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Public lotteries that convince people to receive COVID-19 vaccines raise two fascinating questions: Why does an irrational reward like a lottery ticket work to get people to do what is rational for their health? And can we – should we? – use this approach to address other intractable health challenges that have resisted traditional public education initiatives?
COVID-19 vaccines give people a almost 100 percent chance of not dying from an easily contractable ubiquitous disease. The message from public health officials is simple: Without a vaccine, you are at significant risk of getting very sick or dying. On the other hand, the opportunity offered by lottery operators is to get vaccinated and have a very low chance of getting rich.
Although the first argument is more rational, in many cases it has failed to convince people. During this time, the lottery argument was overwhelmingly successful.
Following the launch of the first COVID-19 lottery in Ohio this spring, participation in immunization programs has jumped 45 percent in the state. Then the idea spread across the country, to new York at California, and even to private companies like United Airlines.
California awards vaccine lottery one 22 percent increase in vaccinations, including vaccinations in hard-to-reach communities. And lotteries motivate positive behavior in people who might not be responsive to other incentives, such as free rides to immunization appointments and vaccines given at convenient locations like train stations and stadiums.
In addition, lotteries offer a huge in for money for states. A few million dollar prices are cheaper than paying $ 50 per person per vaccine, because some states have tried. In addition, lotteries get free media coverage, which saves money on paid advertisements promoting vaccination.
As a scientist who has dedicated my life to improving the health of the community, I have to ask myself: why does this approach work so well?
Behavioral economists have been studying this phenomenon for years. Part of the answer is that a lot of people struggle to make a statistical argument into the reality of their lives. For many, life seems more random than that. Deciding whether or not to receive the COVID-19 vaccine is not a painstaking process of calculating the odds. For them, it’s a matter of luck or bad luck.
Another part of the answer is that it is much better to imagine something pleasant than something scary. Who wants to think about dying when you can think about becoming a millionaire?
Whatever the reason for the success of the COVID-19 vaccine lotteries, they provide suggestions for other public health initiatives that could change irrational behavior with irrational incentives. This is especially compelling when standard health education initiatives have failed.
There is a wide range of diseases that we could target, including diabetes, heart disease, and cancer. But a lottery idea is particularly close to my heart.
Before becoming a hospital administrator, I was a nurse in a neonatal intensive care unit. I can’t help but imagine the good that could be achieved for mothers and young babies if governments or philanthropic foundations tried to entice pregnant women to get adequate prenatal care with spectacular lottery prizes.
After all, the United States, with the most expensive healthcare system in the world, has terribly high rates for both baby and maternal mortality compared to other industrialized countries. Much of this tragedy could be avoided if we could convince more expectant mothers – too many of them forgo life-saving antenatal care – make regular visits to obstetricians. We would attract them with the vision of a better life for their families.
A state-sponsored lottery could offer a ticket for each regular visit and could offer prizes that include tuition-free college education at state universities, “baby bonds” that mature when the child reaches age. adult or big cash prizes.
Does it make sense that we need to offer lottery tickets to encourage people to adopt behaviors that they should rationally choose for themselves? No, but it could work.
Kathleen Silard is President and CEO of Stamford Health, a hospital and health system in Stamford, CT.
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