Lottery-Based Incentives Do Not Increase COVID-19 Vaccination Rates

The COVID-19 pandemic has shown unprecedented levels of vaccine hesitancy and distrust among Americans.

Hospitals and ICUs are overwhelmed and understaffed due to severe COVID-19 disease in unvaccinated persons, but vaccination rates are still lower than anticipated.

To encourage COVID-19 vaccination, some states have gotten creative. On May 12, 2021, Ohio announced a lottery-based incentive that would award randomly selected vaccine recipients up to $1 million.

Initially, Ohio reported that the incentive appeared to drive up vaccinations. However, Ohio’s lottery incentive came 2 days after the US Food and Drug Administration (FDA) issuing an Emergency Use Authorization (EUA) of the Pfizer-BioNTech vaccine for children 12-15 years old.

A study, conducted by investigators from the Boston University School of Medicine and published in JAMA Internal Medicine, sought to examine whether there was any correlation between these 2 announcements. They also looked for any uptick in COVID-19 vaccinations after Ohio added the lottery-based incentive.

The investigators included in the study 15 states that announced cash prizes for vaccinated persons from May 24-July 19, 2021. As a control, they collected vaccination data from 31 non-lottery states as well.

Among the lottery states, the vaccination rate had decreased before the lottery announcements, and did not significantly increase after the lotteries were announced (–0.4 [95% CI, –23.5 to 22.7] vaccinations/100000 people). Overall, the vaccination trends did not significantly change when compared with pre-lottery trends.

Vaccination trends were similar between lottery and non-lottery states before the lottery announcements (-0.5), and there was no statistically significant difference in vaccination rates after 15 states announced their lotteries (1.1). There was also no change in vaccination rate difference (0.4) between the states that offered lottery-bases prizes and the states that did not.

Corresponding author Anica Law, MD, MS, and assistant professor of medicine at Boston University School of Medicine, said, “As in our prior study of Ohio’s lottery incentive, we unfortunately did not find an increase in COVID-19 vaccinations related to lottery incentive programs in other states.”

The investigators concluded that states’ lottery incentives had limited potential to increase vaccination rates.