NC just launched a lottery for people getting COVID vaccine. But do incentives work?

North Carolina is joining over a dozen other states offering residents cash and other rewards in exchange for getting vaccinated against COVID-19.

Thursday, Gov. Roy Cooper announced a Summer Cash program that offers state residents who get at least one jab the chance to win one of four $1 million jackpots as well as the Cash 4 College program, which offers four $125,000 college scholarships. Anyone vaccinated is automatically entered in the drawings, which will be held over the next two months.

Designs of new vaccine lotteries vary from state to state. Some jurisdictions offer cash or prizes or both. In New Mexico, state officials used federal stimulus money to build its Vax 2 the Max program with a $5 million payout, the largest in the nation.

But because vaccine lotteries are new, their long-term success at expanding immunization is unknown.

”The effect of the lotteries is not well understood currently, but they have certainly captured the public’s imagination,” said Noel Brewer, a professor of health behavior at the UNC Gillings School of Public Health. “If that excitement turns into vaccinations, we will all be better off.”

West Virginia officials, who offered specialty rifles and shotguns along with a cash prize in the state’s vaccine lottery, reported that more than 70,000 residents had registered for tickets by Tuesday.

While politicians celebrate their take on early results, researchers and health experts acknowledge there’s still a lot of uncertainty about the new programs’ likely effects.

Brewer, the UNC Gillings researcher, is part of a team advising North Carolina leaders on the roll out of Cooper’s proposed lottery. He said there’s plenty of good research to show what works when trying to convince people to get vaccinated.

Direct interventions – those that try to convince people to change their minds – aren’t likely to work.

“People have pretty fixed ideas about whether the virus is dangerous, and they’ve drawn their own conclusions about whether the vaccine is safe and effective,” Brewer said.

Social pressure can be somewhat effective, and he said more friends, family and medical professionals recommending the vaccine to some hesitant about it might help a bit.

Financial incentives in particular – even modest ones – can provide a boost among low-income populations. That’s because a $25 to $50 payment will do more for them than for a CEO making six figures.

Brewer is not generally a fan of lotteries.

People generally value certainty over uncertainty, he said, and in experiments they’ll take $50 now over a 50-50 chance to win $100 pretty much every time. If they misunderstand their chances of winning though, he said people might make the opposite choice.

“It just works for reasons that are not very nice,” Brewer said. But he acknowledges there are ways to do a lottery right. And he credits North Carolina leaders with “a lot of very careful thinking” for the new program.

“This is a nicely targeted intervention that helps meet the needs of North Carolinians,” he said.

In North Carolina, the lottery is for those 18 and older while the scholarships are for those who are 12 to 17. Those who get vaccinated on June 10 or after will be entered twice in the drawings.

The state is following several other states’ leads by also offering small, guaranteed prizes along with potential dollar winnings.

Louisiana is offering residents free park passes for vaccination cards; Hawaii has centered its lottery around free airline miles and family-friendly tickets.

Maine? Winners there get free hunting or fishing licenses and more, L.L. Bean gift cards included.

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Tyler Dukes is an investigative reporter for The News & Observer who specializes in data and public records. He attended North Carolina State University and grew up in Elizabeth City.

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