I relish the intersection of public health policy informed by behavioral economics.
It's a joy akin to matchmaking your two best friends and then witnessing as their relationship proceeds to marriage. It leaves me giddy and breathless and proud of the clever public health strategist who is able to leverage human psychology to improve population-level health.
My wife relayed a radio piece she heard on NPR that blew my mind. Through an interview with Dr. Katy Milkman, a behavioral economist at Wharton, it explored different financially based vaccine incentives in practice across the US.
There's the cash is king approach: Kroger is paying $100 to employees who get vaccinated. Target is offering employees $25 for each of the two shot series.
There's also the lottery approach: Ohio created a Vax-A-Million lottery, with two prize options for any resident who has received at least one dose of an approved COVID vaccine.
The prize for adults is a million dollars. The prize for kids is a 529 account in their name opened with sufficient funds to pay the cost of the highest Ohio state university tuition, room and board.
The initial results are impressive: a 33% increase in the number of residents who registered to get the vaccine in the week after the lottery was announced, with copycat lotteries inspired in New York and Maryland.
As Milkman explained, human psychology tends to vastly overestimate the chances of winning a life-changing lottery prize. Creating a media sensation based on a significant monetary prize also generates plenty of free press that extends the reach of a program that might otherwise not receive coverage.
Interestingly, the research shows that you don't need a single huge prize to lure people to enter. Smaller prizes with better odds of winning can be perceived as realistic enough to increase the overall numbers that enroll. So giving away ten Hondas may be more effective that one Lamborghini.
There was an interesting approach based on the endowment effect, which is where humans irrationally over-value something they already own compared with what they'd pay for that same item in the marketplace.
People would receive phone calls informing them that a dose of vaccine had already been reserved especially for them, and asking when they'd like to come in to receive their dose. By framing a vaccine as a possession they already owned, those who received the calls were likelier to follow up in receiving vaccination.
My hands down favorite approach was the regret lottery. In this model, every state resident is initially eligible for the drawing to win a million dollars. The name is picked, the individual is called, and then they must answer the key question: "Have you received your first dose of vaccine?"
If the answer is yes, you've just won a million dollars.
If the answer is no, you win nothing, but you (and everyone else) will know you would have won the million dollars if you'd only made a different decision.
This cuts right to the heart of loss aversion - it will hurt far more to lose a million dollars you ought to have won than to skip out on a lottery you were never eligible for in the first place.
Given that estimates of those who are adamantly opposed to receiving the COVID vaccine range from 5-15%, the regret lottery could change behavior in a significant portion of those folks on the fence about whether or not to get the vaccine.
That's the beauty of public health informed by behavioral economics.