Million-dollar COVID vaccine lotteries grab attention, but cheaper, targeted approaches may be just as successful

The Community Health Programs' Mobile Health Unit team administered vaccines to counselors at Camp Winadu on Tuesday afternoon in Pittsfield. CHP's mobile health team makes stops all over the county, focusing on the vaccine hesitant population.Erin Clark/Globe Staff

Free sports tickets. Free beer. Million dollar lotteries.

As the rate of COVID vaccinations declines sharply across the country, community and state leaders are offering sometimes lavish incentives to lure holdouts to roll up their sleeves in the drive to vaccinate 70 percent of American adults by the Fourth of July.

But for Carlos Acosta, it came down to something more simple: convenience. The 39-year-old East Boston resident had been meaning to get a COVID shot but life kept getting in the way — until he stumbled upon a pop-up clinic last weekend in the Market Basket parking lot in Revere, while out shopping.

“I was just waiting until the crowds died down,” said Acosta, ticking off the reasons for his failure to get it done before encountering the no-lines, no-appointment-necessary Revere clinic. And the $25 Market Basket gift card he received for getting his one-shot Johnson & Johnson jab? Acosta wasn’t even aware of the freebie, until he was leaving.

Market Basket gift cards at the vaccination clinic. Erin Clark/Globe Staff

Vaccination boosters are finding that a vast number of unvaccinated people are neither fearful nor anti-vaccine, but simply distracted by all the other issues in their lives. For these people, a mobile vaccine van that shows up at their work could be all it takes, something that Community Health Programs in Berkshire County discovered long ago.

Since January, CHP workers have hopped on “Bob,” their big orange bus, to administer more than 3,300 doses of COVID vaccines to far-flung residents, including gas station attendants, store clerks, and the homebound. They have occasionally offered incentives, such as free grocery gift cards or a raffle for Six Flags amusement park tickets, but have found doorstep convenience to be the biggest attraction.

“We’re not encountering a lot of hesitation, but social vulnerabilities — lack of transportation, lack of time off from a job, lack of child care” to get a shot, said Lia Spiliotes, the center’s chief executive.

To be sure, big-payoff sweepstakes, such as Ohio’s Vax-a-Million, have boosted turnout. Ohio reported a weekly average vaccination rate increase of 77 percent — an average of 68,667 more shots per week — after the lottery was announced in mid-May, compared with the time before.

However, other much lower-cost and lower-key approaches, such as simple text reminder “nudges” about a vaccine reserved for each unvaccinated person, or pop-up vaccination clinics at grocery stores, can also be effective, researchers say.

“We need a lot of different approaches,” said Dr. Mitesh Patel, an associate professor at the University of Pennsylvania’s Perelman School of Medicine.

Last fall, Patel and his colleagues used simple text messages to remind people to get a flu shot, and found in their study of 47,000 patients that texts alerting people that there was already a shot “reserved for you” were the most successful. That tailored message increased by 4.6 percentage points the number of patients who followed through with a vaccine, compared with patients who did not receive such messages.

The approach, Patel said, could easily be used for COVID vaccines.

“The message it conveys is, ‘It’s yours,’ and people are more likely to follow through to avoid losing something,” Patel said.

One of Patel’s colleagues is now joining other researchers to adapt this so-called loss-aversion approach in a newly-announced COVID vaccine lottery in Philadelphia.

The lottery significantly boosts the odds of winning among residents in randomly selected ZIP codes that have the city’s lowest vaccination rates. But they can only collect the $50,000 prizes if they have been vaccinated, giving them a powerful incentive to get a shot before the drawing.

“We are drawing winners from a residential database, and if they say, ‘Sorry, I am not vaccinated,’ then we will call someone else, and they will find out it’s a ‘regret lottery,’” said co-lead researcher Katy Milkman, a behavioral economics professor in the Wharton School at the University of Pennsylvania.

People who don’t get vaccinated are a potential threat even to vaccinated people because they are potential hosts for new strains of COVID that may be more lethal and contagious. Scientists say many people may need COVID booster shots going forward to maintain protection, giving urgency to the search for methods that boost vaccination rates.

