Jun 21, 2021 - Health

The psychology behind COVID-19 vaccine lotteries

Illustration of a syringe injecting a lottery ball.

Illustration: Aïda Amer/Axios

NBA season tickets. Scholarships. A chance at $5 million. The list of lotteries and raffles states are launching to drive up COVID-19 vaccination rates is growing, and some local officials are already reporting "encouraging" results.

Driving the news: The reason why, some psychologists and public health experts say, is that the allure of lotteries for many people is simply that the prospect of winning a great prize seems better than passing up the chance, regardless of the odds.

  • "When you buy a lottery ticket for Mega Millions, for example, you literally have a chance of becoming a multimillionaire. If you don't buy that ticket, you don't have that chance," Nathan Novemsky, a professor of marketing and psychology at Yale University, told Axios.
  • Novemsky noted that people have a hard time conceiving the odds of winning, and when the chances are so "incredibly low," many tend it overweight them.

Another reason incentives could work is that most prizes can be categorized as "fun stuff," Novemsky said.

  • In addition to college scholarships and million-dollar lotteries, states and local governments have offered beer, doughnuts, and even marijuana.
  • "All those things are very positive and emotional and a little hedonic," Novemsky said. 'They're not giving away blenders, toasters, and vacuum cleaners."

The big picture: Some states and local governments offering incentives are already reporting some successes.

  • Ohio, the first state to announce a "Vax-a-Million" campaign, saw a 94% increase in vaccinations among 16- to 17-year-olds, a 46% increase among 18- to 19-year-olds, and a 55% uptick among 20- to 40-year-olds the week following the initiative's announcement, Gov. Mike DeWine (R) said.
  • New York Gov. Andrew Cuomo (D) said that the state's incentive programs have "pushed more New Yorkers to pull up their sleeve" and get vaccinated. Cuomo lifted most COVID restrictions last week after 70% of New York adults received at least one vaccine dose.
  • Los Angeles County's Department of Public Health told Axios that vaccination sites participating in the county's raffle for Lakers season passes and Hamilton tickets reported "between a 30%-50% increase in the number of people getting their first dose."

Yes, but: Public health experts say it's hard to know exactly what is motivating people to get the vaccine.

  • Merely announcing the lottery creates an "informational shock" that raises people's awareness of the vaccine, so it's difficult to "separate the monetary component from the information component," said Anupam Jena, an associate professor of health care policy at Harvard.
  • Timing is also key. Ohio's lottery announcement coincided with the state opening up vaccinations for young people, making it hard to determine whether the upticks in vaccinations were coincidence or genuinely caused by the lotteries, Jena added.

Some experts worry incentives could backfire and make people more skeptical of the vaccine.

  • "Someone who has a lot of distrust of the vaccine might think, 'They'd never offer money if this was a good thing,'" David Asch, executive director of the University of Pennsylvania's Medicine Center for Health Care Innovation, told Forbes.

Still, if studies confirm the lotteries work, their uses could be expanded to other public health initiatives.

  • "[T]here is interest in trying to figure out how to get people to take their medications, how to get people to be adherent to lifestyle and diet behaviors," Jena told Axios. "If this actually is true, then it would make sense for us to try to do these things for things like the flu."

The bottom line: The efficacy of incentives likely depends on the underlying reason for why people waited to get vaccinated in the first place, Novemsky noted.

  • The lotteries will work best on people who simply "haven't bothered" to get vaccinated yet, where the potential prizes act as the extra incentive needed to push them "over the edge from inertia to acting," Novemsky said.
  • "If someone is hesitant or worried that it's going to have, for example, negative health effects, then no, the lottery is probably not going to change much."

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