Offering teens and young adults a chance at a college scholarship, cash, discounts or just some free food might help move the needle on COVID-19 vaccination rates, a study suggests.

But a sizable minority of young people have their doubts about whether such vaccine incentives will work or are ethical.

In all, 82% of people between the ages of 14 and 24 have a positive attitude toward prizes, raffles, giveaways, and other incentives designed to increase vaccination, according to national survey results published in a new research study in JAMA Network Open.

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Most youth said vaccine incentives would help promote vaccination and serve the greater good, while 10% saw incentives as a reward for those who chose to get vaccinated.

But 28% said they weren't sure incentives would work, and 21% questioned the ethics of giving something of value, or a chance at a high-value reward, to people as part of COVID-19 vaccination efforts.

SEE ALSO: How to Make Sure People Get the Second Dose of the COVID-19 Vaccine

"Over the past year, numerous incentive programs have been launched by states and other stakeholders to promote COVID-19 vaccination among youth and adults," said Caroline Hogan, M.D., the lead author of the study and a pediatrics researcher at the University of Michigan. "It's important to understand how young people perceive these efforts, and what those attitudes might mean for future vaccination incentive programs."

Hogan and her colleagues analyzed responses from 1,125 teens and young adults, with an average age of 20, who answered a survey in October 2021 via text message as part of the MyVoice national poll of youth. The survey sample was also somewhat more skewed toward males and non-Hispanic white respondents than the national population of this age group.

While the vast majority said they were aware of vaccine incentive programs and viewed them positively, only 7% said that such a program motivated them personally to get vaccinated. But when asked what might motivate others to get vaccinated, 21% of those who offered an opinion said incentives.

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Most of the respondents volunteered information about their own vaccination status, and 80% said they have received at least one dose of a COVID-19 vaccine. That's a higher proportion than the 79% of 18-24 year olds and 70% of 12-17 year olds who have received at least one dose nationally.

"It's important to study public perceptions of health policies in addition to their effectiveness," said Hogan. "For these incentive programs, it will be important to look at trends in youth vaccination following their implementation, as well as young people's attitudes toward incentives, to determine if they are having the desired public health impact."

Hogan is a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation and a research fellow at the Susan B. Meister Child Health Evaluation and Research Center.

A question of ethics for incentivizing vaccines

As for the ethical questions raised by some of the respondents, Hogan and colleagues say it's important to consider them not only for COVID-19 vaccination campaigns but also for future use of incentives.

This is especially true for teens under age 18, who in most states need a parent or guardian's approval to get vaccinated.

For instance, 21% of the respondents expressed concern that incentives seemed to them a form of bribery, 17% said incentives created "wrong reasons" to get vaccinated, and 13% said that incentives could erode trust in vaccines or the organizations offering them.

An additional 11% felt that incentives were unfair to people who got vaccinated before incentive programs were launched.

More research, and consideration of past research, needed

Hogan, who is compiling other data on COVID-19 vaccine incentive programs aimed at young people and at parents of children and teens, said she wonders if the flurry of incentives around this vaccine might change parents' decision-making around other pediatric vaccines.

She hopes to do further research asking parents about their attitudes and actions related to incentives, especially among those who have not yet chosen to vaccinate their children.

Other researchers have published analyses of the COVID-19 vaccine incentive programs launched in 2021, with mixed findings about how well they actually worked to increase vaccination rates.

SEE ALSO: Most Young People Eager for COVID-19 Vaccine, Poll Shows

"The jury is still out, but certain types of incentive, like guaranteed cash payments, may have worked better than others," said Hogan.

Past evaluations of health-related incentives have largely concluded that the dollar value, or perceived value, of the reward item or potential prize matters when it comes to ethics.

Designers of future vaccine-related incentive programs should examine this body of research to avoid crossing the line into coerciveness, she said. Because both primary COVID-19 vaccination and booster rates are lagging among young people, there may be a resurgence of efforts to incentivize vaccines.

The study, and the MyVoice poll, are funded by the Michigan Institute for Clinical & Health Research, the U-M MCubed program, and the Department of Family Medicine. In addition to Hogan, the study's authors are Marika E. Waselewski, MPH, Park Szachta, Clara Wolff, Xochitl Amaro, and Tammy Chang, MD, MPH, MS. Chang, an associate professor of family medicine and member of IHPI, directs the MyVoice poll.

Citation: Perceptions of COVID-19 Vaccine Incentives Among Adolescents and Young Adults, JAMA Network Open, doi:10.1001/jamanetworkopen.2022.16628

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