Increasing Uptake of COVID-19 Vaccination Through Requirement and Incentive Programs (2022) / Chapter Skim
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Increasing Uptake of COVID-19 Vaccination Through Requirement and Incentive Programs
Increasing Uptake of COVID-19 Vaccination Through Requirement and Incentive Programs
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* This rapid expert consultation was produced by the Societal Experts Action Network (SEAN)
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This guidance comprises the key design considerations listed in Box 1. BOX 1 Key Design Considerations for Implementing Programs to Increase COVID-19 Vaccine Uptake Designing Vaccine Requirement Programs • Public health and ethical considerations have been applied: Before implementing requirement programs, consideration needs to be given to certain public health and ethical criteria, including ensuring that the safety of vaccines has been communicated, other mitigation strategies have not worked, barriers to access have been addressed, and voluntary uptake among groups subject to the requirements has not reached sufficient levels.
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5 These rapid expert consultations include Strategies for Building Confidence in the COVID-19 Vaccines; Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity; and Communication Strategies for Building Confidence in COVID-19 Vaccines: Addressing Variants and Childhood Vaccinations.
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8 Other major public health implications of an uncontrolled, ongoing 6 In this rapid expert consultation, the term "requirement" is used to include compulsory vaccination laws and mandates. 7 The full statement of task states: "The National Academies of Sciences, Engineering, and Medicine will produce a rapid expert consultation to assist decision makers in increasing uptake of COVID-19 vaccines in light of the evolving pandemic.
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11 Tailoring requirement and incentive programs to address the underlying reasons for hesitancy or procrastination across groups could increase vaccine uptake. For incentive programs, understanding the target population and the purpose of the incentives can help in determining how best to design, implement, and frame them.
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BOX 3 Programs for Reducing Distance to Vaccine Sites Vaccine uptake can be increased by placing vaccination sites in the neighborhoods in which people live. Geographic accessibility of vaccine sites can reduce spatial and physical barriers to access, thereby directly increasing vaccine uptake without necessarily influencing people's beliefs about vaccination.
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. The vaccination facility location model used in this study showed that strategically locating these store sites in areas with low vaccination rates would have a greater influence on vaccine uptake compared with increasing the number or capacity of the stores (Bravo, Hu, and Long, 2022)
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. A review of studies on childhood vaccination in high-income countries, including the United States, found that school vaccination requirements were highly successful in increasing vaccination rates (Community Preventive Services Task Force, 2016)
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BOX 4 Considerations When Developing Vaccine Requirements • Public health and ethical considerations have been applied: Before implementing requirement programs, consideration needs to be given to certain public health and ethical criteria, including ensuring that the safety of vaccines has been communicated, other mitigation strategies have not worked, barriers to access have been addressed, and voluntary uptake among groups subject to the requirements has not reached sufficient levels. • Requirements are balanced: Requirement programs need to balance excessive leniency, which allows people to exempt themselves easily, and excessive strictness, which does not allow any exemptions at all.
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. The CDC's Community Guide to Preventive Services recommends use of financial incentives to increase vaccine uptake, although the evidence supporting this recommendation predates the pandemic (Jacob et al., 2016)
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These considerations are discussed below and summarized in Box 5. BOX 5 Key Design Considerations for COVID-19 Vaccine Booster Incentive Programs • The incentive is known and well-advertised: The target population needs to be aware of the availability of the incentive.
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In the past, for example, incentive programs employing lotteries have proven to be particularly cost-effective in motivating health behaviors because individuals tend to overestimate their chances of winning. As a result, these incentives are more cost-effective than guaranteed payments when budgets cannot support such payments that are meaningfully large (Camerer, 2011; Patel et al., 2018; Volpp et al., 2008)
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While evidence that incentives can improve first-dose vaccine uptake is limited, incentives may be able to move the needle on booster uptake, especially for people already inclined toward vaccination and early on in the rollout of new boosters. SEAN is interested in your feedback.
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. Effect of patient financial incentives on statin adherence and lipid control: A randomized clinical trial.
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. The successful implementation of mandatory seasonal influenza vaccination for health care workers.
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. Lottery-based incentives and COVID-19 vaccination rates in the US.
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. Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis.
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. Effective incentives for increasing COVID-19 vaccine uptake.
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. Association between statewide financial incentive programs and COVID-19 vaccination rates.
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We thank as well the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats, particularly Harvey Fineberg (Gordon and Betty Moore Foundation)
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, Georgetown University DOLORES ACEVEDO-GARCIA, Brandeis University MAHZARIN R BANAJI, Harvard University DOMINIQUE BROSSARD, University of Wisconsin–Madison JANET CURRIE, Princeton University MICHAEL HOUT, New York University MARIA CARMEN LEMOS, University of Michigan ADRIAN E
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KESTER, International AIDS Vaccine Initiative PATRICIA KING, Georgetown University Law Center NICOLE LURIE, Coalition for Epidemic Preparedness Innovations JONNA MAZET, University of California, Davis, School of Veterinary Medicine PHYLLIS MEADOWS, The Kresge Foundation TARA O'TOOLE, In-Q-Tel ALEXANDRA PHELAN, Georgetown University DAVID RELMAN, Stanford University MARK SMOLINSKI, Ending Pandemics DAVID WALT, Harvard Medical School Project Staff LISA BROWN, Senior Program Officer EMMA FINE, Associate Program Officer SHALINI SINGARAVELU, Associate Program Officer MARGARET MCCARTHY, Research Associate JULIE PAVLIN, Director, Board on Global Health ANDREW M POPE, Senior Director, Board on Health Sciences Policy
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