Another Study Shows COVID Vaccine Lotteries Didn't Work. Why Not?

People will do a lot of things for money, but getting a COVID vaccine seems to be one of the rare exceptions. According to a research letter just published in JAMA internal medicine, states that ran vaccine lotteries to boost uptake of the COVID-19 shots didn't fare any better than states that offered no such incentives. Research published last summer by two authors of the first paper showed that states with COVID vaccine lotteries actually had slightly lower vaccination rates than states that offered no incentives.

For the new study, researchers analyzed CDC data on first vaccine dose administration per 100,000 between May 24, 2021 and July 19, 2021 from states that offered cash prizes to vaccinated individuals compared to states that didn't. The vaccination trend was similar in lottery and non–lottery states before the lotteries were announced. After the announcements, “there was no significant difference in vaccination level change and no change in trend in vaccination rate difference between lottery and non–lottery states.”

The researchers' conclusion:

This study did not find evidence that vaccine lottery incentive programs in the US were associated with significantly increased rates of COVID-19 vaccinations … Given the lack of a strong association between state lottery-based vaccine incentives and increased vaccination rates, further studies of strategies to increase vaccination rates are needed.

With respect to the authors, I don't think we need additional research to understand this issue, and it's not difficult to see why. The science community tends to start with the assumption that people are driven to vaccine hesitancy primarily by frequent exposure to "misinformation." In reality, this is only one part of the problem. We need to address two other issues: public health policy corrupted by politics, and scientists who refuse to call out this politicization.

“Misinformation” isn't the only factor

Communications experts who study public trust in science tend to focus on a single topic: misinformation. Their argument goes something like this: celebrity athletes, podcasters and fringe physicians use their massive platforms to spread nonsense among their followers. If we want a more science-literate society, we need to crack down on anyone who uses their megaphone to promote vaccine denial and other dubious medical claims.

These sorts of “influencers” pose a real threat to the public's understanding of science; indeed, we have a longstanding tradition here at ACSH of taking on supplement shills like Joe Mercola for that very reason. But everybody should recognize that alternative health gurus only have so much influence.

In one study conducted last spring, for example, respondents were less likely to wear masks and observe social distance protocols because they believed these interventions were ineffective, not because they had watched too many episodes of the Joe Rogan Experience. “With regard to misinformation,” the authors wrote, “we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims.”

Mistakes were made, but not by me

If not just exposure to misinformation, what else could fuel the public's vaccine skepticism? To plagiarize myself from last July, the same officials who championed vaccination also flouted their own lockdown orders and cheered social media censorship of any pandemic-related content that fell outside the boundaries of “acceptable” discourse. California Governor Gavin Newsom, who has been a vocal advocate of mandatory vaccines, even sued to help his political allies avoid the state's vaccine requirement.

Consider all this from the perspective of someone on the fence about vaccination. Why would that person enthusiastically roll up their sleave for a shot when their elected officials allow politics to dictate policy? They wouldn't, and I think there are two reasons why. First, research has shown that most Americans do not want public health institutions to tackle political issues. Second, a review of the pandemic response also published last July found that “scolding and moral outrage” directed towards masking, vaccine and lockdown skeptics only amplified their skepticism.

In my opinion, this is why vaccine lotteries failed. Governments tried to bribe people into getting immunized while politicians bent the rules for their friends and lectured their constituents about following the science. The media amplified the problem by trying to make vaccination a partisan issue. Meanwhile, many experts who could have called out this hypocrisy and partisanship were too busy cheer leading for social media companies that kicked users, some of them reputable scientists, off their platforms.

If we want to stem vaccine hesitancy, let's stop doing the things that encourage it in the first place.