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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.
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 (firstname.lastname@example.org).
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.
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