Incentives for COVID-19 vaccination

Behavioral and social drivers of COVID-19 vaccination initiation in the US: a longitudinal study March─ October 2021

Many studies have examined behavioral and social drivers of COVID-19 vaccination initiation, but few have examined these drivers longitudinally. We sought to identify the drivers of COVID-19 vaccination initiation using the Behavioral and Social Drivers of Vaccination (BeSD) Framework. Participants were a nationally-representative sample of 1,563 US adults who had not received a COVID-19 vaccine by baseline. Participants took surveys online at baseline (spring 2021) and follow-up (fall 2021). The surveys assessed variables from BeSD Framework domains (i.e., thinking and feeling, social processes, and practical issues), COVID-19 vaccination initiation, and demographics at baseline and follow-up. Between baseline and follow-up, 65% of respondents reported initiating COVID-19 vaccination. Vaccination intent increased from baseline to follow-up (p < .01). Higher vaccine confidence, more positive social norms towards vaccination, and receiving vaccine recommendations at baseline predicted subsequent COVID-19 vaccine initiation (all p < .01). Among factors assessed at follow-up, social responsibility and vaccine requirements had the greatest associations with vaccine initiation (all p < .01). Baseline vaccine confidence, social norms, and vaccination recommendations were associated with subsequent vaccine initiation, all of which could be useful targets for behavioral interventions. Furthermore, interventions that highlight social responsibility to vaccinate or promote vaccination requirements could also be beneficial.

Motivators and Demotivators for COVID-19 Vaccination Based on Co-Occurrence Networks of Verbal Reasons for Vaccination Acceptance and Resistance: Repetitive Cross-Sectional Surveys and Network Analysis

BACKGROUND

Vaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons, with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy.

OBJECTIVE

This study was aimed at assessing the connections and relative importance of motivators and demotivators for COVID-19 vaccination in Hong Kong based on co-occurrence networks of verbal reasons for vaccination acceptance and resistance from repetitive cross-sectional surveys.

METHODS

We conducted a series of random digit dialing telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were initially coded to generate categories of motivators and demotivators for COVID-19 vaccination using a bottom-up approach. Then, all the generated codes were mapped onto the 5C model of vaccine hesitancy. On the basis of the identified reasons, we conducted a co-occurrence network analysis to understand how motivating or demotivating reasons were comentioned to shape people's vaccination decisions. Each reason's eigenvector centrality was calculated to quantify their relative importance in the network. Analyses were also stratified by age group.

RESULTS

The co-occurrence network analysis found that the perception of personal risk to the disease (egicentrality=0.80) and the social responsibility to protect others (egicentrality=0.58) were the most important comentioned reasons that motivate COVID-19 vaccination, while lack of vaccine confidence (egicentrality=0.89) and complacency (perceived low disease risk and low importance of vaccination; egicentrality=0.45) were the most important comentioned reasons that demotivate COVID-19 vaccination. For older people aged ≥65 years, protecting others was a more important motivator (egicentrality=0.57), while the concern about poor health status was a more important demotivator (egicentrality=0.42); for young people aged 18 to 24 years, recovering life normalcy (egicentrality=0.20) and vaccine mandates (egicentrality=0.26) were the more important motivators, while complacency (egicentrality=0.77) was a more important demotivator for COVID-19 vaccination uptake.

CONCLUSIONS

When disease risk is perceived to be high, promoting social responsibility to protect others is more important for boosting vaccination acceptance. However, when disease risk is perceived to be low and complacency exists, fostering confidence in vaccines to address vaccine hesitancy becomes more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age.

Policy makers believe money motivates more than it does

To motivate contributions to public goods, should policy makers employ financial incentives like taxes, fines, subsidies, and rewards? While these are widely considered as the classic policy approach, a substantial academic literature suggests the impact of financial incentives is not always positive; they can sometimes fail or even backfire. To test whether policy makers are overly bullish about financial incentives, we asked county heads, mayors, and municipal government representatives of medium-to-large towns in Germany to predict the effects of a financial incentive on COVID-19 vaccination, and tested the exact same incentive in a field experiment involving all 41,548 inhabitants (clustered in 10,032 addresses) of the German town of Ravensburg. Whereas policy makers overwhelmingly predict that the financial incentive will increase vaccination-by 15.3 percentage points on average-the same financial incentive yielded a precisely estimated null effect on vaccination. We discuss when financial incentives are most likely to fail, and conclude that it is critical to educate policy makers on the potential pitfalls of employing financial incentives to promote contributions to public goods.

