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Guaranteed Financial Incentives for COVID-19 VaccinationA Pilot Program in North Carolina

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Uptake of the COVID-19 vaccine remains too low in the US as COVID-19 variant cases and hospitalizations continue to rise. Nudges that remove barriers and facilitate action can increase vaccine uptake.1 Many states, North Carolina included, have announced incentive programs to motivate COVID-19 vaccination, including lotteries for $1 million.2 However, these large but uncertain financial prizes benefit only a few lucky winners and do not broadly address access barriers to vaccination.3,4 In contrast, guaranteed small financial incentives can offset costs related to lost wages, transportation, and childcare.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: September 4, 2021.

Published Online: October 25, 2021. doi:10.1001/jamainternmed.2021.6170

Corresponding Author: Charlene A. Wong, MD, MSHP, Office of the Secretary, North Carolina Department of Health and Human Services, 101 Blair Dr, Raleigh, NC 27603 (charlene.wong@dhhs.nc.gov).

Author Contributions: Dr Kumar had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Wong, Gawande, Kumar, Brewer.

Acquisition, analysis, or interpretation of data: Wong, Pilkington, Doherty, Zhu, Kumar, Brewer.

Drafting of the manuscript: Wong, Pilkington, Doherty, Gawande, Brewer.

Critical revision of the manuscript for important intellectual content: Wong, Doherty, Zhu, Kumar, Brewer.

Statistical analysis: Wong, Pilkington, Doherty, Zhu, Brewer.

Obtained funding: Wong, Kumar, Brewer.

Administrative, technical, or material support: Pilkington, Gawande, Kumar, Brewer.

Supervision: Wong, Gawande, Kumar.

Conflict of Interest Disclosures: Dr Brewer reported grants from the North Carolina Department of Health and Human Services during the conduct of the study, and personal fees from the World Health Organization, the US Centers for Disease Control and Prevention, and Merck outside the submitted work. No other disclosures were reported.

References
1.
Brewer  NT , Chapman  GB , Rothman  AJ , Leask  J , Kempe  A .  Increasing vaccination: putting psychological science into action.   Psychol Sci Public Interest. 2017;18(3):149-207. doi:10.1177/1529100618760521PubMedGoogle ScholarCrossref
2.
National Governors Association. COVID-19 vaccine incentives. 2021. Accessed June 22, 2021. https://www.nga.org/center/publications/covid-19-vaccine-incentives/
3.
Volpp  KG , Cannuscio  CC .  Incentives for immunity–strategies for increasing COVID-19 vaccine uptake.   N Engl J Med. 2021;385(1):e1. doi:10.1056/NEJMp2107719PubMedGoogle Scholar
4.
Walkey  AJ , Law  A , Bosch  NA .  Lottery-based incentive in ohio and COVID-19 vaccination rates.   JAMA. 2021;326(8):766-767. doi:10.1001/jama.2021.11048PubMedGoogle ScholarCrossref
5.
Barry  V , Dasgupta  S , Weller  DL ,  et al.  Patterns in COVID-19 vaccination coverage, by social vulnerability and urbanicity–United States, December 14, 2020-May 1, 2021.   MMWR Morb Mortal Wkly Rep. 2021;70(22):818-824. doi:10.15585/mmwr.mm7022e1PubMedGoogle ScholarCrossref
6.
Wong  CA , Dowler  S , Moore  AF ,  et al.  COVID-19 vaccine administration, by race and ethnicity–North Carolina, December 14, 2020-April 6, 2021.   MMWR Morb Mortal Wkly Rep. 2021;70(28):991-996. doi:10.15585/mmwr.mm7028a2PubMedGoogle ScholarCrossref
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