Carrots or sticks? Do COVID-19 vaccine-hesitant Australians prefer cash incentives or social freedoms?

 

Background

In the midst of surging COVID-19 case numbers and recurring lockdowns, the state and federal governments are wanting COVID-19 vaccines to be administered as quickly as possible. Although the vast majority of Australians are willing to roll up their sleeves, there remains a portion of the population who are either unwilling or undecided about receiving a COVID-19 vaccine. Debate continues as to the best method to increase vaccine uptake amongst this small but significant group.

 

What we did

We surveyed 1,018 adult Australians (NSW, VIC, QLD) who were unwilling or undecided about receiving a COVID-19 vaccine to see what increases vaccine uptake the most - cash incentives or social restrictions.

Participants were invited to take part in a 15-minute online survey about their vaccine policy preferences. Incorporating community preferences into real-world outcomes is known as Community Value Mapping because the process involves mapping features of an item, in this case, vaccination policies, to a person's own value framework. The framework is established using trade-off techniques such as choice tasks that directly measure the relative importance of specific components of the policy (e.g., cash incentives vs. restrictions). To make a choice, decision-makers must trade-off the differing features (pros and cons) according to their own unique value framework. In this study, we used a method called a discrete choice experiment (DCE) which asked people to consider 16 hypothetical policy arrangements that included different combinations of cash incentives ($0 - $500) and restrictions (proof of vaccination required to attend major events, travel, work in shared spaces, gatherings, public transport, and food and entertainment). Then we asked whether or not they would get vaccinated under the different policies with a) the vaccine of their choice, or b) if they only had access to the AstraZeneca (AZ) vaccine.


 

Who we spoke to

Australian residents aged 18+ who lived in NSW, QLD, or VIC (the states most affected by lockdowns) were eligible to participate in the survey. Participants were recruited through online panel companies and social media advertisements. People who said they had received either one or two doses of a COVID-19 vaccine, intended to receive a vaccine as soon as possible, or had already booked an appointment to get vaccinated were not able to complete the study. Only people who said they were deciding whether or not to get vaccinated or were not planning on getting vaccinated were included and considered 'vaccine hesitant'.

 

What we found

Almost half the participants in the current sample said they would consider receiving a COVID-19 vaccine, but had not talked to their healthcare provider (HCP) yet.

Variability across people's choices in the experiment was found. We were able to provide insights into why some people were more likely to respond to different incentives or restrictions than others and the reasons for their choices.

We used latent class modelling (LCM) to investigate how people differed in their decision-making in the choice task. Our analysis showed three distinct groups ('classes') of decision-makers: 1. those who were resistant to a COVID-19 vaccine regardless of restrictions or cash (Resistant), 2. those considering getting vaccinated and strongly influenced by restrictions to their favourite activities (Watch and wait), and 3. those who are hesitant but would get vaccinated with high enough cash incentives (Hesitant but cash motivated). More information on the three groups can be found below. The analysis also took into account how frequently respondents had engaged in each of the potentially restricted social activities prior to the COVID-19 pandemic.

Group 1 - Resistant (41.14% of vaccine hesitant participants): This group was unlikely to endorse receiving a COVID-19 vaccine under any policy arrangement. Social restrictions and cash incentives did not influence this group's decision to receive a COVID-19 vaccine and government policies relating to social restrictions and cash incentives are not expected to increase vaccine uptake in this group.

Group 2 - Watch and wait (36.01% of vaccine hesitant participants): Group 2 represents those probably considering receiving a COVID-19 vaccine at some point and are highly motivated by cash incentives and social restrictions. Without considering restrictions or cash incentives, around half of this group would receive a vaccine by the end of the year. This group may be waiting for their preferred vaccine or until vaccine rates are higher. Social restrictions were most likely to increase vaccination in this group, and proof of vaccination to attend restaurants, cafes, movies, theatres, pubs, bars, and nightclubs increased predicted vaccine uptake by five times. Cash incentives also increased the likelihood of this group receiving a vaccine by around 5 times, although the amount of the incentive did not seem to influence vaccine uptake dramatically (all cash incentives 4-5 times more likely).

The odds ratios indicate how much more likely individuals are to get vaccinated if a certain policy or cash incentive is implemented. Those in Group 2 (Watch and wait) for example, are nearly 4 times more likely to get vaccinated if proof of vaccination is required for interstate travel than if no proof was required. 


Group 3 - Hesitant but cash motivated (22.85% of vaccine hesitant participants): Overall, group 3 was vaccine-hesitant, and social restrictions did not increase the likelihood of receiving a vaccine to a great extent. Cash incentives appeared to be the main factor driving choice toward vaccination and influenced decisions to receive a vaccine linearly (higher cash incentives resulted in a greater likelihood of vaccination). Respondents in this group were 12 times more likely to get a COVID-19 vaccine if they received a $500 cash incentive.