Engaging health plans to prioritize HPV vaccination and initiate at age 9

Health plans can influence pediatric and primary care providers and patients to understand HPV vaccination coverage and increase HPV vaccination uptake. By initiating vaccination at age nine, health plans can lay the groundwork for on-time HPV cancer prevention by age 13. In 2022, the American Cancer Society engaged 28 health plans in a 12-month HPV vaccination learning collaborative in which plans set their own quality improvement targets, implemented multi-pronged interventions, and joined quarterly best-practice sharing calls. Twenty-five of the 28 plans reported including a focus on ages 9 to 10. Preliminary pre-intervention data illustrate that vaccination rates from participating plans follow national trends and reaffirm existing gaps for HPV vaccination. Health plan interventions to address HPV vaccination are consistent with best practices but could be maximized to target initiation at ages 9-10 by using provider and patient reminders, targeted provider education, and dose-specific provider pay for performance and patient incentive programs. Health plans should explore future capacity to analyze non-HEDIS required data, including HPV initiation and HPV vaccination data for adolescents below age 13.

Financial incentives for COVID-19 vaccines in a rural low-resource setting: a cluster-randomized trial

We implemented a clustered randomized controlled trial with 6,963 residents in six rural Ghana districts to estimate the causal impact of financial incentives on coronavirus disease 2019 (COVID-19) vaccination uptake. Villages randomly received one of four video treatment arms: a placebo, a standard health message, a high cash incentive (60 Ghana cedis) and a low cash incentive (20 Ghana cedis). For the first co-primary outcome-COVID-19 vaccination intentions-non-vaccinated participants assigned to the cash incentive treatments had an average rate of 81% (1,733 of 2,168) compared to 71% (1,895 of 2,669) for those in the placebo treatment arm. For the other co-primary outcome of self-reported vaccinations 2 months after the initial intervention, the average rate for participants in the cash treatment was 3.5% higher than for participants in the placebo treatment (95% confidence interval (CI): 0.001, 6.9; P = 0.045): 40% (602 of 1,486) versus 36.3% (672 of 1,850). We also verified vaccination status of participants: in the cash treatment arm, 36.6% (355 of 1,058) of verified participants had at least one dose of the COVID-19 vaccine compared to 30.3% (439 of 1,544) for those in the placebo-a difference of 6.3% (95% CI: 2.4, 10.2; P = 0.001). For the intention and the vaccination outcomes, the low cash incentive (20 Ghana cedis) had a larger positive effect on COVID-19 vaccine uptake than the high cash incentive (60 Ghana cedis). Trial identifier: AEARCTR-0008775 .

College students' influence on COVID-19 vaccination uptake among seniors in China: a protocol of combined cross-sectional and experimental study

BACKGROUND

College students generally have good knowledge about COVID-19 and may facilitate COVID-19 vaccination in family. The purpose of this study is to understand college students' willingness to persuade their grandparents to initiate COVID-19 vaccination and the effect of their persuasion.

METHODS

A combined cross-sectional and experimental study will be conducted online. In the cross-sectional study (Phase I), eligible participants are college students who are aged ≥ 16 years and have at least one living grandparent aged ≥ 60 years who has/have not completed the COVID-19 vaccination. Participants self-complete Questionnaire A to collect information on the socio-demographics of themselves and their grandparents, their knowledge about older adults' COVID-19 vaccination, as well as Health Belief Model (HBM) and Theory of Planned Behavior (TPB) predictor variables. The primary outcome at Phase I is college students' willingness to persuade grandparents to receive COVID-19 vaccines. Those who are willing to persuade grandparents and participate in a follow-up survey will be invited to participate in a randomized controlled trial (Phase II). At Phase II, eligible participants are those who have at least one living grandparent aged ≥ 60 years who completed the COVID-19 initial vaccination series but has/have not received a booster dose. At the baseline, participants self-complete Questionnaire B to collect information on individual grandparents' COVID-19 vaccination status, attitude towards and intention to COVID-19 booster dose. Participants will then be randomly allocated 1:1 to either intervention arm (one-week smartphone-based health education on older adults' COVID-19 vaccination plus two weeks' waiting period) or control arm (three weeks' waiting period). At the end of week three, participants in both arms self-complete Questionnaire C to collect information on their grandparents' COVID-19 vaccination status. The primary outcome at Phase II is the uptake rate of COVID-19 booster dose among grandparents. Secondary outcomes include grandparents' attitude and intention to get a COVID-19 booster dose.

DISCUSSION

No previous study had measured the effect of college students' persuasion on COVID-19 vaccination uptake in older adults. Findings from this study will provide evidence for innovative and potentially feasible interventions that further promote COVID-19 vaccination in older adults.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2200063240. Registered 2 September 2022.

