Did NC’s lottery increase COVID-19 vaccine rates? Here’s what a recent study says

North Carolina’s vaccine lottery over the summer had virtually no impact on vaccination rates, a recent study found.

The study from the Journal of the American Medical Association, first reported locally by CBS17, analyzed vaccination data from late April to July 1 in 19 states that had announced vaccine lotteries, North Carolina among them.

“Estimates of the association between an announcement and vaccination rates were very small in magnitude and statistically indistinguishable from zero,” the researchers wrote.

In the 19 states overall, the number of first doses administered actually went down, and the researchers found no association between lotteries and vaccine rates when comparing rates in states without a lottery.

The decrease in vaccination followed a nationwide trend that began prior to the lottery announcements.

Gov. Roy Cooper announced North Carolina’s lottery on June 10 with the hope that it would increase the state’s vaccination rate against COVID-19. The lottery, which consisted of four $1 million drawings over the summer for anyone vaccinated, was funded by federal coronavirus aid.

But first doses and overall doses administered over the next few weeks continued to decrease, following a weeks-long trend.

Even after the first winner was announced in late June, which officials hoped would spark interest, doses given continued to decrease.

Vaccine rates didn’t start to increase until the highly transmissible delta variant started spreading in North Carolina in mid-July, though rates have tapered off again since then, decreasing week-to-week since late August, N.C. Department of Health and Human Services data show.

New case rates have fallen since then as well.

This increase in vaccination in tandem with increased case rates was seen across the country.

“If you overlay the COVID-10 disease rates and vaccination rates, they’re pretty well lined up,” said Noel Brewer, a professor of health behavior at the UNC Gillings School of Public Health. “When fewer people are getting sick, vaccination seems less pressing, but when lots more people are getting sick, and indeed dying, vaccination becomes more top of mind.”

A better incentive

At the time of the vaccine announcement, Cooper’s office cited data from Ohio that indicated a 28% increase in vaccination in the weeks following.

But Brewer, who also advises North Carolina leaders on vaccine incentive programs, said the claim by Ohio’s governor at the time was not fully evidence-based and that a more thorough analysis has not identified an increase in vaccination from the lottery.

“It was a statement that was based on some data that were available to the governor but in retrospect appear to be overly optimistic,” he said.

Brewer said the most effective incentives for the COVID-19 vaccine are those where people are guaranteed to get cash right after their shot. Non-cash prizes don’t play well either.

“The state lottery was always a bad idea,” he said. “The guaranteed cash incentives were actually well done.”

North Carolina first started offering $25 for vaccination — or for driving someone to get their shot — in late May at select sites. They expanded the program to more locations in late June, and in early August, the cash offering was upped to $100.

DHHS reported in late June that more than 40% of people surveyed at vaccine sites said that having someone drive them played a very important role in them deciding to get vaccinated.

A quarter said the direct cash incentive played a major role in their vaccination.

“There are still people out there who have not gotten vaccinated because they have practical barriers. They can’t take time off work. They need daycare for their kids. There are transportation problems. They know that they would have to take a day off because the next day, they might be really sick and they just can’t afford that,” Brewer said.

As of Aug. 30, the day before the $100 vaccine incentive program ended, 133,098 direct cash incentive payments had been distributed, totaling over $3.3 million, The N&O reported.

“I would far rather see all of the lottery money put toward guaranteed cash payments, it would be much more effective,” Brewer said.

He said the alternative to direct cash incentives is more unvaccinated people, and the loss of life and financial costs that come with that.

“Leaving people unvaccinated is an expensive proposition. Getting COVID is something that gets paid for one way or another, whether through tax dollars or higher insurance premiums,” he said.

Brewer said more resources should be set aside to implement and promote guaranteed cash incentive vaccine programs.

A Cooper spokesperson said, in an email in response to the JAMA study, that the governor believes in numerous strategies to increase vaccination rates.

“Our health officials will continue to monitor and implement the most successful efforts we see here and in other states,” the spokesperson said.

As of Thursday, 55% of North Carolina’s total population and 64% of those eligible, ages 12 and up, were fully vaccinated.