BEST Talks: Get jabbed, get cash? Perspectives on introducing a cash incentive for Coronavirus vaccinations

  • BEST Talks: Get jabbed, get cash? Perspectives on introducing a cash incentive for Coronavirus vaccinations

Welcome to BEST Talks, our new live article series where we ask our talented pool of interdisciplinary researchers and practitioners the same questions on current issues in the media and present their insights, knowledge and perspectives in one place. BEST Talks is designed to allow all of our researchers and BEST fellows to post responses to the same questions in real-time. Articles are dated and researchers are also able to publish follow-up answers to the same questions as the discussion progresses. Each BEST Talks post will be moderated to filter any derogatory, rude or offensive articles and commentary. We will set a time limit on each BEST Talk for new articles, to ensure that they are relevant to the current discourse. Once the deadline is reached, we will read and analyse all of the articles posted and summarise the key themes and differing perspectives from each author. Our hope is that BEST Talks will be a productive forum to publish our expertise on current issues in real-time, as well as provide our researchers and fellows the opportunity to have their full, unaltered articles published to a wider audience.

Our first BEST Talks topic surrounds the current debate of implementing a cash incentive to increase Coronavirus vaccination adoption. BEST will be accepting articles between August 6th, 2021 and August 21st, 2021. The following questions are open to all BEST researchers and fellows to address:

  1. Could cash incentives boost vaccine uptake in Australia?
  2. What is your prediction of the results of implementing cash incentives for vaccines? What do you think will occur if this is implemented?
  3. What do you believe would be a wise strategy to increase vaccine adoption?

To have your article and answers to these questions published, please e-mail Sam Ong at best@qut.edu.au. We look forward to reading your articles and are excited to see this platform grow and develop!

Get jabbed, get cash? Perspectives on introducing a cash incentive for Coronavirus vaccinations

With many states in Australia currently in lockdown and our rate of vaccination moving sluggishly, there are real talks about the potential to introduce a cash incentive to increase vaccination rates. The target of 70-80% of Australia being fully vaccinated is supported by both the LNP and Labour, however the parties have differing views on how we should get there. Labour is proposing a one-off cash payment of $300 as a method to get more Australians to get the jab (Evans, 2021), while the LNP is proposing that we encourage vaccine adoption through freedom incentives, such as exemptions from health restrictions, or more lenient rules around travel or social activities (Scott, de New & Prakash, 2021). In this BEST Talk, our researchers provide their expertise on this issue, predict the effects of implementing a cash incentive and propose a range of solutions to increase vaccine adoption.

References:

To read the full articles and perspectives on this issue, click the links below:

Themes, thoughts and ideas from our researchers

While there was no universal consensus on whether or not Australia should introduce a cash incentive to increase Coronavirus vaccination adoption, the majority of our contributors were hesitant towards, or strongly against the idea, of monetary incentives. A large portion of the articles suggested that while a cash incentive may ‘get some people across the line’, the increase in vaccine adoption would be small to negligible, and would not reach the Australian Government’s vaccination target of 70-80%. Furthermore, many of our authors discussed the potential costs and risks of this approach, both monetarily and ethically. Depending on the approach taken, a one-off-cash payment could end up costing the country approximately $6 Billion and may also increase skepticism and misinformation about vaccines generally (i.e. are people “selling their health”?). In addition, moving forward, the country will need to continue to vaccinate people at various intervals and this approach may set a dangerous precedent for the future.

One authored highlighted that introducing a cash incentive is nothing new and that it is import important to understand who this incentive will best work for, before rolling out a one-off incentive. However, many have also highlighted that freedom incentives may actually drive more to get vaccinated.

Another key theme that became apparent across all of the articles was that education and communication about the vaccine has been poor, confusing and inconsistent. Many authors highlighted the need for the government to provide clearer communication suitable for all Australians, including resources written in other languages and content suitable for people with various physical and intellectual disabilities.

