintended consequences of offering financial incentives for taking the first dose of a COVID-19 vaccine. We use a unique combination of random exposure to financial incentives, population-wide administrative vaccination records and rich survey data. We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety. In a complementary study, we find that informing US residents about the existence of state incentive programmes also has no negative consequences. Our findings inform not only the academic debate on financial incentives for behaviour change but also policy-makers who consider using financial incentives to change behaviour.
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Affiliation(s)
| | - Pol Campos-Mercade
- Lund University, Lund, Sweden.
- University of Copenhagen, Copenhagen, Denmark.
| | | | - Devin Pope
- University of Chicago Booth School of Business, Chicago, IL, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Erik Wengström
- Lund University, Lund, Sweden
- Hanken School of Economics, Helsinki, Finland
| | - Armando N Meier
- Unisanté and Lausanne Center for Health Economics, Behavior, and Policy (LCHE), University of Lausanne, Lausanne, Switzerland.
- Faculty of Business and Economics, University of Basel, Basel, Switzerland.
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19
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Jang SH, Gerend MA, Youm S, Yi YJ. Understanding coronavirus disease 2019 (COVID-19) vaccine hesitancy: Evidence from the community-driven knowledge site Quora. Digit Health 2022; 8:20552076221145426. [PMID: 36544537 PMCID: PMC9761207 DOI: 10.1177/20552076221145426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The present study aims to examine the threshold of coronavirus disease 2019 (COVID-19) vaccine hesitancy over time and public discourse around COVID-19 vaccination hesitancy. Methods We collected 3,952 questions and 66,820 answers regarding COVID-19 vaccination posted on the social question-and-answer website Quora between June 2020 and June 2021 and employed Word2Vec and Sentiment Analysis to analyze the data. To examine changes in the perceptions and hesitancy about the COVID-19 vaccine, we segmented the data into 25 bi-weekly sections. Results As positive sentiment about vaccination increased, the number of new vaccinations in the United States also increased until it reached a ceiling point. The vaccine hesitancy phase was identified by the decrease in positive sentiment from its highest peak. Words that occurred only when the positive answer rate peaked (e.g., safe, plan, best, able, help) helped explain factors associated with positive perceptions toward vaccines, and the words that occurred only when the negative answer rate peaked (e.g., early, variant, scientists, mutations, effectiveness) suggested factors associated with vaccine hesitancy. We also identified a period of vaccine resistance, where people who decided not to be vaccinated were unlikely to be vaccinated without further enforcement or incentive. Conclusions Findings suggest that vaccine hesitancy occurred because concerns about vaccine safety were high due to a perceived lack of scientific evidence and public trust in healthcare authorities has been seriously undermined. Considering that vaccine-related conspiracy theories and fake news prevailed in the absence of reliable information sources, restoring public trust in healthcare leaders will be critical for future vaccination efforts.
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Affiliation(s)
- Sou Hyun Jang
- Department of Sociology, Korea University,
Seoul, South Korea
| | - Mary A. Gerend
- Department of Behavioral Sciences and Social Medicine, College of
Medicine, Florida State University, Tallahassee, FL, USA
| | - Sangpil Youm
- Department of Computer & Information Science & Engineering,
Herbert Wertheim College of Engineering, University of
Florida, Gainesville, FL, USA
| | - Yong J Yi
- Department of Data Science, School of Global Convergence, College of
Computing & Informatics, Sungkyunkwan
University, Seoul, South Korea,Yong J Yi, Department of Data Science,
School of Global Convergence, College of Computing and Informatics, Sungkyunkwan
University, Seoul, South Korea.
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20
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Karaivanov A, Kim D, Lu SE, Shigeoka H. COVID-19 vaccination mandates and vaccine uptake. Nat Hum Behav 2022; 6:1615-1624. [PMID: 35654962 DOI: 10.1038/s41562-022-01363-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/21/2022] [Indexed: 01/14/2023]
Abstract
We evaluate the impact of government-mandated proof of vaccination requirements for access to public venues and non-essential businesses on COVID-19 vaccine uptake. We find that the announcement of a mandate is associated with a rapid and significant surge in new vaccinations (a more than 60% increase in weekly first doses), using the variation in the timing of these measures across Canadian provinces in a difference-in-differences approach. Time-series analysis for each province and for France, Italy and Germany corroborates this finding. Counterfactual simulations using our estimates suggest the following cumulative gains in the vaccination rate among the eligible population (age 12 and over) as of 31 October 2021: up to 5 percentage points (p.p.) (90% confidence interval, 3.9-5.8) for Canadian provinces, adding up to 979,000 (425,000-1,266,000) first doses in total for Canada (5 to 13 weeks after the provincial mandate announcements); 8 p.p. (4.3-11) for France (16 weeks post-announcement); 12 p.p. (5-15) for Italy (14 weeks post-announcement) and 4.7 p.p. (4.1-5.1) for Germany (11 weeks post-announcement).
