Comparative effectiveness of mandates and financial policies targeting COVID-19 vaccine hesitancy: A randomized, controlled survey experiment

Fishman, Jessica; Salmon, Mandy K.; Scheitrum, Daniel; Schaefer, K. Aleks; Robertson, Christopher T.

doi:10.1016/j.vaccine.2022.05.073

Cited by 20 publications

(19 citation statements)

References 38 publications

(61 reference statements)

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“…In the open answers, an additional 3.9% said they had felt pressured by their employer to get vaccinated, highlighting how employers can and do have a measurable impact on public health. This reflects recent findings, such as a large-scale survey by Fishman et al which showed that employer mandates had a significant effect on vaccination decision-making ( 23 ). Other authors have also examined the impact of other non-“crime and punishment” measures, such as incentives and the reduction of what Njoku et al ( 24 ) call “structural barriers,” including paid leave ( 25 ), easy access to non-traditional vaccination locations ( 26 ), or administrative facilitations by employers ( 27 ), and identified their incentivizing potential.…”

Section: Discussionsupporting

confidence: 80%

Employer impact on COVID-19 vaccine uptake among nursing and social care employees in Austria

Ruf

Völkl-Kernstock

Eitenberger

et al. 2022

Front. Public Health

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IntroductionSince becoming available, vaccines against COVID-19 have been a focus of public debate. This is particularly relevant among healthcare and social workers, who interact with vulnerable patients and clients on a daily basis. With employers implementing educational programs and offering incentives to raise vaccine willingness among their staff, it is crucial to understand drivers of vaccine acceptance and hesitancy as well as the impact employers can play on vaccine decision-making.MethodsWe conducted a cross-sectional study via computer-assisted telephone and web interviews. We recruited from a pool of employees from nursing and social care institutions in Vienna and Lower Austria operated by one healthcare NGO. Variables included in the analysis were socio-demographic attributes, reasons for or against the vaccine, sources of information, opinions of mandatory vaccination, and whether respondents had previously been infected with COVID-19 or knew someone who had.Results86.2% of respondents had received at least one dose of the COVID-19 vaccine. 13.8% were unvaccinated. Vaccinated respondents' main reason for getting the vaccine was to protect themselves (79.6%) as well as others (74.1%), while non-vaccinated respondents cited a fear of short or long-term side effects (58.8 and 42.4%, respectively) as their primary reason for not getting vaccinated. 72.8% of the unvaccinated said no incentive would make them change their mind, while 17.4% specified abstract concepts or systemic change as effective incentives. Monetary incentives were not seen as a motivator. Unvaccinated respondents were significantly more worried about the future than vaccinated respondents (78.8 vs. 26.3%, p < 0.001). They were also significantly more likely to view their employers' vaccine recommendations as “manipulative” (50.6 vs. 12.4%, p < 0.001), while vaccinated respondents were significantly more likely to view them as “supportive” (68.0 vs. 25.9%, p < 0.001).ConclusionWhile employers have the means to mediate public health decision-making by providing information, deciding to become vaccinated is a more complex process including public debate, world views, political influences, and the uptake of information. Employers can act as mediators for public health decision-making, moving policy measures beyond an individualized view of health choices and health literacy toward more structural, systemic, and community-based efforts.

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Section: Discussionsupporting

confidence: 80%

Employer impact on COVID-19 vaccine uptake among nursing and social care employees in Austria

Ruf

Völkl-Kernstock

Eitenberger

et al. 2022

Front. Public Health

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“…However, our study found that respondents who reported full-time, formal employment were significantly more likely to be vaccinated than respondents who reported being self-employed. As demonstrated by Fishman in a randomized, controlled survey experiment [22], these findings may indicate the impact of mandates introduced by employers for those returning to workplaces after the introduction of COVID-19 vaccines in Abidjan. These findings are bolstered by anecdotal evidence in Yopougon Est, where factories providing full-time employment have routinely mandated vaccination.…”