The authors have also suggested a range of potential solutions to increase vaccine adoption in Australia and these have been detailed below:

  • Dr Muhammad Zaheer Abbas
    • Clearer communication from the Australian government is key to addressing fears or nervousness about side effects of the vaccine
    • Non-financial incentives, like the freedom to travel and attend recreational and religious activities, should be considered to accelerate the rate of vaccination
    • More Australians could be motivated to have the vaccine if they see their fellow Australians being immunised
      • Giving away a free distinguishable mask, cap, band, ribbon, badge, or even a T-shirt for this purpose can be a financially and practically viable option.
  • Dan O’Halloran 
    • Leverage the lessons learnt from the “No Jab, No Play” policy
    • Educate our people and engage in a mature conversation. We need to engage our community leaders and have them engage their people on the risks.
    • Once the trials have been completed in the USA with COVID-19 vaccines in 6m+ years olds, then the vaccines need to be added to the vaccination schedules for all children.
    • We need to explore how our taxation and social benefits schemes can create incentives.
  • Prof Uwe Dulleck 
    • First and foremost, we need a clear strategy to ensure vaccine supply and then a deadline when all restrictions will end
    • A clear decision to open up the country – i.e. treat COVID from a certain date like the flu – would get people to understand the importance of getting vaccinated
    • Making a decision that also respects individual autonomy and does not coerce people to get the jab should be considered first
  • Prof Rebekah Russell-Bennett
    • The Australian Government should turn to the Hug, Nudge, Smack or Shove Matrix proposed by Prof Jeff French
    • We need to adopt a service-thinking mindset and consider the vaccination experience from the perspective of the customer
    • Designing for the entire customer journey should be a key strategic approach to achieve the vaccine target needed for Australia to move beyond the pandemic
    • There needs to be a positive mindset and understanding about the vaccine and the vaccination process, the registration and booking process needs to be much simpler and streamlined than at present – indeed the option of walk-in vaccination hubs that are open 24/7 should be an option
    • Once the vaccination is done, people need to be rewarded and recognised with digital vaccination certificate benefits publicised widely. Motivation is goal-directed so the roadmap to recovery must have clear goals that do not change to foster trust and goals that are understandable and meaningful to people
    • Australia should enable choice and self-determination whilst making the vaccination experience easy, convenient and beneficial for everyone. This will be achieved best through non-financial rewards.
  • Dr Stephen Whyte
    • Marketer’s and Communications professionals would do well to remind vaccine hesitant groups that the reasons we no longer see some of the horrific diseases that kill thousands of children in poorer nations is because their parents have chosen to engage in a program of vaccination.
  • Dr Frank Mathmann 
    • Cash incentives may be a wise strategy in the face of an imminent outbreak, but a bad strategy long term, although without primary data it is very difficult to say as the general public is poorly represented among researchers.

Dr Muhammad Zaheer Abbas (Postdoctoral Research Fellow – QUT School of Law)

August 18th, 2021

Could cash incentives boost vaccine uptake in Australia?

As the proposed cash rewards would be paid from taxpayers’ money, it is more important to consider whether cash incentives are necessary to boost vaccine uptake in Australia. In my view, blanket or one-size-fits-all cash incentive schemes are not necessary to accelerate the rate of COVID-19 vaccine uptake in Australia. I have explained my position in response to the subsequent questions.

What is your prediction of the results of implementing cash incentives for vaccines? What do you think will occur if this is implemented?

Cash incentives are expected to have one-off effects. People who are already willing to be vaccinated may do so quickly if cash is offered. The real issue is whether this incentive scheme will make a difference for those Australians who are unsure or unwilling about being vaccinated. According to the Melbourne Institute’s Taking the Pulse of the Nation survey, only 10% of this group said they will change their response if a cash incentive is offered.

A Yahoo Finance poll suggests that 60% of Australians would not be motivated by a cash reward.

Considering these statistics, I predict that the proposed cash incentive scheme will not make much difference for those Australians who are unsure or unwilling to being vaccinated.

What do you believe would be a wise strategy to increase vaccine adoption?

It would cost Australia close to $6 billion if a cash bonus of $300 is paid to Australians who get immunised by December 1 as proposed by Labor leader Anthony Albanese. I do not see it a wise approach to waste such a huge amount of taxpayers’ money on providing blanket incentives to a vast majority of Australians who are already willing to be immunised at some point if preferred vaccines are available in sufficient quantity.

