Donuts, drugs, booze, and guns: what governments are offering people to take covid-19 vaccines (BMJ 2021;374:n1737)

Summary

A BMJ feature by Serena Tinari and Catherine Riva, reporting from Bern, Switzerland, published 13 July 2021 and cited as BMJ 2021;374:n1737, on what governments are offering people to take covid-19 vaccines. It describes Ohio's state-funded Vax a Million campaign, five weekly lottery drawings giving those taking their shots the chance to win a million dollars, with a draw for five four-year university scholarships for Ohioans aged 12 to 17, and lists incentives from cash and donuts to hunting licences. It quotes Ross D Silverman, a health policy expert at Indiana University, that incentives focus on individual awards rather than community-level benefits, and cites a Kaiser Family Foundation survey finding nearly four in 10 adults in the wait and see group plan to wait more than a year before getting vaccinated. References close the piece.

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“Donuts, drugs, booze, and guns: what governments are offering people to take covid-19 vaccines (BMJ 2021;374:n1737).” Original at bmj.com. Archived at Pandemic Darlings on 2026-06-25, https://pandemicdarlings.com/source-documents/donuts-drugs-booze-and-guns-what-governments-are-offering-people-to-ta-4b71828509/, SHA-256 667e590eaff01cc8806b64daca1c358c1a4e0d7d6af2e2b05d1348f35e9551ab.

Full text

FEATURE

Bern, Switzerland
VACCINATION

BMJ: first published as 10.1136/bmj.n1737 on 13 July 2021. Downloaded from http://www.bmj.com/ on 19 January 2024 by guest. Protected by copyright.
serena.tinari@re-check.ch
catherine.riva@re-check.ch
Cite this as: BMJ 2021;374:n1737 Donuts, drugs, booze, and guns: what governments are offering people
http://dx.doi.org/10.1136/bmj.n1737
Published: 13 July 2021
to take covid-19 vaccines
As the race to vaccinate the world accelerates, some countries are using novel methods to persuade
those who are less forthcoming. Serena Tinari and Catherine Riva report
Serena Tinari, Catherine Riva
In Ohio, you could get a covid-19 vaccine … and the Foundation15 survey found nearly four in 10 adults
chance to win a million dollars. “Vax a Million,” a in the “wait and see” group plan to wait more than
state funded public outreach campaign, consisted of a year before getting vaccinated).
a five weekly lottery drawing for those taking their
Ross D Silverman, a health policy expert at Indiana
covid-19 shots. For Ohioans aged 12 to 17, there was
University, said that incentives “focus on individual
a draw for five four-year university scholarships.1
awards, rather than, say, offering a benefit should
Cash, donuts, fishing and hunting licences, entry to 85% of a community choose to get vaccinated.” He
museums, zoos, concerts or a sports game: these are is concerned that they signify the limited success of
just some of the offerings to people if they take a common good-based public health messaging and
covid-19 jab in the US.2 “Get a shot and have a beer,” are at risk of drawing public resources away from
teetotaller President Joe Biden had said,3 which New addressing underlying structural barriers in vaccine
Jersey took literally with its “Shot and a Beer” outreach programmes. “I’d rather government
campaign.4 Others go further: Washington state offers agencies not use incentives like guns, alcohol, and
“Joints for Jabs”5 and Michigan, “Pot for Shots.”6 In cannabis for these programmes,” he told The BMJ.
West Virginia, the “Call to Arms” vaccine initiative
Allyson Pollock, who directs Newcastle University’s
will be paid for using federal pandemic relief funds.
Centre for Excellence in Regulatory Science, agrees.
It promises to the vaccinated cash, trucks, and guns.7
“These programmes are the antithesis of good public
And it’s not just the US. In Canada, children as young health practice and are grounded in commercial
as 12 have been offered ice cream for vaccines.8 The interests, not public health,” she says. “Vaccination
Netherlands has one place offering soused herrings.9 policies should be built on information, trust, and
In Chang Mai, Thailand, you might win a cow.10 Hong consent and not coercion and bribes. The policies of
Kong has gold bars and a Tesla on offer.11 In Romania, these incentives are adding public health harms as
the Dracula castle has been transformed into a fancy incentives for vaccine uptake.”
vaccination centre to attract people.12 Some have
In the US in particular, Pollock worries about the lack
turned instead to disincentives not to vaccinate (box).
of universal health insurance and high costs of care.
As coronavirus variants dominate the news, and some “What are the safeguards for people who suffer
batches of vaccine approaching expiry dates, health adverse health events as a result of vaccination and
officials appear to be doing whatever it takes to get have no insurance cover?”
vaccination levels up, particularly in the face of
vaccine hesitancy. But Ana Santos Rutschman, a legal Unintended consequences
scholar at Saint Louis University School of Law, has Ana Santos Rutschman says small tokens like donuts
serious concerns about the trend, particularly where or beer “do not strike me as posing the same type of
cash is concerned. ethical problems as direct payments” and that raffles
and lotteries—being unpredictable and with low odds
Rutschman argues that paying people “is undesirable
of winning—are in her view preferable to cash prizes.
against the backdrop of a pandemic marked by the
intertwined phenomena of health misinformation But others say incentives of any kind could still
and mistrust in public health authorities. Even selectively pressure people of lower socioeconomic
beyond the context of covid-19, paying for vaccination status over others. Goldenberg asked: “What do those
is a dubious public health policy likely to backfire in who don’t win the lottery get? They are vaccinated
terms of (re)building public trust in vaccines.”13 (a benefit), but if they feel mistreated because they
were compelled to do it (ie, because the unjust system
Trust and mistrust makes college out of reach for many), then there is
Maya J Goldenberg, a philosopher of medicine who legitimate moral harm.”
has published a book on the complexity of vaccine
Poorly designed incentives may ultimately backfire.
hesitancy,14 says incentives fail to address the
Research conducted by behavioural economist George
underlying problem. “Incentive programmes do not
Loewenstein has shown that people believe a study’s
target the trust relationship between the public and
riskiness to be greater when payment is higher.16 In
the providers,” Goldenberg told The BMJ. “They are
a recent article in the New York Times, Loewenstein
meant to gently steer the ‘fence sitters’ in favour of
and a colleague write: “Humans don’t respond to
the desired behaviour” (a recent Kaiser Family

