Alberta clinical psychologist explains vaccine lotteries and behavioural change
Long-term vs. immediate rewards at play in motivating people to get their shot
With first-dose uptake lagging in Alberta, Premier Jason Kenney recently announced three $1-million jackpots are up for grabs to encourage those who are vaccine hesitant to get the shot — and only the vaccinated are eligible to win the "Open For Summer" lottery.
But when it comes to swaying the undecided, do vaccine lotteries actually work?
Robert Williams, who is a University of Lethbridge professor and a research co-ordinator with the Alberta Gambling Research Institute, thinks so.
In fact, Williams explained on the Monday edition of the Calgary Eyeopener that the psychology behind lotteries makes the plan a "very good" one.
"[Vaccine] lotteries look successful no matter where you introduce them," Williams said. "[And] the early results suggest that this really does inject a lot of life into participation rates."
Early data suggests boost in Ohio
Knowing that demand for first doses would wane, Kenney said Monday the Alberta government had been actively brainstorming creative solutions, finally landing on the mega-prize lottery modelled after similar draws in the United States and Manitoba.
While some Alberta health-care specialists characterized the move as a gimmick, early data suggests lotteries might make a difference.
The Associated Press reported last month that after a slump in vaccinations, the number of people in Ohio age 16 and older who received their initial COVID-19 vaccine jumped 33 per cent in the week after the state announced a million-dollar incentive lottery.
Though Ohio doesn't track the motive of those getting the shot, the state health department said the boost was promising.
"The bottom line is that this has changed the trend line in Ohioans starting the vaccination process, and rather than a decline, the trend is moving upward," spokesperson Alicia Shoults said.
Long-term vs. immediate rewards
According to Williams, there is research to suggest that lotteries can have an impact in behavioural change.
In part, this is because people are more strongly driven by immediate consequences and rewards, rather than long-term aspirations.
"Many of us have good intentions of exercising more, or giving up smoking, or saving for retirement because of the long-term benefits these produce," Williams said.
"The problem is that many people don't end up doing anything about these aspirations because the reward is a dissonant long-term one."
What does prompt behavioural change is an immediate financial incentive — for example, a tax reduction for contributing to an RRSP, or having to pay $20 rather than $3 for a pack of cigarettes.
He says that for those dragging their feet on getting vaccinated, the "immediate reward" of a chance to win $1 million can help tip the scales.
"People respond well to concrete, short-term financial rewards," Williams said. "So, yeah — lotteries and financial incentives generally motivate people."
Lotteries are also especially clever when applied to the vaccine hesitant, Williams said, because of a likely overlap in demographics.
The chances of actually winning a lottery are usually very low — for example, the Lotto 6/49 has odds of about 1 in 14 million, he said.
"There are 14 million households in Canada — so it's equivalent to me thinking of a particular address, on a particular street, in a particular town, in a particular province," Williams said.
"You pay me money to guess that, and I'm changing the address every time."
However, Williams said those who are vaccine hesitant because they worry about experiencing very rare side-effects — like those associated with the AstraZeneca-Oxford vaccine, for example — are also likely to overlap with the demographic who perceive their odds of winning a lottery to be higher.
"The people who overestimate the risk of COVID adverse effects are probably the same people who are overestimating the chances of winning the lottery," Williams said.
"It's appealing to that demographic specifically. So, it's particularly clever for that segment of the population."
The primary mechanism for this is that when people are trying to estimate how common something is, we don't consult the statistics. Instead, we consult our memory bank of instances.
Because we read about lottery winners, and not losers — "Or know of someone, who knows someone, who won" — people judge probability by availability in memory, Williams said.
"And the same people who are drawn to instance-based probability are likely to believe in the probability of adverse effects," Williams said.
Lotteries and public health
In addition to having the potential to motivate those who are hesitant, it also can motivate those who simply haven't gotten around to booking their shot yet, Williams said.
And because of these factors, the use of lotteries in public health has a lot of potential.
Incentivizing people to proactively and regularly monitor their health, from flu shots to prostate exams, can prevent strain on the health-care system.
And while some critics suggest the money spent on a lottery could be funnelled elsewhere, the price tag of a lottery is negated by the savings they allow, Williams said.
"The money you save in health-care costs when you get more people vaccinated far outweighs the cost of holding small-scale lotteries," Williams said.
"These things really do work. And so I think there should be a lot more financial incentivization of public health measures to move people — in addition to public education — to sort of maximize the benefits."
With files from the Calgary Eyeopener, CBC Edmonton and The Associated Press