According to a survey conducted by news.com.au, only 12% of Australians do not want to get any vaccine.

According to other research, almost 90% of Australians are willing to get vaccinated at some point even without being offered cash incentives. Only around 10% of Australians are hesitant to embrace vaccination.

Taxpayers’ money should be efficiently used to address the actual reasons behind vaccine hesitancy. The WHO-SAGE defined vaccine hesitancy as a ‘delay in [the] acceptance or refusal of vaccination despite [the] availability of vaccination services’. According to a study, concerns over effectiveness and safety are the main reasons for vaccine hesitancy. Around 50% of Australians who are not willing to take a vaccine are afraid of side effects like blood clotting. If someone is genuinely concerned about side-effects or health risks of being immunised, a cash incentive of $300 may prove too little to motivate them to come forward while still having fears or mental barriers. Even a higher amount, say $3000, may not be enough to pay off their health concerns.

Fears about the safety of COVID-19 vaccines caused delays in Australia’s rollout. There were reported cases of blood clotting linked to the use of the AstraZeneca vaccine and the Australian Technical Advisory Group on Immunisation had declared that ‘people under 50 should take the Pfizer vaccine due to the very small risk of blood clots from the AstraZeneca vaccine’. Later, Professor Kidd noted that ‘the benefits of the COVID-19 vaccine AstraZeneca are greater than the risk of rare side effects occurring, in all age groups’. However, Jeanette Young, Queensland’s top health official, stood firm that the AstraZeneca vaccine should not be taken by those under 60. ‘I still don’t want 18-year-olds to receive the AstraZeneca jab’, she said. These conflicting statements cause confusion and delays. People should have a better understanding of the risk-benefit ratio. If the benefits of having the AstraZeneca vaccine outweigh any risks associated with its use, it should be clearly communicated to the Australian population at large.

Clearer communication from the Australian government is key to addressing these fears or nervousness about side effects. Evidence-based information strategies should be considered to improve acceptance of COVID-19 vaccines through the dissemination of better and reliable information about COVID-19 vaccines. Views and beliefs of unwilling and unsure Australians around vaccine safety and significance can be changed by providing authentic and trustworthy information about the effectiveness of COVID-19 vaccines. Resources must be invested in providing unbiased advice on vaccine safety to inform individual choices. The Australian government needs to make sure that positive and easy to understand messages about the benefits of getting vaccinated are getting through. There may be a need to overcome any cultural and/or linguistic barriers while dealing with diverse groups within the hesitant group. Community organizations can be mobilized to meaningfully engage with diverse groups to pass on positive messages about vaccines through grassroots communications campaigns aimed at trust-building and social approval of COVID-19 vaccines.

Another reason for vaccine hesitancy, as shown in the above chart, is complacency over the perceived risk or a lack of urgency among Australians to get immunised. Confusion about eligibility status is arguably a contributing factor to a lack of urgency. As noted by Dr. Karen Price, President of the Royal Australian Council of General Practitioners (RACGP), ‘Patients across Australia are suffering from information overload and confused about their eligibility status and what next steps they should take. The goalposts seem to be shifting every other day and I am concerned that some patients will find it all too difficult and delay or avoid getting vaccinated altogether’. There is a critical need to make concerted efforts to provide clarity on updated eligibility criteria in each jurisdiction and convince people at large that vaccination is key to reducing transmission of COVID-19 and protecting people, especially their own families, from infection and death. People who are willing but deliberately waiting for one reason or the other should be encouraged to come forward for the individual as well as collective benefit in getting vaccinated. The message should be clear that there are no benefits to waiting or deliberately holding off. Rather, the economic, social, and psychological impacts of the COVID-19 pandemic should be adequately highlighted to nudge and shake complacent people or groups that have taken a wait-and-see approach. Clarity on what is the right thing to do in a given situation is important in motivating the right choices.