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Affiliation(s)
- Alexander Karaivanov
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Dongwoo Kim
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Shih En Lu
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Hitoshi Shigeoka
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
- Graduate School of Public Policy, University of Tokyo, Tokyo, Japan
- NBER, Cambridge, Massachusetts, USA
- IZA, Bonn, Germany
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21
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Dubé È, Dionne M, Rochette L. Exploring the impact of Quebec's vaccine lottery and vaccine passports on Covid-19 vaccination intention: Findings from repeated cross-sectional surveys. Hum Vaccin Immunother 2022; 18:2100168. [PMID: 35947802 DOI: 10.1080/21645515.2022.2100168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In Quebec, during the summer of 2021, different strategies to enhance COVID-19 vaccine uptake were implemented (e.g. mobile vaccination clinics, mass communication campaigns, home vaccination). The aim was that at least 75% of 12 years and older individuals receive two doses of COVID-19 vaccines before the fall. This article explores the impact of incentives and disincentive strategies on Quebecers' intention to be vaccinated against COVID-19. A series of cross-sectional surveys have been ongoing in Quebec since March 2020 to measure Quebecers' attitudes and behaviors during the pandemic. In July and August 2021, in addition to sociodemographic information, the survey assessed COVID-19 risks perceptions, adherence to and perception of recommended measures (e.g. masks, physical distancing, vaccine lottery, vaccine passport) as attitudes and intention toward COVID-19 vaccines. Descriptive statistics were generated. Between July 9 to September 1, the vaccine uptake (two doses) rose from 62% to 88%. Among respondents who were unvaccinated during the period, 32% reported a positive influence of the lottery on their intention to be vaccinated against COVID-19 and 39% for the vaccine passport. Approximately half (51%) of unvaccinated respondents reported no influence from the two measures, and both positively influenced 20%. The vaccine lottery had a limited impact on willingness to receive COVID-19 vaccines among unvaccinated adults in Quebec, but the implementation of the vaccine passport appears more influential based on survey respondents' responses.
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Affiliation(s)
- Ève Dubé
- Département des risques biologiques et de la santé au travail, BIESP, Institut national de santé publique du Québec, Québec, Canada.,Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Maude Dionne
- Département des risques biologiques et de la santé au travail, BIESP, Institut national de santé publique du Québec, Québec, Canada
| | - Louis Rochette
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
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22
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Effectiveness of COVID-19 Vaccination Mandates and Incentives in Europe. Vaccines (Basel) 2022; 10:vaccines10101714. [PMID: 36298578 PMCID: PMC9608578 DOI: 10.3390/vaccines10101714] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
During 2021-2022 many countries in the European region of the World Health Organization (WHO) adopted mandatory and incentive-based vaccination measures to stimulate immunization against COVID-19. The measures ranged from positive incentive-based programs (i.e., cash incentives, meal discounts, and lotteries) to introducing COVID-19 certificates and enforcing the universal mandatory vaccination with fines. We assessed the effect of such interventions on COVID-19 vaccine uptake in the population of eight countries within the region. An interrupted time series (ITS) analysis was performed using an autoregressive integrated moving average (ARIMA) approach to account for autocorrelation and seasonality. The results showed the immediate positive impact of vaccination incentives on vaccine uptake in most cases, with the highest impact being cash incentives for the population (1197 per million population per day). Discount incentives did not show any significant impact. The introduction of COVID-19 certificates was associated with a significant immediate or gradual increase in daily administered vaccine doses in all the countries included in the study, up to 117,617 doses gained per million per month. The effect of mandatory vaccination for all or some groups of the population varied from a continuous decrease in daily administered doses (332 per million capita per day), no significant effect, or a delayed or temporary increase (1489 per million capita per day).
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23
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Jacobson M, Chang TY, Shah M, Pramanik R, Shah SB. Can financial incentives and other nudges increase COVID-19 vaccinations among the vaccine hesitant? A randomized trial. Vaccine 2022; 40:6235-6242. [PMID: 36137900 PMCID: PMC9424519 DOI: 10.1016/j.vaccine.2022.08.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022]
Abstract
Despite rapid initial uptake, COVID-19 vaccinations in the United States stalled within a few months of widespread rollout in 2021. In response, many state and local governments, employers and health systems used public health messaging, financial incentives and creative scheduling tools to increase vaccine uptake. Although these approaches drew on evidence from influenza and other vaccination efforts, they were largely untested in the context of SARS-CoV-2. In mid-2021, months after vaccines were widely available, we evaluated vaccination intentions and vaccine uptake using a randomized control trial. To do this, we recruited unvaccinated members of a Medicaid managed care plan in California (n = 2,701) and randomly assigned them to different public health messages, $10 or $50 financial incentives for vaccination, a simple vaccination appointment scheduler, or control. While messages increased vaccination intentions, none of the interventions increased vaccination rates. Estimates for financial incentives rule out even relatively small increases in vaccination rates. Small financial incentives and other behavioral nudges do not meaningfully increase COVID-19 vaccination rates amongst the vaccine hesitant.
