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COVID-19 Resource Center

Disclosures: Wong reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
October 25, 2021
3 min read
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Financial incentive increases COVID-19 vaccine uptake in NC

Disclosures: Wong reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Guaranteeing a cash card to COVID-19 vaccine recipients and those who drove someone to a COVID-19 vaccine appointment “slowed the decline in vaccination and promoted more equitable distribution” in North Carolina, according to researchers.

“We’re using multiple strategies to try to get as many North Carolinians vaccinated against COVID-19 as quickly as possible,” Charlene A. Wong, MD, MSHP, the chief health policy officer for COVID-19 within the North Carolina Department of Health and Human Services, told Healio Primary Care.

COVID-19 sign
The guarantee of a cash card increased COVID-19 vaccine uptake in North Carolina.
Photo source: Adobe stock

Wong and colleagues provided a $25 cash card through a pilot program to adults who received the first of two COVID-19 vaccine doses at a participating site in one of four North Carolina counties. People who drove someone to an appointment for their first vaccine dose at one of the same sites were also provided with a $25 cash card “but were not paid twice for the same trip (eg, receiving a vaccine while also bringing someone else),” the researchers wrote in JAMA Internal Medicine. They then compared vaccine uptake for two baseline periods (April 28 through May 11 and May 12 through May 25) with the intervention period (June 2 through June 8).

The researchers reported that during the baseline periods, COVID-19 vaccine uptake increased 46.2% at the participating sites, dropped 9.5% at other locations in the four participating counties and rose 1.7% elsewhere in North Carolina (P for all < .001). From the second baseline period to the intervention period, COVID-19 vaccine uptake dropped significantly less at sites offering the financial incentive (-26.4%) when compared with other sites in the same counties (-51.1%) and in the rest of the state (-48.6%; both difference-in-differences, P < .001).

Among 401 vaccine recipients who were surveyed (mean age, 41.8 years; 52% women; 47% Black), 41% indicated “the cash card was an important reason for vaccination,” the researchers wrote. Cash cards were more often described as being an important factor in vaccine uptake among participants who were Hispanic (OR = 2) or “other” race (OR = 4.68) compared with white participants, and among those with an annual income of less than $20,000 (OR = 2.36), $20,000 to $39,999 (OR = 1.94) or $40,0000 to $59,999 compared with those who had an annual income of $60,000 or more. Approximately 9% of survey respondents said “they would not have been vaccinated if the cash card had not been offered and 15% waited to get vaccinated until they found an event that gave a cash card or other incentive,” Wong and colleagues wrote.

In addition, having a person who could drive a vaccine recipient to a participating site was “an important reason” for why 49% of survey respondents received a vaccine, and was more commonly cited among Black individuals (OR = 1.74; 95% CI, 1.04-2.91), Hispanic individuals (OR = 2.51; 95% CI, 1.32-4.77), and lower income individuals (OR = 2.77-6.09), according to the researchers.

“We were really thrilled to see how effective this pilot program was in helping get more North Carolinians vaccinated,” Wong said. “We also saw that the $25 cash cards also helped alleviate some of the cost barriers to vaccination, particularly for some of our historically marginalized populations. That was certainly our hope and intent in designing the program.”

Wong said that federal funding allocated to the North Carolina Department of Health and Human Services covered the cost of the gift cards. She encouraged other entities to establish partnerships with businesses and foundation-based organizations to defray the costs of similar incentive programs.

Charlene A. Wong

She also offered three tips for creating an incentive program once the partnerships are in place.

“The first is to keep it ... as simple as possible, so that people understand what you’re asking them to do and what the incentive will be in return. The second is to make the incentive immediately available,” Wong said. “Third, think about a social incentive that includes people in someone’s social network, who can help motivate or help an individual achieve the goal of getting vaccinated.”