Vaccine hesitancy is not the only reason why Australia has been one of the slowest among developed countries to vaccinate against COVID-19. Insufficient supply of the preferred COVID-19 vaccines is also a formidable issue that needs to be addressed on a priority basis. According to the Melbourne Institute’s Taking the Pulse of the Nation survey, 54% of Australians overall and 100% of Australians aged 18 to 34 years have a preference for a particular COVID-19 vaccine.

Demand has exceeded the supply of the preferred vaccines. The first priority for the Australian government should be to focus on the 90% of Australians who are willing to become vaccinated if sufficient supplies are ensured. The key focus at this stage should be to increase supplies of the preferred COVID-19 vaccines. Meanwhile, policy efforts should be directed at educating, informing, and convincing the close to 10% hesitant group to embrace vaccination. A range of targeted and tailored incentive schemes may be considered, in tandem with other strategies, at a later stage for specifically motivating the left-over or firm hesitant group in Australia.

Non-financial incentives, like the freedom to travel and attend recreational and religious activities, can be considered to accelerate the rate of vaccination. As compared to the possibility of getting motivated by a one-off cash payment of $300, a majority of people are more likely to be interested in getting back to the freedoms, normalcy and lifestyle they used to enjoy before the pandemic. While devising incentive strategies, policymakers should consider that ‘Australians love fun, sport, spending time with family and friends, and travelling’.

Another strategy to drive a faster take up of COVID-19 vaccines would be to distinguish people who are getting vaccinated or who have already got their shot. More Australians could be motivated to have the vaccine if they see their fellow Australians being immunised. Australia may learn from Singapore where immunised ‘people receive a free #igotmyshot mask to show they’ve been vaccinated. As more people don these masks, people in this group would likely feel encouraged to get a vaccine’. Giving away a free distinguishable mask, cap, band, ribbon, badge, or even a T-shirt for this purpose can be a financially and practically viable option.

Muhammad Zaheer Abbas is a Postdoctoral Research Fellow at the Faculty of Business and Law, Queensland University of Technology (QUT) and a Member of the Centre for Behavioural Economics, Society and Technology (BEST). View his profile HERE.

Dan O’Halloran (Financial Analyst & Healthcare Professional)

August 12th, 2021

Could cash incentives boost vaccine uptake in Australia?

This is a very interesting question, as the mere premise of it suggests that there is no social contract, or collective agreement to address the challenges of COVID-19 as a community.

It is probable that, yes, cash incentives could boost vaccine uptake in Australia. However, cash is not the only means of an incentive to reach this objective. Further, spending money to achieve this now, may cause us further financial challenges in the short and medium term.

Cash incentives can come in multiple forms, that is:

  1. A payable and receivable incentive where one receives cash in their hand after completing two doses of a COVID-19 vaccine. It is probable that the cost of paying people to become vaccinated is likely to be less than the cost of the lockdowns to the broader community. That is, the opportunity cost is lower; or
  2. A non-payable incentive where one maintains their social benefits after completing two doses of a COVID-19 vaccine. This is similar to the “No Jab, No Play” policy that has been very effective in increasing vaccination rates in our children. I suppose the question that should be asked is – if it is ok for one to expect financial support from the greater community when they need help, then what is their responsibility to contribute to the greater success of that community? If I am to expect financial support for my hardship that has been caused by a pandemic, where that hardship could have been ameliorated through the broader use of vaccines, and I choose not to receive a safe and effective vaccine when I have choice in which one to choose, then why should I be entitled to receive benefits?

Before a cash incentive is implemented, we need to understand the barriers. Why is there hesitation? If the hesitation is concerned over safety, efficacy, or fear – then cash incentives are unlikely to close the gap that is needed to achieve population protection. In such a situation, the cash that is proposed to be used for such an incentive may better be spent on education and community engagement.

Australia will face significant financial challenges moving forward. We must be smart with how we invest our money. If we look to Iceland as an example, despite having very high levels of vaccination their community is currently facing significant challenges from COVID-19. There is no doubt that vaccinations have saved lives in Iceland, and there is no doubt that they are necessary for the future, if we spend all our cash now – our ability to respond in the future will be compromised as we already have incurred significant debt.

