States' COVID-19 Vaccine Lotteries Didn't Boost Rates, Research Shows

• States' vaccine lotteries did not raise COVID-19 vaccination rates, new research suggests.
• The tens of millions of dollars spent on those lotteries were not a good use of funds, economists say.
• The finding could inform plans for future public-health emergencies.

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In the spring, when Ohio announced it was holding a $1 million lottery to encourage residents to get vaccinated for COVID-19, many governors' ears perked up. Could incentivizing people to get shots – rather than mandating them – actually work? 

At first, the answer seemed to be yes. In Ohio, the vaccination rate spiked 33% in May, with 119,394 people age 16 and up receiving the vaccine in the week after the lottery was announced. That's compared to 89,464 shots given the week prior, an Associated Press analysis found.

Before long, more than a dozen states had announced their own versions of Ohio's "Vax-a-Million," including "VaxCash" in Maryland and "Vax and Scratch" in New York.

But that early trend didn't seem to hold. Research published in JAMA Health Forum on Friday suggests that none of the states' lotteries were effective at raising vaccination rates. 

To reach that conclusion, researchers analyzed state-level COVID-19 vaccination data between April and July 2021, when shots were widely available and while 19 states were running vaccine lotteries. Their results indicated that the association between those states' announcements and their respective vaccination rates was "very small in magnitude and statistically indistinguishable from zero."

"There's a lot of hype around these programs, and we can't find any evidence that they helped," Andrew Friedson, a coauthor of the research and associate professor of economics at University of Colorado Denver, told Insider.

That's despite huge sums spent on these programs.

"Each state's doing several drawings, and these drawings are around a $1 million a pop, although some of them are less. With 19 states, you're looking at a large amount of money that's been spent on this," Friedson said.

The researchers only included cash lotteries in their analysis, leaving out non-cash items like drawings to win a hunting license, which was a vaccine prize in Arkansas. They also didn't take into account private sweepstakes, such as the $1 million cash prizes that Kroger awarded to five people who got vaccinated in Kroger supermarkets.

Nor did the paper calculate exactly how much money states cumulatively spent on lottery programs. So Insider combined Friedman's estimate of lottery spending in 11 states ($50 million) with data provided by six additional state health departments ($39.4 million).

The rough grand total: At least $89.4 million.

Two states — Massachusetts and Maine — not included in Friedman's estimate did not respond to Insider's request, so that total is likely an underestimation. Additionally, a spokesperson for North Carolina's health department pointed out that the state's lottery money came from federal coronavirus relief funding.

"No state funds have been used to pay for the prizes," she told Insider. 

'This may not be the first innovation we want to reach for'

Friedson called the results of the paper disappointing, since many people were rooting for these programs.

"There's an opportunity cost to spending money. Every dollar that you're spending on a lottery, you could have been spending on something else. That's the really economist-y answer," he said, adding, "so to the extent that we have policies that could have helped people, that we could have been spending money on, these were not a great use of funds."

Still, it's a learning opportunity, Friedson said: "Sadly, this is not gonna be the last time we're going to have a national public-health campaign."

Whenever the next public-health emergency arrives, whether it's a campaign for COVID-19 booster shots or another pandemic, it's important to know what doesn't work as well as what does. 

"With regard to policies to try to raise vaccination rates, this may not be the first innovation we want to reach for," Friedson said.

So which incentives, if any, do work? 

As an economist, Friedson said, suggesting an alternative approach that would work is beyond his purview. For the scientists focused on that, it's a process of experimentation.

"The short answer is, we don't know until we try these things," Friedson said. 

Previous research may hint at an answer. 

A review of scientific literature about interventions to address vaccine hesitancy, published prior to the pandemic, did not find strong evidence that monetary rewards have much effect on vaccination rates. But those campaigns largely focused on children, not adults.

That said, Nichole Lighthall, an assistant psychology professor at the University of Central Florida, told ABC News in May that guaranteed cash rewards, such as the $100 savings bonds that West Virginia offered residents for getting vaccinated, may work better than lotteries. 

"People like to gamble, but people love to get money for sure even more," she said. 

There's a possibility, though, that Americans' beliefs about COVID-19 vaccines are too deeply rooted for a reward to be effective, in larger part because of the way some leaders and groups politicized them. 

"If you buy into the idea that vaccines are dangerous – and I can't stress enough that that this idea is wrong – but if you believe that there's something sinister going on with this vaccine, it's unlikely that a payment is going to convince you, regardless of how big it is," Friedson said.

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