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Affiliation(s)
- Mireille Jacobson
- Leonard Davis School of Gerontology, University of Southern California & NBER, 3715 McClintock Ave, Los Angeles, CA 90230, United States; Leonard Schaeffer Center for Health Policy & Economics, University of Southern California, United States.
| | - Tom Y Chang
- Marshall School of Business, University of Southern California, United States
| | - Manisha Shah
- Department of Public Policy, University of California, Los Angeles & NBER, United States
| | - Rajiv Pramanik
- Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Services, United States
| | - Samir B Shah
- Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Services, United States
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24
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Schwalbe N, Hanbali L, Nunes MC, Lehtimaki S. Use of financial incentives to increase adult vaccination coverage: A narrative review of lessons learned from COVID-19 and other adult vaccination efforts. Vaccine X 2022; 12:100225. [PMID: 36217357 PMCID: PMC9535879 DOI: 10.1016/j.jvacx.2022.100225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/29/2022] [Accepted: 09/29/2022] [Indexed: 10/25/2022] Open
Abstract
To encourage COVID-19 vaccination, governments have offered a wide range of incentives to their populations ranging from cash to cows. Often these programs were rolled out at scale before assessing potential effectiveness. To inform future policy, we conducted a narrative review to understand the evidence base informing these programs and the extent to which they are effective. While we found evidence on cash transfers increasing both the coverage and intention to be vaccinated for COVID-19 and other adult vaccines, improvements in coverage were limited. With mixed evidence, lottery programs did not appear to have a consistent meaningful impact on vaccination for COVID-19, and no evidence was identified on the positive effects of other non-cash incentives for COVID-19 or other adult vaccines. We conclude that the impact of cash transfers in incentivizing adult vaccination is marginal and their effectiveness in addressing vaccine hesitancy remains inconclusive.
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Affiliation(s)
- Nina Schwalbe
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Spark Street Advisors, New York, NY, United States,Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States,Corresponding author at: 722 W 168th St, New York, NY 10032, USA.
| | | | - Marta C. Nunes
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases; and South African Medical Research Council, Vaccines & Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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25
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Bennett NG, Bloom DE, Ferranna M. Factors underlying COVID-19 vaccine and booster hesitancy and refusal, and incentivizing vaccine adoption. PLoS One 2022; 17:e0274529. [PMID: 36136997 PMCID: PMC9498968 DOI: 10.1371/journal.pone.0274529] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
The paper investigates the factors underlying COVID-19 vaccine and booster hesitancy in the United States, and the efficacy of various incentives or disincentives to expand uptake. We use cross-sectional, national survey data on 3,497 U.S. adults collected online from September 10, 2021 to October 20, 2021 through the Qualtrics platform. Results from a multinomial logistic regression reveal that hesitancy and refusal were greatest among those who expressed a lack of trust either in government or in the vaccine’s efficacy (hesitancy relative risk ratio, or RRR: 2.86, 95% CI: 2.13–3.83, p<0.001). Hesitancy and refusal were lowest among those who typically get a flu vaccine (hesitancy RRR: 0.28, 95% CI: 0.21–0.36, p<0.001; refusal RRR: 0.08, 95% CI: 0.05–0.13, p<0.001). Similar results hold for the intention to get a booster shot among the fully vaccinated. Monetary rewards (i.e., lottery ticket and gift cards) fared poorly in moving people toward vaccination. In contrast, the prospect of job loss or increased health insurance premiums was found to significantly increase vaccine uptake, by 8.7 percentage points (p<0.001) and 9.4 percentage points (p<0.001), respectively. We also show that the motivations underlying individuals’ hesitancy or refusal to get vaccinated vary, which, in turn, suggests that messaging must be refined and directed accordingly. Also, moving forward, it may be fruitful to more deeply study the intriguing possibility that expanding flu vaccine uptake may also enhance willingness to vaccinate in times of pandemics. Last, disincentives such as work-based vaccination mandates that would result in job loss or higher health insurance premiums for those who refuse vaccination should be strongly considered to improve vaccine uptake in the effort to address the common good.