In summary, do I think we should pay people to be vaccinated? No, I do not. I believe we should first seek to understand why people are hesitant, and that should be achieved through education and community engagement in the first instance. If, after education and engagement the gap is reduced, and then a financial incentive is shown to help increase vaccination uptake, and this led to reducing the need for lockdowns, then I think on the balances of the opportunity costs, then this is something that should be considered at that time. But we are not at that juncture yet.

I believe as a society we have a role to enable people to have choice and do this by engaging with them on this difficult and complex matter. If they choose not to be vaccinated, then that means they choose not to be part of the broader society, and the benefits that this provides. This is a very similar approach to that which is being taken in France. Those that make the choice not to be vaccinated should not expect the rest of the society to pick up the pieces when the resources allocated to them down the track are exhausted, and this should form part of a difficult and mature conversation with the population. We need to quarantine our hospital resources so that those that suffer from Strokes, Heart Attacks, Cancers and other live changing events, of which some are not acutely avoidable, have access to the care they need when they need it – those people should not be prevented from accessing healthcare, because of someone else who chose not to receive a safe and effective COVID-19 vaccine. These are ethical issues, no one life is better than another – however, there will be trade-offs that occur for those that choose not to be vaccinated – because as a society we won’t be able to provide the response that is needed for those that need care, because they chose not to be vaccinated. We saw this reality in Italy, Japan, the UK and USA.

What is your prediction of the results of implementing cash incentives for vaccines? What do you think will occur if this is implemented?

I believe paying people to be vaccinated sets a very dangerous precedent. We know that we will need to continue to vaccinate people at various intervals moving forward. So, if we start now – are we going to continue to do this? Why are we not using our tax and social benefits system to incentivise our population? If you are vaccinated, you pay a lower Medicare Levy. If you are receiving benefits, you would receive 100% of the benefit if you vaccinated; but only a proportional benefit if you are unvaccinated. I don’t believe splashing cash about is good policy, particularly for our future generations.

What do you believe would be a wise strategy to increase vaccine adoption?

  1. Leverage the lessons learnt from the “No Jab, No Play” policy
  2. Educate our people and engage in a mature conversation. People don’t want to hear the statistics anymore – in fact some of these are irrelevant. I fear that focusing on the cases that are detected is like applying more armour to a plane that returned in WWII where the bullet holes were. This is wrong – the armour needed to be applied to where there were no bullet holes, as the planes that returned could still fly. Those planes that didn’t return were shot at where there were no bullet holes in the planes that returned. We need to engage our community leaders and have them engage their people on the risks. The risks being that most infections would be from someone they know, from their household. The virus doesn’t discriminate, and doesn’t just come from people that you don’t know.
  3. Once the trials have been completed in the USA with COVID-19 vaccines in 6m+ years olds, then the vaccines need to be added to the vaccination schedules for all children. This will form part of the “No Jab, No Play” policy.
  4. We need to explore how our taxation and social benefits schemes can create incentives.

Dan O’Halloran is the Director of Financial Analysis and Benchmarking at HealthConsult Pty Ltd and a Partner Investigator with the ARC Training Centre for Behavioural Insights for Technology Adoption (BITA). View his profile HERE.

Prof Uwe Dulleck (Behavioural Economist)

August 9th, 2021

Could cash incentives boost vaccine uptake in Australia?

I am sure it would get a couple of people across the line, but we will not be able to achieve the 70—80% vaccination rates we need. On the upside, the discussed $300 cash incentive is likely to be particularly effective for people with a lower socio-economic background, and may increase vaccine uptake in that demographic. Furthermore, it is a clear signal that government thinks getting vaccinated is what everyone should do – while that is the message for everyone following the news, with some of the confusion created around the different vaccines, such a signal may help. The main downside – in my eyes is the ethical dilemma. If we really do not want to coerce people to get vaccinated, then a payment of $300 – in particular if it aims to increase vaccinations among people with a lower socio-economic background – is another form of coercion. So, if ethical dilemmas stop us from making shots compulsory, then the cash incentive hits a similar road block.

What is your prediction of the results of implementing cash incentives for vaccines? What do you think will occur if this is implemented?