Assessing the user satisfaction on COVID-19 vaccination service in Indonesia

Background

The implementation of the COVID-19 vaccination is still being carried out in Indonesia to enhance immunity against SARS Cov-2 infection. However, the information about vaccination service satisfaction is still very limited. This study aims to assess how satisfied Covid-19 vaccination service users are in Indonesia.

Design and methods

This is an analytic study with a cross-sectional design was conducted through an online survey in the third week of June 2022. People with a minimum age of 17 years, having received at least one COVID-19 vaccination, and residing in Indonesia were allowed to participate in this study. We used the SERVQUAL model as an instrument, measuring five aspects covering tangibility, responsiveness, reliability, assurance, and empathy. The analysis carried out included univariate analysis and bivariate test using chi-square statistical test.

Results

A total of 509 respondents were included in this study. The findings of this study revealed that there was not much of a difference between the satisfied (50.1%) and dissatisfied categories (49.9%) of vaccination users. Of the five dimensions measured, the highest level of dissatisfaction is in tangibility particularly on facility (48.7%), while the highest level of satisfaction is in reliability (the vaccination service following applicable procedures; 59.7%). We find out that vaccination location (p = 0.038), provision of refreshment/reward/incentives (p = 0.001), providing emergency contact post-vaccination (p = 0.000), and observation time post-vaccination (p = 0.000) were associated with the satisfaction of users.

Conclusion

Many respondents in this study are still dissatisfied with the COVID-19 vaccination services, so it is necessary for taking continuous efforts to raise the quality of vaccination services to increase user satisfaction.

Factors associated with COVID-19 vaccination for patients in an inpatient forensic psychiatric hospital

OBJECTIVE

The aim of this study was to assess factors associated with SARS-CoV-2 (COVID-19) vaccination in patients in 2 inpatient forensic psychiatric hospitals.

METHODS

This was a retrospective chart review evaluating factors associated with COVID-19 vaccination for patients residing in two inpatient forensic psychiatric hospitals between January 1, 2021 and February 28, 2022. Data was collected through electronic medical records utilizing MetaCare Enterprise™ and secure facility computer drives, individual patient paper charts, and Missouri's vaccination records database, ShowMeVax. Several variables were collected to assess factors associated with COVID-19 vaccination. Additionally, COVID-19 vaccination rates were compared to the influenza vaccination rates at these hospitals.

RESULTS

Overall, 229 patients (84.5%) were vaccinated against COVID-19 during or before the study period and 42 (15.5%) were unvaccinated. Patients who were deemed incompetent to stand trial were less likely to receive the COVID-19 vaccine. Those that had a higher body mass index (BMI), were diagnosed with multiple comorbid conditions, not prescribed involuntary medications, were offered incentives, and received the influenza vaccine were more likely to receive the COVID-19 vaccine. Education level, race, sex, age, and being prescribed psychiatric medications did not affect vaccination status.

CONCLUSIONS

Patient specific factors should be used when educating and offering COVID-19 vaccines to patients in an inpatient forensic psychiatric unit. Awareness of these results can facilitate targeted interventions for optimal care in a psychiatric population.

Behavioral and Social Drivers of COVID-19 Vaccination in the United States, August-November 2021

INTRODUCTION

COVID-19 vaccines are safe, effective, and widely available, but many adults in the U.S. have not been vaccinated for COVID-19. This study examined the associations between behavioral and social drivers of vaccination with COVID-19 vaccine uptake in the U.S. adults and their prevalence by region.

METHODS

A nationally representative sample of U.S. adults participated in a cross-sectional telephone survey in August-November 2021; the analysis was conducted in January 2022. Survey questions assessed self-reported COVID-19 vaccine initiation, demographics, and behavioral and social drivers of vaccination.

RESULTS

Among the 255,763 respondents, 76% received their first dose of COVID-19 vaccine. Vaccine uptake was higher among respondents aged ≥75 years (94%), females (78%), and Asian non-Hispanic people (94%). The drivers of vaccination most strongly associated with uptake included higher anticipated regret from nonvaccination, risk perception, and confidence in vaccine safety and importance, followed by work- or school-related vaccination requirements, social norms, and provider recommendation (all p<0.05). The direction of association with uptake varied by reported level of difficulty in accessing vaccines. The prevalence of all of these behavioral and social drivers of vaccination was highest in the Northeast region and lowest in the Midwest and South.

CONCLUSIONS

This nationally representative survey found that COVID-19 vaccine uptake was most strongly associated with greater anticipated regret, risk perception, and confidence in vaccine safety and importance, followed by vaccination requirements and social norms. Interventions that leverage these social and behavioral drivers of vaccination have the potential to increase COVID-19 vaccine uptake and could be considered for other vaccine introductions.

