The United States has low vaccination rates for COVID-19. They are currently at 50 percent for adults and three medicines for free.
Some states offer financial incentives such as million-dollar lotteries to encourage more people to seek the potentially lifesaving treatment. North Carolina's pilot program suggests that there might be a better way.
The lottery doesn't benefit everyone, so most people who enter the lottery don't receive a refund for lost wages, transportation or childcare.
What if we just cover these costs? Researchers and politicians are considering this idea, but ethicists are also considering the possibility of vaccine coercion.
This isn't an original idea. Financial incentives have been used in the past to encourage the UK's uptake of the HPV vaccine. A survey conducted in the US earlier this year found that a third of people who had not been vaccinated were willing to try it if they received a cash payment. The benefits increased as the money was raised from $25 to $100.
The results of a North Carolina pilot program over two weeks suggest that the incentives might work in the real world.
The "quasi-experimental" study was initiated in four counties of the state. Some clinics offered a $25 cash card to anyone who came to receive their COVID-19 vaccination or brought someone to the clinic to receive their first dose.
The clinics gave out almost 3,000 cards to 1,374 individuals in two weeks. The clinics that offered financial incentives were more likely to have more vaccine recipients than those in the same county.
First-dose vaccinations declined by almost 10 percent at clinics not participating in the pilot program, while those who were included in the pilot program saw a 46 per cent increase.
Researchers surveyed the patients who took part in the program and found that a large number were motivated by money.
41% of all 401 vaccine recipients were surveyed and said that the cash card was an important reason they got vaccinated. This was particularly true for Black people and people with lower incomes.
Nearly 10% of respondents stated that they wouldn't bother to get vaccinated without a cash card. 15% of respondents indicated that they waited until they found a clinic with a cash card or some other incentive before they got their jab.
People with lower incomes and older people were more likely than those with higher income to have been driven by someone to the clinic to get vaccinated.
The authors state that small financial incentives are a good idea in combination with other equity-promoting strategies, as vaccination rates in areas of higher social vulnerability are low.
"The social incentive of cash card drivers for drivers may encourage people to help their friends and families get vaccinated. This is a powerful motivator that can be used by those who aren't sure about vaccination."
Not all Americans who are not vaccinated oppose vaccines. Some people are vaccine hesitant and actively consider whether they should get the COVID-19 vaccination. Many others are more apathetic and don't think about the vaccine.
Researchers believe that financial incentives can help to turn indifference and enthusiasm in this case.
For example, young people who don't fear the COVID-19 virus might be motivated by easy cash. The money could be used to provide childcare for older adults who are struggling to find the time.
Those who have been discriminated against in the medical field or who ignore topics such as vaccinations could be more open to vaccination.
"If you don't think about getting a vaccine, then they are at your local baseball game, swimming pool, or airport and they're giving away free pizza and T-shirts, well, I'm interested," Stacy Wood, a marketing researcher from NC State University, stated on a recent podcast.
It is not clear what the pilot program in North Carolina can reveal about vaccine motivation success. It was conducted in the real world and is therefore difficult to compare it with a control group.
Given that it was only implemented in four counties in one state, it is difficult to predict how this program will work elsewhere in the country.
However, these initial results suggest that this strategy is promising for increasing COVID-19 vaccine rates. It's one we should consider moving forward, especially with vaccine apathy, which seems to be more serious than we thought.
The study authors concluded that "Hundreds of millions of dollars have been spent to accelerate COVID-19 vaccination uptake,"
The study was published by JAMA Internal Medicine.