As indicated above – in the short term or for particular groups, I feel this can make a difference. I am much less convinced that the effect will be particularly large.

What do you believe would be a wise strategy to increase vaccine adoption?

I feel first and foremost, we do need a clear strategy of the government to ensure vaccine supply (so that everyone who wants to get vaccinated can get vaccinated) and then a deadline when all restrictions (travel etc.) fall. In my eyes, a clear decision to open up the country – i.e. treat COVID from a certain date like the flu – would get people to understand the importance of getting vaccinated, and better sooner than later. More importantly, it respects peoples autonomy – they can decide to take the risk to get COVID if they do not get vaccinated, the health system by the time should be able to help them – and one could argue for rules around financial contributions to COVID treatment costs if people who could get vaccinated and decided not to, requires expensive treatments. All of this would work similar to a cash incentive – just on avoiding health and potentially financial cost of catching COVID, but allow people to decide. Furthermore, it would get us to open up the economy. The only problem we have here is – what do we do about those that cannot get vaccinated for health reasons – with opening up the country, these people would carry extra risk. In my eyes, we will get to that situation sooner or later, and picking a date at least allows people to plan.

Prof Uwe Dulleck is Co-Director of the Centre for Behavioural Economics, Society and Technology (BEST) at Queensland University of Technology, Australia and Program Lead for the BEST program of Behavioural Economics and Public Policy. View his profile HERE.

Prof Rebekah Russell-Bennett (Services and Social Marketer)

August 6th, 2021

“Hug, Nudge, Smack AND shove: A social marketing perspective on COVID-19 Vaccination Uptake in Australia”

Could cash incentives boost vaccine uptake in Australia?

Cash incentives will work for some of the population however will not work for everyone. Financial rewards appeal to people who are extrinsically motivated and not motivated by altruism while non-financial incentives are more appealing to those who are intrinsically or altruistically motivated.

A recent study by the University of Melbourne about the effectiveness of cash incentives for Australians show that it won’t make much difference to the 16% of Australians who are unwilling or unsure of being vaccinated – only 10% said it would make them get vaccinated, which is 1.6% of Australians or 40,000 people.  For those who are willing, a cash incentive would speed up the vaccination however as these people are already willing, you have to ask whether speeding up the vaccinations when supply is limited is actually worth the money.

Therefore, while cash incentives might boost vaccine uptake, at best it would be an increase of 1-2% of the unwilling segment population, at worst it would unnecessarily reward people who do not need rewards to get vaccinated.

What is your prediction of the results of implementing cash incentives for vaccines? What do you think will occur if this is implemented?

The use of intentions as a predictor of behaviour has a long history of questionable reliability. Asking a person via a survey or interview what they would do sometime in the future does not take into account many of the barriers that people face when doing a behaviour and suffers from social desirability bias (people providing socially desirable answers). Research on vaccinations show discrepancies between intentions and behaviours i.e. in a study of free HPV vaccination in the USA, 168 parents intended to have their children vaccinated but only 58% actually performed the behaviour. I think that the number of people who will actually be motivated by cash incentives to be vaccinated will be smaller than the predicted number and this minimises the effect and the return on investment.

While the cash incentives may work for some, a bigger question is, what is the harm that might be caused by cash incentives, now and in the future?  There are a number of unintended negative effects that are likely to occur that need to be offset against the marginal gain. A good place to look is blood donation which is not incentivised by cash in Australia and is an altruistic behaviour to help others (in many ways similar to a mass vaccination program). A systematic review of incentives in blood donation by BEST collaborator Dr Kathleen Chell and colleagues showed that incentives have largely been ineffective in achieving first-time behaviour although were more successful in encouraging repeat behaviour. More importantly, offering cash donations would stop current donors. So there is likely to be an unintended negative effect of backlash from people who believe that vaccinations are a community-minded behaviour (as the cash conflicts with the intrinsic motivation of altruism) and people who have already been vaccinated and missed out on the cash. There is also the likelihood of the unintended negative effect of negative spillover that for future vaccination efforts, people may wait for the cash incentive that may or may not come (in the same way people wait for the end of financial year sales and delay their purchases).

