In late April, West Virginia Gov. Jim Justice made a major announcement: Any state resident between 16 and 35 who got vaccinated for Covid-19 would receive a $100 savings bond.

"I'm trying to come up with a way that's truly going to motivate them — and us — to get over the hump," Justice said in a statement released after the press conference.

The "hump" was a sudden slowdown in West Virginia's vaccination rate. At the beginning of the year, the Mountain State was celebrated for a very effective public rollout of the Covid shots. As that pace began to falter later in the spring, Justice and his administration got creative.

In recent weeks, West Virginia's model has spread. Ten states and the District of Columbia are now offering some kind of incentive to encourage people to get vaccinated, from a ride around the Talladega Superspeedway in Alabama to free beers in Washington, D.C.

Local governments are also stepping up: New York City is giving away everything from tickets to Lincoln Center to Shake Shack French fries, while the Los Angeles Unified School District is awarding cash grants to schools that get a certain percentage of their student population vaccinated.

As states run out of eager vaccine recipients, the incentives keep increasing. In early May, New Jersey began offering vaccine recipients a free beer at participating restaurants. By May 19, it had expanded the program into Operation Jersey Summer, with giveaways like free passes to state parks and beaches and a raffle to have dinner with New Jersey Gov. Phil Murphy and his wife Tammy.

While these incentives continue to be the exception and not the rule — only one in five states is offering them — that could change, depending on the programs' success in increasing vaccination rates.

Ohio's vaccine incentive: a Vax-a-Million lottery

The incentive that's gotten the most buzz is Ohio's Vax-a-Million lottery, which will award five $1-million cash jackpots to randomly selected vaccine recipients. Any Ohio adult who has received at least one Covid vaccine dose by May 26 is eligible. Five parallel drawings for teenagers will give the winners full four-year scholarships (including room and board) to any public university in Ohio.

The Buckeye State's vaccine lottery has drawn praise for its out-of-the box approach, but it's also garnered criticism for funding its jackpot with federal money intended for Covid relief. Critics argue that the money should be used to build the state's public health infrastructure, not fund windfalls for random Ohioans.

Kevin Volpp, professor of behavioral economics and health policy at the University of Pennsylvania, disagrees. While funding a lottery may not be ideal, he says, the gambit is worthwhile if it noticeably increases Ohio's vaccination rates.

"A lot of people decry the fact that it's $5 million plus the cost of five four-year college scholarships," he says. "But I think it's important to point out that that is a pittance when it comes to the economic impact of Covid on any state in the U.S., or the country as a whole."

A lot of people decry the fact that it's $5 million plus the cost of five four-year college scholarships, but I think it's important to point out that that is a pittance when it comes to the economic impact of Covid.

Kevin Volpp

professor of behavioral economics, University of Pennsylvania

Psychologically speaking, lottery entrants have a tendency not to focus on their low chance of winning (in this case, more than 1 in a million), but on the size of the prize. That excitement makes them want to participate, Volpp says.

The amount of money Ohio currently plans to spend will run a lot less per capita than if it had given all vaccine takers $100. Even if only another 1 million of the state's 11.6 million residents get Covid shots, the cost to the state per person would be just $5, Volpp argued in a recent opinion piece in The Washington Post.

"In an ideal world, we wouldn't need to be incentivizing people to get vaccinated against Covid. The vaccine is extremely safe. The risks are minimal," he says. "Many of us would have hoped that people would just get vaccinated on their own once the vaccines were available. That said, obviously that's not happening for a substantial portion of the population, so now we have to think about the best alternatives to increase vaccination rates."

While more data is still forthcoming, the early results are promising: Ohio has already recorded an over 50% increase in vaccination rates since it announced the lottery last week, and on Thursday, both Maryland and New York announced lotteries of their own.

Video by Stephen Parkhurst

'If they work, they're definitely worth the money'

Governors and public health officials in several states, including Minnesota, Wyoming, and Washington state, have said they're watching the results of Ohio's lotteries closely and are open to copying the program.

They shouldn't wait too much longer, says Harold Pollack, professor of public health at the University of Chicago. Infection rates are already dropping, thanks to the effective U.S. vaccination campaign, and they're likely to decrease further as summer kicks into high gear and people start spending more time outside, Pollack says. That will decrease the urgency to get vaccinated, and potentially lead to high case rates in the fall, when viruses tend to be on the upswing.

"Time is the enemy," Pollack says. "If [the incentives] work, they're definitely worth the money. The value of another person vaccinated is just enormous by any metric."

"We should be throwing spaghetti at the wall," he adds. "We should have lots of places trying lots of different things, being very open and transparent about it and seeing what seems to catch people's fancy."

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