A large cash incentive in exchange for receiving a full COVID-19 vaccination series proved successful among employees of a large private company, a cross-sectional study showed.
Among more than 2,000 employees, 75.7% were fully vaccinated before the incentive announcement, which increased to 86.1% after the announcement, reported Archelle Georgiou, MD, of Starkey Hearing Technologies in Eden Prairie, Minnesota, and colleagues.
Prior to the incentive announcement, flat weekly trends were observed for first and second doses among employees. During the week of the announcement, an additional 54 employees received their first dose (95% CI 29-79, P=0.001), and 70 more received their second dose (95% CI 30-110, P=0.002), they noted in a research letter published in JAMA Network Open.
Of the 500 employees who were not fully vaccinated before the announcement, 42.8% reported full vaccination by the deadline of Sept. 30, 2021.
"Frankly, we were pleasantly surprised to observe a 10.4 percentage point increase in vaccination uptake," Georgiou told MedPage Today. "Other published studies (with smaller financial incentives) have reported increases of less than 5 percentage points."
Cash-based or vaccine lottery incentive programs are not always successful. While one small study found that giving cash cards to underserved communities helped boost vaccination uptake, mixed outcomes were reported in a larger study, Georgiou's group noted.
Some experts have argued that fully vaccinated people should be compensated for providing a public service. Other tried-and-true strategies to target vaccine hesitancy include pre-scheduled appointments and "regret lotteries."
"[Our] incentive program was bold and innovative," said Georgiou. "We were not aware of any other employers or organizations who had offered a $1,000 financial incentive to encourage vaccination, and we had not identified any published research that measured the impact of a large guaranteed incentive."
Georgiou touted the benefits of the program, which included "maintaining stable business operations."
"A large amount of compensation potentially speaks to a motivating factor for overcoming barriers to immunization, including inertia, work schedules, under-assessment of risk, and safety concerns," said Paul Auwaerter, MD, of Johns Hopkins University School of Medicine in Baltimore, who was not involved in this study.
For this study, Georgiou and colleagues examined data on 2,055 people employed by a large medical device manufacturer, 500 of whom were not fully vaccinated. On Aug. 6, 2021, the company announced that it would offer a cash incentive of $1,000 to all U.S.-based employees who could provide proof of full vaccination by the September deadline.
After watching and acknowledging an online-based educational program, employees who received their full vaccination series by the deadline received their payment in October 2021.
Among the 2,055 employees, 54.7% were women, 37% were ages 50 to 64, and about 32% were ages 25 to 39. Three-quarters were white, 12.5% were Asian, and 6.8% were Hispanic.
A post-hoc analysis showed that a greater number of previously unvaccinated women were vaccinated after the announcement compared with men (45.3% vs 38.2%). Additionally, more previously unvaccinated Asian employees (52.4%) received vaccination after the announcement versus white (43.6%) and Black (15.4%) employees. There were no significant differences between age groups or salary levels.
Auwaerter called the racial/ethnic mix of the study "notable," but added there were potential confounders, "such as a single company and recent FDA approval" of the Pfizer vaccine in Aug. 2021, "however, this didn't do much nationally," he said.
Georgiou and colleagues also acknowledged that the study lacked a control group.
"Future research should evaluate the impact of this program approach across multiple employers and across different industries," said Georgiou. "In addition, there would be value in researching the impact of smaller (and maybe larger) incentive amounts."
Disclosures
This study was supported by Starkey Hearing Technologies.
Georgiou reported no conflicts of interest.
Co-authors reported relationships with Health Care Cost Institute, Sempre Health, United Health Foundation, the University of Minnesota Office of Academic and Clinical Affairs, and XanthosHealth.
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