Vaccinations are ramping up in Canada and much of the world, but it’s not happening as fast as many would like.
While access and eligibility remain barriers in Canada, vaccine hesitancy has started to hamper efforts in the United States. To combat it, some states are getting creative, incentivizing people to roll up their sleeves by offering everything from free baseball tickets to pints of beer and $100 in cash.
Experts say offering incentives for shots is a short-term solution but may have long-term benefits — so long as it’s done equitably and ethically.
“It’s about using financial or other incentives as a strategy to promote positive health behaviours, which might seem like common sense, but it’s challenging,” said Laura Desveaux, a behavioural scientist and co-chair of the Ontario COVID-19 Science Table’s Behavioural Science Working Group.
“It’s not that incentives function to pressure people … it’s meant to recognize a reward of choice without limiting the choice you have.”
Vaccine hesitancy
Canada has waded into vaccine rewards, though more at a local and private level.
Sombrero Latin Food, a grocery purveyor in Toronto, is offering candy to people who post a vaccine selfie or help relatives or neighbours book appointments. In Whitehorse, Polarity Brewing will give vaccinated customers a $6 discount on a beer or food purchase.
At the Jamaican Canadian Association’s vaccine pop-up clinic in Toronto, recipients were offered free patties and chicken soup. Those who got their jab on Mother’s Day took home free flowers.
Corina Pardo of Sombrero Latin Food insists the candy-giving is not an incentive, rather a way to celebrate the occasion with customers.
Experts say that’s a better way to frame it.
“It’s recognition of achievement and it’s meant to motivate behaviour. The presence of that incentive does not change your autonomy and decision-making capacity as an individual provided it’s an appropriate incentive,” said Desveaux.
“It’s not black and white, though. I can’t point to what the tipping point would be or when an incentive would be too large because it also depends on individual circumstance. Fifty dollars may seem small to some, but large to others.”
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In Alberta, the University of Lethbridge turned the incentive strategy into a contest. Students who can prove they’ve received their first shot by September can win a full term’s tuition.
While it may seem like a grandiose gesture in Canada, it pales in comparison to Ohio. Its governor on Wednesday announced a $1-million lottery for adults who had received at least one dose of a COVID-19 vaccine. The prize money will come from federal pandemic relief funds.
With vaccine uptake in Ohio far below the national average, Gov. Mike DeWine says the winnings are far from a waste.
“The real waste at this point in the pandemic — when the vaccine is readily available to anyone who wants it — is a life lost to COVID-19.”
Americans are up against vaccine hesitancy more so than Canada, said Raywat Deonandan, an epidemiologist with the University of Ottawa, so there might be a “cultural divide” with how far an incentive strategy could go.
Deonandan doesn’t think a lottery-type incentive will take many roots in Canada but acknowledges incentives will happen here to some extent.
“The question is: Is a cash payment a step too far?” he said.
“There may be a bit of usury when it comes to poorer people, coercing behaviour and activities that they otherwise would not be prepared to do…. If you are a poor person who really doesn’t want a vaccine, but you really need $100, suddenly I am exploiting your poverty to get what I want out of you, which is your co-operation. That doesn’t rub me the right way.”
Data from the U.S. suggests there’s interest in financial compensation for vaccination.
A recent survey experiment by the University of California Los Angeles’s COVID-19 Health and Politics Project found that incentives, particularly cash payments, could cut vaccine hesitancy by as much as one-third.
Even so, Deonandan fears the cash rewards don’t get at the core of vaccine hesitancy, which is why states and cities are finding themselves getting creative in the first place.
“If you bought someone’s co-operation, you only bought it for one day. The problem still persists,” he said, noting that there may still be hurdles with second doses and boosters.
“The vaccine-hesitant are hesitant because they don’t understand the science. So I don’t see how a sufficient amount of money is really going to overcome a large proportion of people who are concerned about their health.
“How do you buy someone’s concern for their health?”
Social rewards
Desveaux agrees that incentives — especially at a system level — work best when they’re accompanied by information to help people make an informed choice.
While the coffee shop giving out discounts may not seem effective in that sense, Desveaux said it’s beneficial in another way — by helping build acceptance and social norms around vaccine confidence.
“Incentives feel inherently personal,” said Desveaux. “I’m having that doughnut and drinking that coffee, so I feel like I’m getting rewarded, even though what I did also protects other people.”
As time passes, incentives will take a different form, she said.
Much of Canada is still under strict COVID-19 restrictions, but at some point, the tides will change and Canadians will get a chance to eat at a restaurant, work out at a gym or sit in a classroom. And it’s becoming increasingly clear that vaccination status will play a role in how people participate in these things.
The U.S. Centers for Disease Control and Prevention, for example, announced Thursday that fully vaccinated people don’t have to wear masks or physically distance in most cases, even during large gatherings indoors. Private businesses are also cooking up their own rules about COVID-19 protocols and vaccinations as population immunity grows.
Given our current vaccination rate, Canada is not at that point yet. But “incentives function as a bridge to that long-term impact,” said Desveaux.
“Once we start to see things like reopening, that retroactively reinforces vaccination behaviour.”
Behavioural and social opportunities are the better levers, Deonandan added. They’re more scalable and ethical, he said. Getting vaccinated makes it safer to see your family and hug a loved one but it also “opens the door” to being maskless indoors, going to the theatre and travelling.
“One could argue you’re not compelling someone to do it, you’re making it more attractive,” he said.
For now, coupons and freebies are the safer bet, said Desveaux.
“They don’t threaten the medium or long-term ability for us to achieve those other milestones that people are really wanting.”
— with files from The Canadian Press and Global News’ Sean Boynton and Jackson Proskow
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