So essentially my prediction is that the cash incentives will not generate the desired results and will cause harm.

What do you believe would be a wise strategy to increase vaccine adoption?

As a social marketer, I look to the behavioural exchange matrix created by Professor Jeff French in the UK that has four approaches; a hug, nudge, smack or shove.  All four of these approaches should be used in a holistic approach to vaccine uptake in Australia. The two appeals on the top of the matrix aim to leverage motivators while the bottom two aim to overcome barriers.

  • The Hug is a positive motivator and consists of rewards – these rewards should not be direct financial rewards such as cash incentives due to negative unintended effects. Using blood donation as an example of how to encourage community-focused health behaviours, if monetary incentives are to be used these would be better in indirect forms such as gift vouchers, store discounts, tax relief or a charitable donation. Hugs should also include non-financial rewards such as freedom to travel and avoid lockdowns through a vaccination passport, digital badges, commemorative coin or badge or though indirect financial rewards such as tax relief or thank you gift vouchers.
  • The Smack is a negative motivator and consists of punishments and penalties. Evidence on the use of penalties such as fines, loss of parental rights or educational-access penalties show that they are effective in increasing vaccination compliance. However, these should be used sparingly as they can backfire and cause citizen reactance particularly in democratic societies where liberty and freedom is a core value.
  • The Nudge is a positive way to address barriers through making the behaviour, easy, attractive, social and timely. Nudges for Flu-vaccination in the form of self-framed messaging have been shown to increase vaccination behaviour compared to social benefits. A recent study in Nature on the effectiveness of text-message nudges to encourage COVID vaccination if they prompt, enable and motivate behaviour. Nudges via communication can address the key attitudinal barriers to COVID vaccination identified in a Lancet article of mistrust, uncertainty and misinformation. Designing the vaccination registration and booking process to be easier, pro-active and convenient appeals to self-interest and would be helpful in increasing uptake as would choice architecture nudges of vaccination locations or we-come-to-you vaccination services.
  • The Shove is a negative way to address barriers through restricting choice and access to the behaviour. While people need choice, they do not need too many choices. Information overload or confusion by overchoice prevents effective participation in preventative health. Limiting the number of messages in communication, ensuring a single credible source of information would help people enormously.  Shoves should be used with caution as too many limitations to choice will deter participation (a survey in July reported by the Royal Australian College of GPs  showed 7% of Australians believe freedom of choice is a valid reason for refusing the COVID vaccine).

In addition to these four approaches, we need to adopt a service-thinking mindset and consider the vaccination experience from the perspective of the customer. The customer journey for vaccination starts well before the registration and booking stage, it starts with information search and attitudes and continues well after the jab. Designing for the entire customer journey should be a key strategic approach in the health approach to achieving the vaccine target needed for Australia to move beyond the pandemic. There needs to be a positive mindset and understanding about the vaccine and the vaccination process, the registration and booking process needs to be much simpler and streamlined than at present – indeed the option of walk-in vaccination hubs that are open 24/7 should be an option. Research on increasing HPV vaccination showed that enabling planning and implementation of the behaviour such as completing vaccine tasks immediately (i.e., returning consent form right away), developing a specific plan, electronic alerts and reminders, and implementing solutions for barriers are key.

Once the vaccination is done, people need to be rewarded and recognised with digital vaccination certificate benefits publicised widely. Motivation is goal-directed so the roadmap to recovery must have clear goals that do not change to foster trust and goals that are understandable and meaningful to people – without goals, there is no motivation and without motivation there is no vaccination. End of story.

So the wisest strategy to achieve the vaccination target for Australia is to enable choice and self-determination whilst making the vaccination experience easy, convenient and beneficial for everyone. This will be achieved best through non-financial rewards.

Professor Rebekah Russell-Bennett is Co-Director of the Centre for Behavioural Economics, Society and Technology (BEST) at Queensland University of Technology, Australia and Program Lead for the BEST program of Social Marketing and Behaviour Change. View her profile HERE.