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Affiliation(s)
- Neil G. Bennett
- CUNY Institute for Demographic Research, City University of New York, New York, New York, United States of America
- Austin W. Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, New York, United States of America
- PhD Program in Sociology, CUNY Graduate Center, City University of New York, New York, New York, United States of America
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, City University of New York, New York, New York, United States of America
- * E-mail:
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maddalena Ferranna
- Department of Pharmaceutical and Health Economics, USC School of Pharmacy, Los Angeles, California, United States of America
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26
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Mardi P, Djalalinia S, Kargar R, Jamee M, Esmaeili Abdar Z, Qorbani M. Impact of incentives on COVID-19 vaccination; A systematic review. Front Med (Lausanne) 2022; 9:810323. [PMID: 36160125 PMCID: PMC9492889 DOI: 10.3389/fmed.2022.810323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAlthough vaccination is the most effective way to limit and overcome the COVID-19 pandemic, a considerable fraction of them are not intended to get vaccinated. This study aims to investigate the existing research evidence and evaluate the effectiveness and consequences of all incentives provided for increasing the uptake of COVID-19 vaccination.MethodsA systematic search in PubMed, Web of Science (WoS), and SCOPUS from 2020 until October 10, 2021, was conducted on experimental studies evaluating the effects of incentives including cash, lottery voucher, and persuasive messages on COVID-19 vaccination intention and uptake. The study selection process, data extraction, and quality assessment were conducted independently by two investigators using Consolidated Standards of Reporting Trials (CONSORT 2010) checklist.ResultsTwenty-four records were included in the qualitative analysis. Most of the included studies assessed the effect of financial incentives. In 14 studies (58%) the assessed outcome was vaccination uptake and in nine (37.5%) others it was vaccination intention. One study considered self-reported vaccination status as the outcome. This study shows that high financial incentives and the Vax-a-million lottery are attributed to a higher vaccination rate, while the low amount of financial incentives, other lotteries, and persuasive messages have small or non-significant effects.ConclusionPaying a considerable amount of cash and Vax-a-million lottery are attributed to a higher vaccination. Nevertheless, there is a controversy over the effect of other incentives including other lotteries, low amount of cash, and messages on vaccination. It is noteworthy that, inconsistency and imprecision of included studies should be considered.
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Affiliation(s)
- Parham Mardi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Reza Kargar
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnaz Jamee
- Pediatric Nephrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Esmaeili Abdar
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- *Correspondence: Mostafa Qorbani
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27
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Wang Y, Hernandez J, Stoecker C. Moving the Needle: Association Between a Vaccination Reward Lottery and COVID-19 Vaccination Uptake in Louisiana. Public Health Rep 2022; 138:68-75. [PMID: 36062380 PMCID: PMC9703024 DOI: 10.1177/00333549221120676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE On June 17, 2021, Louisiana launched a lottery campaign to reward residents who received a COVID-19 vaccination. We investigated the association between the lottery and vaccination uptake by characteristics of parishes. METHODS We constructed an interrupted time series based on daily parish-level data on COVID-19 vaccinations to analyze the association with the lottery. We used recursive partitioning to separate vaccination uptake due to the Delta variant from vaccination uptake due to the lottery and limited our study period to May 25 through July 20, 2021. We performed subanalyses that grouped parishes by political affiliation, hesitancy toward COVID-19 vaccines, race and ethnicity, and socioeconomic status to detect heterogeneous responses to the lottery by these characteristics. We ran models separately for parishes in the top and bottom tertiles of each sociodemographic indicator and used a z test to check for differences. RESULTS The lottery was associated with an additional 1.03 (95% CI, 0.61-1.45; P < .001) first doses per parish per day. Comparing lottery impacts between top and bottom tertiles, we found significantly larger associations in parishes with lower vaccine hesitancy rates, higher percentage of Hispanic population, higher median annual household income, and more people with a college degree. CONCLUSIONS Results suggest that the lottery was associated with increased COVID-19 vaccination uptake in Louisiana. However, larger associations were observed in parishes with an already higher likelihood of accepting vaccines, which raises equity issues about the opportunity created by the lottery and its effectiveness as a long-term behavioral incentive.
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Affiliation(s)
- Yin Wang
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Julie Hernandez
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Charles Stoecker, PhD, Tulane University School of Public Health and Tropical Medicine, Department of Health Policy and Management, 1440 Canal St, New Orleans, LA 70112, USA.
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Milien E, Enoma E, Pierre-Louis L, Jones M, King K, Extravour T, Nolen LT. We Got Us: A community-centered approach to increasing vaccine access for minoritized groups. J Hosp Med 2022; 17:765-768. [PMID: 36039960 DOI: 10.1002/jhm.12927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Eileen Milien
- We Got Us: A Community Empowerment Project, Boston, Massachusetts, USA
- Emmanuel College, Boston, Massachusetts, USA
| | - Efosa Enoma
- We Got Us: A Community Empowerment Project, Boston, Massachusetts, USA
- Northeastern University, Boston, Massachusetts, USA
| | - Laetitia Pierre-Louis
- We Got Us: A Community Empowerment Project, Boston, Massachusetts, USA
- Northeastern University, Boston, Massachusetts, USA
| | - Melissa Jones
- We Got Us: A Community Empowerment Project, Boston, Massachusetts, USA
- Harvard College, Harvard University, Cambridge, Massachusetts, USA
| | - Kareem King
- We Got Us: A Community Empowerment Project, Boston, Massachusetts, USA
- Harvard College, Harvard University, Cambridge, Massachusetts, USA
| | - Taylor Extravour
- We Got Us: A Community Empowerment Project, Boston, Massachusetts, USA
- Northeastern University, Boston, Massachusetts, USA
| | - LaShyra T Nolen
- We Got Us: A Community Empowerment Project, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Harvard Kennedy School of Government, Cambridge, Massachusetts, USA
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Jun D, Scott A. Association between COVID-19 vaccination rates and the Australian 'Million Dollar Vax' competition: an observational study. BMJ Open 2022; 12:e062307. [PMID: 35977766 PMCID: PMC9388712 DOI: 10.1136/bmjopen-2022-062307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the association between financial incentives from entry into a vaccine competition with the probability of vaccination for COVID-19. DESIGN A cross-sectional study with adjustment for covariates using logistic regression. SETTING October and November 2021, Australia. PARTICIPANTS 2375 respondents of the Taking the Pulse of the Nation survey. PRIMARY AND SECONDARY OUTCOME MEASURES The proportion of respondents who had any vaccination, a first dose only, or second dose after the competition opened. RESULTS Those who entered the competition were 2.27 (95% CI 1.73 to 2.99) times more likely to be vaccinated after the competition opened on 1 October than those who did not enter-an increase in the probability of having any dose of 0.16 (95 % CI 0.10 to 0.21) percentage points. This increase was mostly driven by those receiving second doses. Entrants were 2.39 (95% CI 1.80 to 3.17) times more likely to receive their second dose after the competition opened. CONCLUSIONS Those who entered the Million Dollar Vax competition were more likely to have a vaccination after the competition opened compared with those who did not enter the competition, with this effect dominated by those receiving second doses.
