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Lotteries and prizes aren’t working. Here’s how to boost vaccination rates.

Hint: More appeals from Democrats probably won’t get it done.

Heidi Russell of Aurora, Colo., was the fifth and final winner of a $1 million prize in that state's vaccine lottery.David Zalubowski/Associated Press

In West Virginia, they have held lotteries offering trucks and custom shotguns or hunting rifles to those who have received at least one shot of a COVID-19 vaccine. In parts of New York, vaccinations come with a free beer or a Krispy Kreme doughnut. A vaccine lottery program that began in Ohio has been emulated in California, Michigan, and New York, and of course Massachusetts too. In Indiana, health officials are handing out boxes of Girl Scout cookies, while Alabama has offered the chance to drive a truck two laps around the Talladega superspeedway.

Public health officials, in other words, are getting desperate. It’s understandable: Only 20 states reached President Biden’s goal of getting one dose of vaccine in 70 percent of adults by July 4; only 54 percent of adults in rural areas have received at least one shot; and the more contagious Delta variant threatens to rip through unvaccinated communities.


Fortunately, there is a growing body of evidence on the messaging strategies most likely to prove effective in boosting vaccination rates. And one of the lessons of this research is that financial and similar incentives are unlikely to do much to overcome vaccine hesitancy in the most conservative parts of the country.

Ohio Governor Mike DeWine’s innovative vaccine lottery was announced with great fanfare, and versions of it were soon adopted in at least 16 other states. Initial reports suggested that the Ohio lottery led to increases in vaccination rates, but as a new study published in the Journal of the American Medical Association points out, those reports did not account for the expansion of eligibility to adolescents at the same time. In fact, Ohio had worse vaccination trends after the launch of its lottery than the rest of the country. It has since given up on the program.


Other financial incentives have proved similarly unsuccessful. In Minnesota, most people have bypassed the state’s COVID-19 vaccination incentive program, with only 13 percent of those eligible registering to receive a reward. Other research finds that financial incentives decrease vaccine hesitancy among liberals but not among conservatives. And financial incentives can even backfire: In one study, about 15 percent of unvaccinated people reported they were less willing to get vaccinated because of the payments.

So what does work? The most effective messaging seems to emphasize, above all, the safety of the vaccines. And this message is especially persuasive to vaccine-hesitant conservatives when it comes from prominent Republicans.

One new study, for example, finds that short video messages encouraging vaccination did more to increase conservatives’ intentions to get the shot when they stressed the safety and efficacy of the vaccine and how easy it is to get one. Emphasizing social norms and peer pressure in these messages worked less well. In other research, people responded well to messages emphasizing that the vaccines are approved by health care workers and that they are the quickest way to get life back to normal. Sharing information about how vaccination promotes herd immunity also helps, as does emphasizing the risks that COVID poses to the most vulnerable Americans.

Other new research confirms just how important it is for Republican leaders to support the vaccine. Unvaccinated Republicans who were shown prompts about President Trump’s connection to the vaccine — such as the fact that he played a role in vaccine funding — were significantly more likely to say they intended to get vaccinated than those who were not.


The researchers also found evidence of a backlash against Democratic messaging. Republicans who viewed endorsements of the vaccine from members of the Democratic elite said they would be much less likely to encourage others to get vaccinated and had more negative attitudes toward the vaccine. In other words, appeals for vaccination from Democrats may soon hit a point of diminishing returns; in some places, Democratic politicians may want to think twice about making direct appeals to conservative voters.

So Republican politicians need to take the lead. A few Republican governors have shown the way: Asa Hutchinson, of Arkansas, has declared that “the solution is the vaccinations.” Jim Justice, of West Virginia, has said that the unvaccinated have entered “the death lottery.” Now would be a good time for others to speak up, too. One voice in particular has been notably quiet lately. In a televised interview in March, Trump encouraged his supporters to get vaccinated, but he skipped two recent vaccine ad campaigns that featured every other living ex-president.

Bryan Schonfeld and Sam Winter-Levy are PhD candidates in politics at Princeton University.