Dr Stephen Whyte (Behavioural Economist)

August 6th, 2021

Could cash incentives boost vaccine uptake in Australia?

Price incentives & increased consumption are inextricably linked. It’s the very foundation of the science of Economics. There’s no question that a federal cash incentive will increase consumption, a better question is (1) who it will incentivise, and from an efficiency perspective (2) do we need to boost vaccination numbers for those particular groups.

What is your prediction of the results of implementing cash incentives for vaccines? What do you think will occur if this is implemented?

A one off federal cash payment to incentivise behaviour in a large scale health decision is nothing new. The Albanese lead opposition are proposing (with significant criticism from the Morrison Government) something the LNP already have a history of utilising as fiscal instrument for (pro-natal) behavioural change. The Howard/Costello government of course famously implemented a federal “baby” bonus between 2004-2014.

QUT Alumni Dr Suzanne Bonner conducted research on how such a one off cash incentive impacted changes in total fertility (Bonner & Sarkar 2020). Dr Bonner’s key findings show an “increase in fertility for women with low levels of educational attainment.”.  Education and income are positively correlated, and again, from a neo-classical perspective its of little surprise to see that a cash bonus results in greater change in populations where the marginal benefit of the dollar amount is greater. So cash incentives do work, but its more important to understand who they best work for. As such, from a socio-economic perspective, I would predict that we would see an increase in low-socio-economic uptake of vaccination. For med-high socio-economic groups its more likely that $300 would just increase the speed of those who had already planned to get the jab.

Reference

  • Bonner, S., & Sarkar, D. (2020). Who responds to fertility-boosting incentives? Evidence from pro-natal policies in Australia. Demographic Research, 42, 513-548.

What do you believe would be a wise strategy to increase vaccine adoption?

Assuming there are no issues with supply, what do we know about vaccination behaviour that works. What has a history of being successful. Well Australia is very good at childhood vaccination, a staggering 92.53% for Australian 2 year olds in 2021 we fully immunised (Australian Immunisation Register 2021). Childhood vaccination is a four year program of tablets, oral liquids, and injections for things like rubella, measles, mumps and whooping cough, but to name a few. Now the current Delta variant outbreaks in Sydney, Melbourne and Brisbane doesn’t allow for a four year program of education, and most of all ongoing engagement with GP’s and Dr’s relating to childrens’ health. But that doesn’t mean the trust and moral capital built from our children’s vaccination programs can’t be used as a flagship for engaging those in vaccine hesitant groups. Marketer’s and comms would do well to remind vaccine hesitant groups that the reason we no longer see some of the horrific diseases that kill thousands of children in poorer nations is because their parents have chosen to engage in a program of vaccination. Some of the very parents that are now vaccine hesitant.

Dr Stephen Whyte is Co-Deputy Director of the Centre for Behavioural Economics, Society and Technology (BEST) at Queensland University of Technology, Australia and Deputy Program Lead for the BEST program of Behavioural Economics and Public Policy. View his profile HERE.

Dr Frank Mathmann (Senior Lecturer, Marketing)

August 6th, 2021

Could cash incentives boost vaccine uptake in Australia?

I believe cash incentives may actually reduce vaccine uptake in Australia and increase skepticism and misinformation about vaccines.

What is your prediction of the results of implementing cash incentives for vaccines? What do you think will occur if this is implemented?

I think on the short term there may be an increased adoption as some people who wanted to get vaccinated anyway will get vaccinated quicker in the fear that as such a program progresses, the money may run out. However, the fact that people have to be paid for a vaccine, and the perception that comes with that may increase skepticism and misinformation as consumers may adopt a “compensatory logic” where they feel that they are “selling their health”. That is, if I get money for it, I must be giving something away.

What do you believe would be a wise strategy to increase vaccine adoption?

It may be a wise strategy in the face of an imminent outbreak, but a bad strategy long term, although without primary data it is very difficult to say as the general public is poorly represented among researchers.

Dr Frank Mathmann is Member of the Centre for Behavioural Economics, Society and Technology (BEST) at Queensland University of Technology, Australia and Senior Lecturer in Marketing at QUT. View his profile HERE.