Section: Discussionmentioning

confidence: 73%

Identifying Drivers of COVID-19 Vaccine Uptake among Residents of Yopougon Est, Abidjan, Côte d’Ivoire

et al. 2022

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This study applied the Fogg Behavioral Model (FBM) to identify and prioritize factors influencing COVID-19 vaccination among residents of Yopougon Est, Abidjan, Côte d’Ivoire. A total of 568 respondents were recruited from among individuals entering eleven participant recruitment and data collection sites located near high pedestrian trafficked areas. Among all respondents, 52% reported being vaccinated versus 48% who reported not being vaccinated. Of those who reported being vaccinated, 42% reported received a single dose, 54% a double dose, and 4% three or more doses. A categorical regression analysis suggested that potential predictors of COVID-19 vaccination included acceptance and rejection factors, which are both aligned with motivation in the FBM and socio-demographic characteristics, proximity to services, and religion. Our findings suggest that demand creation activities should target individuals with less formal education, those who are not formally employed, non-Catholic Christians, and individuals who do not identify as Akan. Results also suggest the need to design programmatic messages and activities that focus on generating family and community support for COVID-19 vaccination.

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“…Various hypotheses could explain this finding and more research is needed to understand why the different payment amounts had similar effects. However, diminishing returns between smaller and larger incentive amounts have also been observed in other vaccination research and in lower income populations [12,13,45].…”

Section: Plos Onementioning

confidence: 66%

“…Studies in the U.S. have begun to examine the effects of financial incentive policies on COVID-19 vaccine motivation, but they have lacked comparisons between relatively small and large payment amounts. (For an exception, see different study population [12].) Some studies have exclusively tested the effects of policies offering relatively large payments.…”

Section: Introductionmentioning

confidence: 99%

Large and small financial incentives may motivate COVID-19 vaccination: A randomized, controlled survey experiment

et al. 2023

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Introduction Experts continue to debate how to increase COVID-19 vaccination rates. Some experts advocate for financial incentives. Others argue that financial incentives, especially large ones, will have counterproductive psychological effects, reducing the percent of people who want to vaccinate. Among a racially and ethnically diverse U.S. sample of lower income adults, for whom vaccine uptake has lagged compared with higher income adults, we empirically examine such claims about relatively large and small guaranteed cash payments. Methods In 2021, we conducted a randomized, controlled experiment among U.S. residents with incomes below $80,000 who reported being unvaccinated against COVID-19. Study participants were randomized to one of four study arms. In two arms, respondents first learned about a policy proposal to pay $1,000 or $200 to those who received COVID-19 vaccination and were then asked if, given that policy, they would want to vaccinate. In the two other arms, respondents received either an educational message about this vaccine or received no vaccine information and were then asked if they wanted to vaccinate for COVID-19. The primary analyses estimated and compared the overall percentage in each study arm that reported wanting to vaccinate for COVID-19. In other analyses, we estimated and compared these percentages for subgroups of interest, including gender, race/ethnicity, and education. Main results Among 2,290 unvaccinated adults, 79.7% (95%CI, 76.4–83.0%) of those who learned about the proposed $1,000 payment wanted to get vaccinated, compared with 58.9% (95%CI, 54.8–63.0%) in the control condition without vaccine information, a difference of 20 percentage points. Among those who learned of the proposed $200 payment, 74.8% (95% CI, 71.3–78.4%) wanted to vaccinate. Among those who learned only about the safety and efficacy of COVID-19 vaccines, 68.9% (95% CI, 65.1–72.7%) wanted to vaccinate. Findings were consistent across various subgroups. Discussion Despite several study limitations, the results do not support concerns that the financial incentive policies aimed to increase COVID-19 vaccination would have counterproductive effects. Instead, those who learned about a policy with a large or small financial incentive were more likely than those in the control condition to report that they would want to vaccinate. The positive effects extended to subgroups that have been less likely to vaccinate, including younger adults, those with less education, and racial and ethnic minorities. Financial incentives of $1,000 performed similarly to those offering only $200.

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Comparative effectiveness of mandates and financial policies targeting COVID-19 vaccine hesitancy: A randomized, controlled survey experiment

Cited by 20 publications

References 38 publications

Employer impact on COVID-19 vaccine uptake among nursing and social care employees in Austria

Employer impact on COVID-19 vaccine uptake among nursing and social care employees in Austria

Identifying Drivers of COVID-19 Vaccine Uptake among Residents of Yopougon Est, Abidjan, Côte d’Ivoire

Large and small financial incentives may motivate COVID-19 vaccination: A randomized, controlled survey experiment

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