Youth Not Totally on Board With COVID Vaccine Incentives

Adolescents and young adults generally viewed COVID-19 vaccine incentive programs favorably, though a sizeable share also expressed concerns, according to a national survey-based study conducted via text messaging.

Of over 1,100 youth who responded to a survey about these programs — which can include college scholarships, lottery entries, cash payments, or tickets for events — 82% felt the incentives were a “good idea” or at least positive in some ways, but 28% said they were not or expressed concerns, reported Caroline Hogan, MD, of the University of Michigan in Ann Arbor, and colleagues in JAMA Open Network.

“For these incentive programs, it will be important to look at trends in youth vaccination following their implementation, as well as young people’s attitudes toward incentives, to determine if they are having the desired public health impact,” Hogan said in a press release.

Most participants in the study (79%) stated that they were aware that incentive programs for vaccination existed, though only 7% said they influenced their decision on vaccination. Still, when asked what might encourage anyone unvaccinated to get vaccinated, 21% of respondents mentioned incentives. Another 21% said further vaccine testing, safety data, or regulation could be a motivating factor for the unvaccinated.

The survey was conducted over a 1-week period in October 2021 and was sent to 1,206 participants through MyVoice, a text message-based polling platform. Participants were paid $1 for their response to the questions.

Respondents were an average age of 20 years, 68% reported being non-Hispanic white, and 59% reported being male (the latter two of which are over-representations based on national averages).

The survey received 1,125 responses from participants ages 14 to 24 years who were sent five open-ended questions, with responses analyzed thematically:

1. Have you heard about incentives for getting the COVID-19 vaccine (lotteries, scholarships, free stuff, etc.)? If yes, what have you heard of?
2. Do you think incentives are a good idea? Why or why not?
3. Did an incentive influence your decision about getting vaccinated? Tell us about it.
4. If you have not gotten vaccinated against COVID-19, what would it take for you to get vaccinated?
5. If someone you know has not gotten vaccinated, what would it take for them to get vaccinated?

To the question of whether vaccines are a good idea, 70% said yes, 16% said no, and 12% gave “yes and no” type of answers. Example responses included: “Yea, it may motivate people”; “No, it seems sketchy”; and “Yes, but I think it can also send the wrong message.” The other 3% expressed being unsure about whether incentives were good or not.

For the 305 respondents expressing skepticism to incentives (the “no” and “yes and no” groups), 21% cited ethical concerns, likening them to “bribery”; 17% said they created the wrong motivations for getting vaccinated, 13% said they “decreased trust” in the vaccines themselves along with the institutions promoting them, and 11% said they were unfair to those who got vaccinated without an incentive.

“Policymakers and investigators should consider youths’ perspectives on COVID-19 vaccine incentives, along with the ethical implications of offering incentives to children who cannot independently consent to vaccination or participation in incentive programs,” Hogan’s group concluded.

While COVID-19 vaccination status was not included as part of the questions for participants, 80% volunteered information that they had received at least the first dose, a potential limitation of the study as this puts the selected group of participants at a higher vaccination rate than the national average for adolescents ages 12 to 17 years (69.5% have received one dose) and adults ages 18 to 24 (78.5%).

“It is possible that unvaccinated respondents have substantively different opinions about incentives compared with their vaccinated counterparts,” wrote Hogan and coauthors. “Relatedly, since our study provides monetary incentives for participation, it is possible the cohort is biased toward those who are motivated by incentives, however small.”