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Affiliation(s)
- Dajung Jun
- Melbourne Institute: Applied Economic and Social Research, Faculty of Business and Economics, The University of Melbourne, Parkville, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute: Applied Economic and Social Research, Faculty of Business and Economics, The University of Melbourne, Parkville, Victoria, Australia
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Andreas M, Iannizzi C, Bohndorf E, Monsef I, Piechotta V, Meerpohl JJ, Skoetz N. Interventions to increase COVID-19 vaccine uptake: a scoping review. Cochrane Database Syst Rev 2022; 8:CD015270. [PMID: 35920693 PMCID: PMC9347311 DOI: 10.1002/14651858.cd015270] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vaccines are effective in preventing severe COVID-19, a disease for which few treatments are available and which can lead to disability or death. Widespread vaccination against COVID-19 may help protect those not yet able to get vaccinated. In addition, new and vaccine-resistant mutations of SARS-CoV-2 may be less likely to develop if the spread of COVID-19 is limited. Different vaccines are now widely available in many settings. However, vaccine hesitancy is a serious threat to the goal of nationwide vaccination in many countries and poses a substantial threat to population health. This scoping review maps interventions aimed at increasing COVID-19 vaccine uptake and decreasing COVID-19 vaccine hesitancy. OBJECTIVES To scope the existing research landscape on interventions to enhance the willingness of different populations to be vaccinated against COVID-19, increase COVID-19 vaccine uptake, or decrease COVID-19 vaccine hesitancy, and to map the evidence according to addressed populations and intervention categories. SEARCH METHODS We searched Cochrane COVID-19 Study Register, Web of Science (Science Citation Index Expanded and Emerging Sources Citation Index), WHO COVID-19 Global literature on coronavirus disease, PsycINFO, and CINAHL to 11 October 2021. SELECTION CRITERIA We included studies that assess the impact of interventions implemented to enhance the willingness of different populations to be vaccinated against COVID-19, increase vaccine uptake, or decrease COVID-19 vaccine hesitancy. We included randomised controlled trials (RCTs), non-randomised studies of intervention (NRSIs), observational studies and case studies with more than 100 participants. Furthermore, we included systematic reviews and meta-analyses. We did not limit the scope of the review to a specific population or to specific outcomes assessed. We excluded interventions addressing hesitancy towards vaccines for diseases other than COVID-19. DATA COLLECTION AND ANALYSIS Data were analysed according to a protocol uploaded to the Open Science Framework. We used an interactive scoping map to visualise the results of our scoping review. We mapped the identified interventions according to pre-specified intervention categories, that were adapted to better fit the evidence. The intervention categories were: communication interventions, policy interventions, educational interventions, incentives (both financial and non-financial), interventions to improve access, and multidimensional interventions. The study outcomes were also included in the mapping. Furthermore, we mapped the country in which the study was conducted, the addressed population, and whether the design was randomised-controlled or not. MAIN RESULTS We included 96 studies in the scoping review, 35 of which are ongoing and 61 studies with published results. We did not identify any relevant systematic reviews. For an overview, please see the interactive scoping map (https://tinyurl.com/2p9jmx24) STUDIES WITH PUBLISHED RESULTS Of the 61 studies with published results, 46 studies were RCTs and 15 NRSIs. The interventions investigated in the studies were heterogeneous with most studies testing communication strategies to enhance COVID-19 vaccine uptake. Most studies assessed the willingness to get vaccinated as an outcome. The majority of studies were conducted in English-speaking high-income countries. Moreover, most studies investigated digital interventions in an online setting. Populations that were addressed were diverse. For example, studies targeted healthcare workers, ethnic minorities in the USA, students, soldiers, at-risk patients, or the general population. ONGOING STUDIES Of the 35 ongoing studies, 29 studies are RCTs and six NRSIs. Educational and communication interventions were the most used types of interventions. The majority of ongoing studies plan to assess vaccine uptake as an outcome. Again, the majority of studies are being conducted in English-speaking high-income countries. In contrast to the studies with published results, most ongoing studies will not be conducted online. Addressed populations range from minority populations in the USA to healthcare workers or students. Eleven ongoing studies have estimated completion dates in 2022. AUTHORS' CONCLUSIONS: We were able to identify and map a variety of heterogeneous interventions for increasing COVID-19 vaccine uptake or decreasing vaccine hesitancy. Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID-19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID-19 vaccine uptake. A research gap was shown for studies conducted in low and middle-income countries and studies investigating policy interventions and improved access, as well as for interventions addressing children and adolescents. As COVID-19 vaccines become more widely available, these populations and interventions should not be neglected in research. AUTHORS CONCLUSIONS We were able to identify and map a variety of heterogeneous interventions for increasing COVID-19 vaccine uptake or decreasing vaccine hesitancy. Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID-19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID-19 vaccine uptake. A research gap was shown for studies conducted in low and middle-income countries and studies investigating policy interventions and improved access, as well as for interventions addressing children and adolescents. As COVID-19 vaccines become more widely available, these populations and interventions should not be neglected in research.