The largest sub-group consisted of those who were resistant to a COVID-19 vaccine (Group 1), however, the relative size of each group differs based on particular personal characteristics such as age (18 - 40 or 41+), region (metro/regional) and state (NSW, VIC, QLD). For example, if we simulated the results based on regional Queenslanders aged of 41+, the proportion in Group 1 increases to 58.62% and overall predicted vaccine uptake drops rapidly because this group is resistant to vaccines.

 

Interactive dashboard

All results are available via an online interactive dashboard where users can simulate different combinations of policy arrangements ('what if' scenarios) and see the associated predicted vaccine uptake. Different predictions of vaccine uptake can be simulated by personal characteristics (age, region, state) by using the red cog in the 'Total split by group' tab. You can access the interactive dashboard here.

The effect of recent government policy to open up vaccine brand choice, such as Pfizer, to previously excluded groups can be seen in the dashboard by setting cash incentives to $0 and removing all restrictions. This provides a predicted uptake of 20%, which can be considered a brand effect because the question was framed to allow for vaccine choice. Comparatively, if we were to restrict choice to only the AZ vaccine, then predicted uptake would be close to 0%. The results from the AZ vaccine model are not reported in this press release.

Overall, vaccine uptake could be increased dramatically amongst those who are motivated by cash incentives and social restrictions (Groups 2 and 3), however, it is not realistic to expect a scenario where all social activities require proof of vaccination in addition to $500 cash incentives. A more realistic scenario may include the $300 cash incentive proposed by the Labor government, and perhaps where proof of vaccination is required for interstate and international travel, as well as for major events such as concerts and festivals. In this hypothetical scenario, vaccine uptake is predicted to be 53.48% amongst those who are vaccine hesitant. Other hypothetical policy scenarios can be simulated in the interactive dashboard and the resulting predicted uptake estimated.

 


 

Other findings

The biggest reason for not yet receiving a COVID-19 vaccine was concern around the safety of the vaccine.


Participants who sought information about COVID-19 from official government sources also reported lower vaccine conspiracy beliefs, and those who sourced information from family and friends and social media tended to report higher vaccine conspiracy beliefs.


Responses to the OCEANS Coronavirus Conspiracy Scale (Freeman et al., 2021) showed that just over 40% of the sample agreed with the statement that the COVID-19 virus was manmade.


Participants' attitudes towards the COVID-19 vaccine1, 2 can be viewed in the interactive dashboard by different combinations of personal characteristics such as their age, state, education, language, information sources, voting preferences3 and experience with COVID-19.

Note: It is important to note that this study was conducted with people who were unwilling or undecided about receiving a COVID-19 vaccine and thus represent a portion of the population who are vaccine-hesitant. People who indicated that they were definitely going to receive a vaccine or had already booked an appointment with their healthcare provider were not permitted to take part in the survey. The vast majority of Australians are willing and interested in receiving a COVID-19 vaccine.

 

About CaPPRe

Community and Patient Preference Research (CaPPRe) is an independent group committed to meaningful and high-quality research and consulting. At CaPPRe, we use choice modelling to understand why people make the choices they do and predict the choices they will make in the future. Our business is built around conducting, teaching, sharing, reviewing, and developing all things related to decision-making and preferences. Experience from academia, market research, and industry allows CaPPRe to deliver practical results using cutting-edge experimental design and statistical modelling techniques.

For more info: If you have any questions or would like to understand more about CaPPRe, please contact Dr Simon Fifer at simon.fifer@cappre.com.au.

References:

  1. Shapiro, G. K., Tatar, O., Dube, E., Amsel, R., Knauper, B., Naz, A., Perez, S., & Rosberger, Z. (2018). The vaccine hesitancy scale: Psychometric properties and validation. Vaccine, 36(5), 660-667. https://doi.org/10.1016/j.vaccine.2017.12.043
  2. Freeman, D., Loe, B. S., Chadwick, A., Vaccari, C., Waite, F., Rosebrock, L., Jenner, L., Petit, A., Lewandowsky, S., Vanderslott, S., Innocenti, S., Larkin, M., Giubilini, A., Yu, L.-M., McShane, H., Pollard, A. J., & Lambe, S. (2021). COVID-19 vaccine hesitancy in the UK: The Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychological Medicine, 1-15. https://doi.org/10.1017/S0033291720005188
  3. Edwards, B., Biddle, N., Gray, M., & Sollis, K. (2021). COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population. PLOS ONE, 16(3), e0248892. https://doi.org/10.1371/journal.pone.0248892