Millions of South Africans have been clamouring to get vaccinated over the past few months — and yet some countries are having to dream up increasingly creative ways to lure people into getting their jabs.
In the US, most of those who want vaccines have had them, and yet only 48% of the population (161-million people) are vaccinated. This is some way off the 80% proportion that the New England Journal of Medicine this month estimated to be the herd immunity target for the US.
So what to do to motivate millions more Americans, when the usual education efforts to encourage vaccination aren’t working? Will doughnuts, free beer and lottery tickets do the trick?
Take New York state’s "vax and scratch" programme, launched in May. People getting shots at one of 10 mass vaccination sites received free lottery scratch-off tickets with a chance to win up to $5m.
New York City has offered its own range of incentives, from free tickets for sports events, ferry rides and the Bronx zoo to the chance to win $2,500 or a hotel staycation.
It’s a win for tourists too. In June the Empire State Building offered free access to its 86th-floor observation deck — normally a $42 ticket — for the first 100 people getting jabs at its pop-up vaccination centre.
And the city gives community-and faith-based organisations that persuade New Yorkers to go for a vaccination $100 per referral.
Of course, New York state is comparatively well covered, with 74% of adults vaccinated. The numbers are less impressive elsewhere.
So Ohio offered five weekly lotteries, with prizes of up to $1m for adults who had their shots and full four-year college scholarships for those aged up to 17. And it worked: Ohio said its vaccination rates doubled in some counties after the lottery was announced.
In New Jersey and Connecticut, the incentives are more prosaic: a free beer or non-alcoholic beverage for the vaccinated. The coastal state of Maine rolled out free fishing licences, baseball tickets and LL Bean gift cards.
Maryland celebrated Independence Day by paying $400,000 to one lucky vaccination lottery winner. The July 4 payout followed 40 daily draws offering prizes of $40,000.
Washington state, one of the first jurisdictions in the US to legalise marijuana, launched a "joints for jabs" incentive campaign in which those over 21 could get a free, pre-rolled joint with their vaccination.
Private enterprise is getting in on the incentive drive as well.
Krispy Kreme, one of the first businesses to roll out a national vaccine incentive, has since March been offering a free glazed doughnut to any adult with a vaccination card. According to CNBC, by June more than 1.5-million doughnuts had been handed out — and the offer still stands for the rest of the year.
The New York City-based burger chain Shake Shack announced in May that crinkle-cut fries would be free with the purchase of a burger or chicken sandwich if customers had vaccine cards. Initially the "get vaxxed, get Shack" promotion applied only in the city, but it has been extended.
Beer companies Budweiser and Samuel Adams gave free beer to those with proof of vaccination, while Target handed out $5 coupons for those getting the vaccine in its stores. For a few weeks, the Vitamin Shoppe offered a free full-sized snack or drink to anyone with at least one shot.
Still, these lotteries are not a magic wand. Survey research company Morning Consult said this month its polling showed 30% of Americans were either "unwilling or uncertain" about vaccination — the third-highest percentage among the 15 largest global economies, after Russia and Australia.
The US is not alone in getting creative to boost vaccine takeup. Serbia in May paid €25 — equivalent to about 5% of the average monthly salary — to everyone who had a shot, Euronews.com reported.
Visitors to the 14th-century Bran Castle in Transylvania, Romania — said to be the inspiration for Dracula’s castle in Bram Stoker’s iconic novel — were greeted by medics wearing fang stickers on their scrubs as they administered Pfizer shots, according to the BBC.
Carrot and stick
Israel, which rolled out the world’s fastest Covid vaccination campaign and has reached 65% coverage, is combining incentives and threats to get the rest of the population vaccinated.
The government has introduced "green passports" that allow people to enter gyms and hotels now and will eventually allow them to embark on quarantine-free travel.
The private sector has followed suit — Check Point Software Technologies, for example, is allowing only vaccinated employees (with green bracelets) to use its in-house salon, outdoor balconies and manicure/ pedicure room.
Russia is also using both stick and carrot. Even though it was the first country in the world to authorise a vaccine, infections are surging. So the government has made vaccines mandatory for many with public-facing jobs, including hairdressers, taxi drivers, bank tellers and teachers.
Pensioners in Moscow have been offered goods worth the equivalent of $14 from grocery shops and pharmacies as a reward for getting vaccinated.
Russians were entered for a lottery offering five cars as prizes every week, and in the city of Ufa those who went for shots stood the chance of winning an apartment. But still, there has been no mass rush for the Sputnik V shot.
Some of the richest giveaways are in Hong Kong. There, private companies are offering such rewards as a $1.4m condominium, a Tesla car or a gold bar. At the bottom of the scale, incentives included iPhones and shopping vouchers.
Moderation applies in the Netherlands, where pickled herring is on offer as an incentive, and in Melbourne, Australia, a cinema group is offering free popcorn and choc-tops.
Then there’s livestock. In the rural Mae Chaem district in Thailand, the authorities have launched a raffle with 27 cows as prizes. The UK’s Independent newspaper reports that nearly half the 1,400 residents in the district rushed to register for a jab. Indonesia, meanwhile, is offering free chickens.
In Las Piñas in the Philippines, 10 people a month will win a $100 "livelihood starter package", with enough food to start a small convenience store, in return for being vaccinated.
Morning Consult says its polling shows vaccination incentives are more effective among some demographics than others; men, for example, are more inclined than women to be tempted.
"Democrats, more than Republicans, also said they’d be more likely to get vaccinated if they could get free goods or services and, when broken down by generation, millennials were the most likely to say certain freebies would motivate them to get vaccinated," it says.
There are, of course, other options — including refusing access to restaurants and similar facilities for the unvaccinated, or raising premiums for health and life insurance.
Either way, it’s clear that some combination of carrot and stick will be necessary to push many of the doubters over the line. The New England Journal of Medicine sees no problem with carrots: "Payments could ensure that vaccination is indeed ‘free’ to all," it says.
Downside of freebies
Maybe, but one expert who has spent decades studying how people make health decisions — David Asch, the executive director of the Centre for Health Care Innovation at the University of Pennsylvania — says freebies can backfire.
Asch says on the website of the Association of American Medical Colleges: "What we’re really trying to do here is motivate people who don’t want to get vaccinated. Financial incentives can help people who are already interested in a behaviour, like quitting smoking. But if someone really doesn’t want to get vaccinated, I’m not sure there’s an amount of money we’d be willing to offer that would also work."
And, Asch says, offering money can confirm the suspicions of anti-vaxxers, who might respond: "They’d never offer money if this was a good thing."
The Krispy Kreme doughnuts giveaway, he says, is probably a marketing stunt more than anything else.
"I don’t have a problem with that — other than the risk of obesity from all the doughnuts possibly being consumed every day. But I’d rather people use prosocial approaches, like an ‘I donated blood’ sticker," Asch says.
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