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Affiliation(s)
- Marike Andreas
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claire Iannizzi
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Bohndorf
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematology, Cologne, Germany
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Chandir S, Siddiqi DA, Abdullah S, Duflo E, Khan AJ, Glennerster R. Small mobile conditional cash transfers (mCCTs) of different amounts, schedules and design to improve routine childhood immunization coverage and timeliness of children aged 0-23 months in Pakistan: An open label multi-arm randomized controlled trial. EClinicalMedicine 2022; 50:101500. [PMID: 35784436 PMCID: PMC9241101 DOI: 10.1016/j.eclinm.2022.101500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cost-effective demand-side interventions are needed to increase childhood immunization. Multiple studies find tying income support programs (≥USD 50 per year) to immunization raises coverage. Research on maximizing impact from small mobile-based conditional cash transfers (mCCTs) (≤USD 15 per fully immunized child) delivered in lower-income settings remains sparse. METHODS Participants in Karachi, Pakistan, were individually randomized into a seven arm, factorial open label study with five mCCT arms, one reminder (SMS) only arm, and one control arm. The mCCT arms varied by amount (high ∼USD 15 per fully immunized child versus low ∼USD 5 per fully immunized child), schedule (flat versus rising payments over the schedule), design (certain versus lottery payments), and payment method (airtime or mobile money). Children were enrolled at BCG, pentavalent-1 (penta-1) or pentavalent-2 (penta-2) vaccination and followed until at least 18 months of age. A serosurvey in 15% sub-sample validated reported study coverage. The full immunization coverage (FIC) at 12 months (primary outcome) was analyzed using logit regression. ClinicalTrials.gov (NCT03355989), 3ie registry (58f6ee7725fc1), and AEA RCT Registry (AEARCTR-0001953). FINDINGS Between November 6, 2017, and October 10, 2018, a total of 11,197 caregiver-child pairs were enrolled, with 1598-1600 caregiver-child pairs per arm. FIC at 12 months was statistically significantly higher for any mCCT versus SMS (OR:1.18, 95% CI: 1.05-1.33; p = 0.005). Within the mCCT arms, FIC was statistically significantly higher for high versus low amount (OR: 1.16, 95% CI: 1.04-1.29; p = 0.007), certain versus lottery payment (OR: 1.30, 95% CI: 1.17-1.45; p < 0.001) and airtime versus mobile money (OR: 1.17, 95% CI:1.01-1.36; p = 0.043). There was no statistically significant difference between a flat and increasing schedule (OR: 1.03, 95% CI: 0.93-1.15; p = 0.550). SMS had a marginally statistically significant impact on FIC versus control (OR: 1.16, 95% CI: 1.00-1.35; p = 0.046). Findings were similar for up-to-date coverage of penta-3, measles-1 and measles-2 at 18 months. INTERPRETATION Small mCCTs (USD 0.8-2.4 per immunization visit) can increase FIC at 12 months and up-to-date coverage at 18 months at USD 23 per additional fully immunized child, in resource-constrained settings like Pakistan. Design details (certainty, schedule and delivery method of mCCTs) matter as much as the size of payments. FUNDING Global Innovation Fund, GiveWell.
