Financial incentives for vaccination do not have negative unintended consequences

Abstract

Financial incentives to encourage healthy and prosocial behaviours often trigger initial behavioural change1–11, but a large academic literature warns against using them12–16. Critics warn that financial incentives can crowd out prosocial motivations and reduce perceived safety and trust, thereby reducing healthy behaviours when no payments are offered and eroding morals more generally17–24. Here we report findings from a large-scale, pre-registered study in Sweden that causally measures the unintended consequences of offering financial incentives for taking the first dose of a COVID-19 vaccine. We use a unique combination of random exposure to financial incentives, population-wide administrative vaccination records and rich survey data. We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety. In a complementary study, we find that informing US residents about the existence of state incentive programmes also has no negative consequences. Our findings inform not only the academic debate on financial incentives for behaviour change but also policy-makers who consider using financial incentives to change behaviour.

Cash for COVID-19 Vaccines in Africa: A Financial Incentives Trial in Rural Ghana

“…We confidently conclude that there is no evidence supporting our pre-registered hypothesis that the cash incentives treatments would depress the vaccination intentions and behaviors of those residing in cash-treated villages who did not receive cash for vaccines. This is consistent with a recent Swedish random control trial that has found no evidence of spillover effect of COVID-19 financial incentives on future vaccination uptake (Schneider et al, 2023). More generally it is consistent with a recent large-scale cash-transfer trial in rural Africa that also find no evidence of negative spill-over to proximate non-recipients of these cash transfers (Egger et al, 2022).…”

“…There is limited evidence regarding the unintended consequences of COVID-19 vaccine financial incentives. The most notable evidence to date are the results from U.S. and Swedish trials that found no evidence of significant negative unintended effects of financial incentives (Schneider et al, 2023). We explicitly design our Ghana trial in order to estimate geographic spillover effects of the cash incentive treatments that might result from diffusion of information about cash payments (Giné and Mansuri, 2018).…”

The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray

“…Finding institutions that avoid or mitigate these kinds of objections may determine the extent to which societies succeed or fail in dealing with the challenges of our time. A stream of recent research at the design-behavior interface is thus concerned with understanding the empirical nature of such behavioral constraints (Ambuehl, 2017;Ambuehl, Bernheim, & Ockenfels, 2021;Berger, Ockenfels, & Zachmann, 2023;Kölle, Kübler, & Ockenfels, 2023;Leider & Roth, 2010;Schneider et al, 2023). Another literature develops mechanisms that are consistent with the constraints imposed by attitudes about appropriateness.…”

Vaccine incentives do not backfire — policymakers take note

“…Or they might think the payments are compensation for something that isn't safe or could be unpleasant. Now, the results of two trials published in a paper on 11 January in Nature suggest that simple cash payments have no such unintended effects 4 . The research team took the important step of designing the studies to test a null hypothesis.…”