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We implemented a clustered randomized controlled trial with 6,963 residents in six rural Ghana districts to estimate the causal impact of financial incentives on coronavirus disease 2019 (COVID-19) vaccination uptake. Villages randomly received one of four video treatment arms: a placebo, a standard health message, a high cash incentive (60 Ghana cedis) and a low cash incentive (20 Ghana cedis). For the first co-primary outcome—COVID-19 vaccination intentions—non-vaccinated participants assigned to the cash incentive treatments had an average rate of 81% (1,733 of 2,168) compared to 71% (1,895 of 2,669) for those in the placebo treatment arm. For the other co-primary outcome of self-reported vaccinations 2 months after the initial intervention, the average rate for participants in the cash treatment was 3.5% higher than for participants in the placebo treatment (95% confidence interval (CI): 0.001, 6.9; P=0.045): 40% (602 of 1,486) versus 36.3% (672 of 1,850). We also verified vaccination status of participants: in the cash treatment arm, 36.6% (355 of 1,058) of verified participants had at least one dose of the COVID-19 vaccine compared to 30.3% (439 of 1,544) for those in the placebo—a difference of 6.3% (95% CI: 2.4, 10.2; P=0.001). For the intention and the vaccination outcomes, the low cash incentive (20 Ghana cedis) had a larger positive effect on COVID-19 vaccine uptake than the high cash incentive (60 Ghana cedis).
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Paper Citation
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@Article{Duchetal2023,
author={Duch, Raymond
and Asiedu, Edward
and Nakamura, Ryota
and Rouyard, Thomas
and Mayol, Alberto
and Barnett, Adrian
and Roope, Laurence
and Violato, Mara
and Sowah, Dorcas
and Kotlarz, Piotr
and Clarke, Philip},
title={Financial incentives for COVID-19 vaccines in a rural low-resource setting: a cluster-randomized trial},
journal={Nature Medicine},
year={2023},
month={Dec},
day={01},
volume={29},
number={12},
pages={3193-3202},
abstract={We implemented a clustered randomized controlled trial with 6,963 residents in six rural Ghana districts to estimate the causal impact of financial incentives on coronavirus disease 2019 (COVID-19) vaccination uptake. Villages randomly received one of four video treatment arms: a placebo, a standard health message, a high cash incentive (60 Ghana cedis) and a low cash incentive (20 Ghana cedis). For the first co-primary outcome---COVID-19 vaccination intentions---non-vaccinated participants assigned to the cash incentive treatments had an average rate of 81{\%} (1,733 of 2,168) compared to 71{\%} (1,895 of 2,669) for those in the placebo treatment arm. For the other co-primary outcome of self-reported vaccinations 2{\thinspace}months after the initial intervention, the average rate for participants in the cash treatment was 3.5{\%} higher than for participants in the placebo treatment (95{\%} confidence interval (CI): 0.001, 6.9; P{\thinspace}={\thinspace}0.045): 40{\%} (602 of 1,486) versus 36.3{\%} (672 of 1,850). We also verified vaccination status of participants: in the cash treatment arm, 36.6{\%} (355 of 1,058) of verified participants had at least one dose of the COVID-19 vaccine compared to 30.3{\%} (439 of 1,544) for those in the placebo---a difference of 6.3{\%} (95{\%} CI: 2.4, 10.2; P{\thinspace}={\thinspace}0.001). For the intention and the vaccination outcomes, the low cash incentive (20 Ghana cedis) had a larger positive effect on COVID-19 vaccine uptake than the high cash incentive (60 Ghana cedis). Trial identifier: AEARCTR-0008775.},
issn={1546-170X},
doi={10.1038/s41591-023-02670-4}}
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