Incentivizing COVID-19 vaccination among racial/ethnic minority adults in the United States: $209 per dose could convince the hesitant

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.

Financial incentives for vaccination do not have negative unintended consequences

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.

Healthcare workers' attitudes on mandates, incentives, and strategies to improve COVID-19 vaccine uptake: A mixed methods study

Healthcare workers are a trusted health information source and are uniquely positioned to reduce the burden of the COVID-19 pandemic. The purpose of this sequential exploratory mixed methods study was to understand attitudes of healthcare workers working in Massachusetts during the COVID-19 pandemic regarding strategies to improve COVID-19 vaccine utilization, including vaccine mandates and incentives. Fifty-two individuals completed one-on-one interviews between April 22nd and September 7th, 2021. The survey was developed based on findings from the interviews; 209 individuals completed the online survey between February 17th and March 23rd, 2022. Both the interview and survey asked about attitudes toward COVID-19 vaccine and booster mandates, incentives, and strategies to improve vaccination rates. Most participants were female (79%-interview, 81%-survey), Caucasian (56%, 73%), and worked as physicians (37%, 34%) or nurses (10%, 18%). Overall, nuanced attitudes regarding vaccine and booster mandates were expressed; many supported mandates to protect their patients' health, others emphasized personal autonomy, while some were against mandates if job termination was the consequence of declining vaccines. Similarly, views regarding vaccine incentives differed; some considered incentives helpful, yet many viewed them as coercive. Strategies believed to be most effective to encourage vaccination included improving accessibility to vaccination sites, addressing misinformation, discussing vaccine safety, tailored community outreach via trusted messengers, and one-on-one conversations between patients and healthcare workers. Healthcare workers' experiences with strategies to improve utilization of COVID-19 vaccines and boosters have implications for public health policies. Generally, efforts to improve access and education were viewed more favorably than incentives and mandates.

Impact of incentives on COVID-19 vaccination; A systematic review

Introduction

Although 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.

Methods

A 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.

Results

Twenty-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.

Conclusion

Paying 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.

Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study

BACKGROUND

Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population.

OBJECTIVE

To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states.

METHODS

We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study.

RESULTS

Roughly 28 (19%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one's own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54%) and mistrust of vaccine safety (n=13, 46%), of effectiveness (n=12, 43%), and of the government's involvement with vaccines (n=12, 43%). Experiences of discrimination (n=60, 40%) and mistrust of vaccines (n=54, 36%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons.

CONCLUSIONS

Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation.

COVID-19 Vaccination Hesitancy among Healthcare Workers-A Review

The COVID-19 pandemic and its associated vaccine have highlighted vaccine hesitancy among healthcare workers (HCWs). Vaccine hesitancy among this group existed prior to the pandemic and particularly centered around influenza vaccination. Being a physician, having more advanced education, and previous vaccination habits are frequently associated with vaccine acceptance. The relationship between age and caring for patients on COVID-19 vaccination is unclear, with studies providing opposing results. Reasons for hesitancy include concerns about safety and efficacy, mistrust of government and institutions, waiting for more data, and feeling that personal rights are being infringed upon. Many of these reasons reflect previous attitudes about influenza vaccination as well as political beliefs and views of personal autonomy. Finally, several interventions to encourage vaccination have been studied, including education programs and non-monetary incentives with the most effective studies using a combination of methods.

Governmental Incentives, Satisfaction with Health Promotional Materials, and COVID-19 Vaccination Uptake among Community-Dwelling Older Adults in Hong Kong: A Random Telephone Survey

COVID-19 vaccination is proven to be effective and safe for older adults. This study investigated the impacts of incentives and health promotional materials provided by the government on the completion of the primary COVID-19 vaccination series among older adults in Hong Kong. Participants were Chinese-speaking community-dwelling adults aged ≥65 years. Telephone numbers were randomly selected from up-to-date Hong Kong telephone directories. A total of 440 participants completed the telephone interview. Logistic regression models were fitted. Among the participants, 58.4% had completed the primary COVID-19 vaccination series. Most participants believed that incentives provided by the government had almost no impact on increasing their motivation to receive COVID-19 vaccination, and less than half thought that vaccination promotional materials produced by the government could address their concerns and help them make decisions. After adjustment for significant background characteristics, we found perceived higher impacts of the incentives and belief that vaccination promotional materials produced by the government could address their concern and were helpful for them to make decisions to be associated with a higher rate of completion of primary COVID-19 vaccination series. Perceptions supporting COVID-19 vaccination and less decisional conflict regarding the choice of vaccine were also positively associated with the dependent variable. Government should develop incentives and health promotional materials tailored to the needs of older adults.