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Affiliation(s)
- Subhash Chandir
- IRD Global, 583 Orchard Road, #06-01 Forum, Singapore, 238884
- Corresponding author at: IRD Global; 583 Orchard Road, #06-01 Forum, Singapore 238884.
| | | | - Sara Abdullah
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi, 75190, Pakistan
| | - Esther Duflo
- MIT Department of Economics, room 544 Morris and Sophie Chang Building, 50 Memorial Drive, Cambridge, MA02142
| | | | - Rachel Glennerster
- MIT Department of Economics, room 544 Morris and Sophie Chang Building, 50 Memorial Drive, Cambridge, MA02142
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Reddinger JL, Levine D, Charness G. Can targeted messages reduce COVID-19 vaccination hesitancy? A randomized trial. Prev Med Rep 2022; 29:101903. [PMID: 35844628 PMCID: PMC9272666 DOI: 10.1016/j.pmedr.2022.101903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 12/05/2022] Open
Abstract
We find no evidence that tailoring public health communication regarding COVID-19 vaccination for broad demographic groups would increase its effectiveness. A post hoc analysis finds that a vaccine endorsement from Dr. Fauci reduces stated intent to vaccinate among conservatives. We recommend further research on communicators and endorsers, as well as incentives.
Background Widespread vaccination is certainly a critical element in successfully fighting the COVID-19 pandemic. We apply theories of social identity to design targeted messaging to reduce vaccine hesitancy among groups with low vaccine uptake, such as African Americans and political conservatives. Methods Participants. We conducted an online experiment from April 7 to 27, 2021, that oversampled Black, Latinx, conservative, and religious U.S. residents. We first solicited the vaccination status of over 10,000 individuals. Of the 4,609 individuals who reported being unvaccinated, 4,190 enrolled in our covariate-adaptive randomized trial. Interventions. We provided participants messages that presented the health risks of COVID-19 to oneself and others; they also received messages about the benefits of a COVID-19 vaccine and an endorsement by a celebrity. Messages were randomly tailored to each participant’s identities—Black, Latinx, conservative, religious, or being a parent. Outcomes. Respondents reported their intent to obtain the vaccine for oneself and, if a parent, for one’s child. Results We report results for the 2,621 unvaccinated respondents who passed an incentivized manipulation check. We find no support for the hypothesis that customized messages or endorsers reduce vaccine hesitancy among our segments. A post hoc analysis finds evidence that a vaccine endorsement from Dr. Fauci reduces stated intent to vaccinate among conservatives. Conclusions We find no evidence that tailoring public-health communication regarding COVID-19 vaccination for broad demographic groups would increase its effectiveness. We recommend further research on communicators and endorsers, as well as incentives.
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Affiliation(s)
- J Lucas Reddinger
- 1725 State St., 339C Wimberly Hall, La Crosse, WI 54601.,Department of Economics, University of California, Santa Barbara, 93106.,Menard Family Initiative, College of Business Administration, University of Wisconsin, La Crosse, 54601
| | - David Levine
- Haas School of Business, University of California, Berkeley, 94720
| | - Gary Charness
- Department of Economics, University of California, Santa Barbara, 93106
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Guo Y, Gao J, Sims OT. Associations between Bonus and Lottery COVID-19 Vaccine Incentive Policies and Increases in COVID-19 Vaccination Rates: A Social Epidemiologic Analysis. Trop Med Infect Dis 2022; 7:118. [PMID: 35878130 PMCID: PMC9320144 DOI: 10.3390/tropicalmed7070118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 01/25/2023] Open
Abstract
The objectives of this longitudinal study were to analyze the impact of COVID-19 vaccine incentive policies (e.g., bonuses and lottery entries) on county-level COVID-19 vaccination rates, and to examine the interactive effects between COVID-19 vaccine incentive policies and socioeconomic factors on COVID-19 vaccination rates. Using publicly available data, county-level COVID-19 vaccination rates and socioeconomic data between January 2021 and July 2021 were extracted and analyzed across counties in the United States (US)-an analysis of 19,992 observations over time. Pooled ordinary least squares (OLS) analysis was employed to longitudinally examine associations with COVID-19 vaccination rates, and four random-effects models were developed to analyze interaction effects. Bonus incentive policies were effective in counties with a high per capita income, high levels of education, and a high percentage of racial minorities, but not in counties with high unemployment. Lottery incentive policies were effective in counties with a high percentage of racial minorities, but not in counties with high per capita income, high levels of education, and high unemployment. County-level socioeconomic factors should be considered ahead of implementing incentive policies, versus a blanket approach, to avoid the unintentional misuse of economic resources for futile COVID-19 vaccination outcomes.