President Biden last week called for a “month of action” in an effort to get at least one COVID shot to 70 percent of adults, but it comes as the number of people rolling up their sleeves for a shot plummets. Nationally, vaccinations hit a peak in early April, with a seven-day average of just over 3 million shots a day. That is now down to a third of that, at around 1 million.

That steep decline is mirrored in Massachusetts, where vaccinations peaked in mid-April with a seven-day average of about 90,000 shots daily. Today, it’s less than half that, hovering at about 40,000.

Phillip Griffin rested his arm around his 4-year-old daughter, Harper, while he received the COVID-19 vaccine from Kornelia Krzyzanowska while on board the Community Health Programs' Mobile Health Unit. If the mobile health unit had not visited Monroe Muffler, where Griffin works, he says he would have not had the time to to receive vaccine elsewhere. Erin Clark/Globe Staff

Still, Massachusetts is second only to Vermont in vaccinations, with at least 4.6 million, or 66 percent, of residents with at least a first dose — and that’s without any statewide incentive based programs. Governor Charlie Baker has said he would study the idea of a lottery, but an administration spokeswoman said they are first focused on eliminating potential barriers and incorporating smaller, targeted incentives, like the state-funded grocery gift cards at Market Basket pop-up clinics in communities harder hit by the pandemic.

State data show the first round of pop-up clinics, from June 3 to June 5 in Chelsea, Revere, Lawrence, Lynn, and Fall River — communities where shots have lagged — yielded 583 additional people vaccinated. Other low-key events have done even better at getting people vaccinated.

CIC Health, a Cambridge technology company that managed several state mass vaccination sites, is also organizing the pop-up Market Basket clinics. Last month, it sponsored a free ice cream night targeted at people under age 25 at the Reggie Lewis Center vaccination site in Roxbury, with a DJ, walk-ins welcome, and doors open until 10:30 p.m.

That day, a total of 837 people under age 25 were vaccinated at the center, with more than 40 percent of them — 350 people — walking in during the special evening hours. A week later, with the free ice cream offer ended, just 244 people under age 25 were vaccinated during the entire day, although the doors were only open until 6 p.m., the normal closing time.

“The impact is not to just increase the number who get vaccinated,” said Rodrigo Martinez, CIC’s chief marketing officer. “It’s the factor that these people had a great experience and go back to the community and reach someone else.”

Nurse Naiya Patel helped homebound patient Geaylamar Artis fill out paperwork before she received her COVID-19 vaccine in Pittsfield.Erin Clark/Globe Staff

On the other side of the state, in rural Berkshire County where public transportation is spotty, the biggest issue is simply reaching people. Community Health Programs, the county’s only community health center, is used to bringing care to people’s doorstep and has relied on mobile vans to administer flu vaccines for a decade.

For Angie Dowd, a 42-year-old cashier at a gas station in Lee, convenience and timing were key. Dowd, who was nervous after hearing about very rare blood-clotting problems associated with the Johnson & Johnson single shot, kept putting off vaccination, even when she brought her 18-year-old son to a local pharmacy for one.

Then the big “Bob” van pulled into her parking lot on Tuesday, right after she started her shift, and a colleague pointed to Dowd when van workers asked if anyone was unvaccinated and would like a shot.

Angie Dowd, an employee of the Mobil gas station in Lee, exited the CHP Mobile Health Unit after receiving her COVID-19 vaccine in Lee. Dowd had been skeptical of getting the vaccine, but after the Mobile Health Unit visited the gas station on Tuesday morning, she was convinced. Erin Clark/Globe Staff

“I didn’t have to make an appointment or go somewhere, and I think that was probably most of my reasoning because I am so busy with work and bringing kids to school and afterschool stuff,” said Dowd, who got her first Moderna shot that morning.

“And maybe,” she said, “I’m not the only one that thinks like this.”

Globe staff reporter John Hilliard and photographer Erin Clark contributed to this story.