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Affiliation(s)
- Yuqi Guo
- School of Social Work, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC 28262, USA;
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28262, USA
| | - Jingjing Gao
- Public Policy Program, University of North Carolina at Charlotte, Charlotte, NC 28262, USA;
| | - Omar T. Sims
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35222, USA
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL 35222, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35222, USA
- Integrative Center for Aging Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35222, USA
- African American Studies, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL 35222, USA
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Kałucka S, Kusideł E, Grzegorczyk-Karolak I. A Retrospective Cross-Sectional Study on the Risk of Getting Sick with COVID-19, the Course of the Disease, and the Impact of the National Vaccination Program against SARS-CoV-2 on Vaccination among Health Professionals in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7231. [PMID: 35742481 PMCID: PMC9223641 DOI: 10.3390/ijerph19127231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 02/01/2023]
Abstract
Six months after starting the National Vaccination Program against COVID-19, a cross-sectional retrospective study was conducted among 1200 salaried and non-salaried healthcare workers (HCWs) in Poland. Its aim was to assess factors including the risk of exposure to COVID-19, experiences with COVID-19, the trust in different sources of knowledge about the pandemic and SARS-CoV-2 vaccines, and the government campaign on vaccination as predictors of vaccination acceptance. The strongest awareness of a high risk of work-associated infection was demonstrated by doctors (D) (72.6%) and nurses and midwives (N) (64.8%); however, almost half of the medical students (MS) and nursing and midwifery students (NS) did not identify as a risk group. Out of several dozen variables related to sociodemographic characteristics and personal experience of COVID-19, only occupation, previous COVID-19 infection, and high stress seemed to significantly influence vaccination acceptance. Interestingly, only 6.7% of respondents admitted that the government campaign impacted their decision to vaccinate. This result is not surprising considering that the vast majority of respondents (87.8%) learned about vaccinations from sources such as academic lectures (29.9%), health professionals (29.0%), or the internet (28.9%). Those who gained information about vaccination from traditional media (radio, television, and daily press), a popular platform of the government campaign, had a lower propensity to vaccinate (OR = 0.16, p < 0.001). Additionally, almost twice as many considered the information provided in the campaign to be unreliable. Our findings, from this retrospective study, do not confirm that the government campaign was effective for healthcare professionals. Therefore, in this group, other forms of vaccination incentives should be sought. However, the vaccinated respondents were significantly more likely to support compulsory vaccination against COVID-19 among health professionals.
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Affiliation(s)
- Sylwia Kałucka
- Department of Coordinated Care, Medical University of Lodz, 90-251 Lodz, Poland
| | - Ewa Kusideł
- Department of Spatial Econometrics, Faculty of Economics and Sociology, University of Lodz, 90-255 Lodz, Poland
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Thirumurthy H, Milkman KL, Volpp KG, Buttenheim AM, Pope DG. Association between statewide financial incentive programs and COVID-19 vaccination rates. PLoS One 2022; 17:e0263425. [PMID: 35353815 PMCID: PMC8966995 DOI: 10.1371/journal.pone.0263425] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
To promote COVID-19 vaccination, many states in the US introduced financial incentives ranging from small, guaranteed rewards to lotteries that give vaccinated individuals a chance to win large prizes. There is limited evidence on the effectiveness of these programs and conflicting evidence from survey experiments and studies of individual states’ lotteries. To assess the effectiveness of COVID-19 vaccination incentive programs, we combined information on statewide incentive programs in the US with data on daily vaccine doses administered in each state. Leveraging variation across states in the daily availability of incentives, our difference-in-differences analyses showed that statewide programs were not associated with a significant change in vaccination rates. Furthermore, there was no significant difference in vaccination trends between states with and without incentives in any of the 14 days before or after incentives were introduced. Heterogeneity analyses indicated that neither lotteries nor guaranteed rewards were associated with significant change in vaccination rates.
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Affiliation(s)
- Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Katherine L. Milkman
- Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Alison M. Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Devin G. Pope
- Booth School of Business, University of Chicago, Chicago, Illinois, United States of America
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The Effectiveness of Interventions for Increasing COVID-19 Vaccine Uptake: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10030386. [PMID: 35335020 PMCID: PMC8949230 DOI: 10.3390/vaccines10030386] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
Vaccination is vital to protect the public against COVID-19. The aim of this systematic review is to identify and evaluate the effectiveness of interventions to increase COVID-19 vaccine uptake. We searched a range of databases (Embase, Medline, Psychology & Behavioral Science, PsycInfo, Web of Science and NIH Preprints Portfolio) from March 2020 to July 2021 for studies which reported primary quantitative or qualitative research on interventions to increase COVID-19 vaccine uptake. Outcome measures included vaccination uptake and reported intention to vaccinate. Reviews, position papers, conference abstracts, protocol papers and papers not in English were excluded. The NHLBI quality assessment was used to assess risk of bias. In total, 39 studies across 33 papers met the inclusion criteria. A total of 28 were assessed as good quality. They included interventions relating to communication content, communication delivery, communication presentation, policy or vaccination delivery, with 7 measuring vaccination uptake and 32 measuring vaccination intention. A narrative synthesis was conducted, which highlighted that there is reasonable evidence from studies investigating real behaviour suggesting that personalising communications and sending booking reminders via text message increases vaccine uptake. Findings on vaccination intention are mixed but suggest that communicating uncertainty about the vaccine does not decrease intention, whereas making vaccination mandatory could have a negative impact. Although much of the research used experimental designs, very few measured real behavioural outcomes. Understanding which interventions are most effective amongst vaccine-hesitant populations and in the context of booster vaccinations will be important as vaccine roll outs continue across the world.
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Gandjour A. Financial Incentives in the Path to Recovery from the COVID-19 Pandemic. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:5-8. [PMID: 34719753 PMCID: PMC8557961 DOI: 10.1007/s40258-021-00689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Adickesallee 32-34, 60322, Frankfurt am Main, Germany.
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