the bmj | BMJ 2021;374:n1737 | doi: 10.1136/bmj.n1737 1
FEATURE

incentives like rats pressing levers for food; they try to interpret
16 Ariely D, Loewenstein G, Prelec D. Tom Sawyer and the construction of value. J Econ Behav
what being offered payment means. In this case, the offer risks Organ 2006;60:1-10. doi: 10.1016/j.jebo.2004.10.003. https://www.sciencedirect.com/science/ar-
implying that the vaccine is not a thing of value.”17

BMJ: first published as 10.1136/bmj.n1737 on 13 July 2021. Downloaded from http://www.bmj.com/ on 19 January 2024 by guest. Protected by copyright.
ticle/abs/pii/S0167268105001265?casa_token=kkZ0VCxC9D8AAAAA:TcJkxrT-ESePbgX0Ry-
WD9yr18ZKAPR-7xQ5GjB5eiLiocXlk9WwyZniq2y-r1GglNaRjoqz
Disincentives 17 Loewenstein G, Cryder C. Why paying people to be vaccinated could backfire. New York Times
2020. https://www.nytimes.com/2020/12/14/upshot/covid-vaccine-payment.html
While rewards dominate, some locales have turned to retribution. In the 18 Ranada P. Duterte threatens to arrest people who refuse getting vaccinated. Rappler 2021.
Philippines, President Rodrigo Duterte has stated: “Get vaccinated or I’ll https://www.rappler.com/nation/duterte-order-arrest-people-who-refuse-to-get-vaccinated
jail you.”18 And while Serbia is offering the vaccinated €25 (£21, $29) 19 Holt E. Serbia begins paying citizens to receive a COVID-19 vaccine. Lancet 2021;397:1793.
(around 1.5 days’ earnings for the average worker),19 its president 20 Serbia in ‘world first’ as citizens offered €25 to have COVID vaccine. Euronews 2021.
announced that unvaccinated public sector employees would no longer https://www.euronews.com/2021/05/05/serbia-in-world-first-as-citizens-offered-25-to-have-
covid-vaccine
be eligible for sick pay if they contracted covid-19.20
21 Stokel-Walker C. Covid-19: The countries that have mandatory vaccination for health workers.
Various governments and businesses are considering the case for BMJ 2021;373.n1645.
employees—health workers in particular.21 In Moscow, two million people 22 Doshi P. Covid-19 vaccines: In the rush for regulatory approval, do we need more data?BMJ
in public-facing jobs have been told they must be vaccinated by the city’s 2021;373:n1244.
mayor. Businesses will be monitored to make sure they comply, with at
least 60% of employees needing a first dose by 15 July or firms risking
being fined. In May, Saudi Arabia’s government said employees in the
public, private, and non-profit sectors must be vaccinated before they
can return to work. And the city of San Francisco has announced a similar
requirement for its 35 000 public employees, to take effect once the
covid-19 vaccines are approved.22

Competing interests: Serena Tinari and Catherine Riva are the co-founders and co-chairs of Re-Check,
Investigating and Mapping Health Affairs.

Provenance and peer review: Commissioned; not externally peer reviewed.

1 DeWine M. Don’t roll your eyes at Ohio’s vaccine lottery. New York Times 2021.
https://www.nytimes.com/2021/05/26/opinion/ohio-vaccine-lottery-mike-dewine.html?ac-
tion=click&module=Opinion&pgtype=Homepage
2 National Governors Association. COVID-19 vaccine incentives. 2021. https://www.nga.org/cen-
ter/publications/covid-19-vaccine-incentives/
3 Miller Z. Free beer, other new incentives for Biden’s ‘vaccine sprint.’ Associated Press News 2021.
https://apnews.com/article/coronavirus-pandemic-business-government-and-politics-health-
8168ae1c68ca955b620082d862c911ad
4 New Jersey COVID-19 Information Hub. What is the New Jersey “Shot and a Beer” program?
What breweries are participating? 2021. https://covid19.nj.gov/faqs/nj-information/slowing-the-
spread/what-is-the-new-jersey-%E2%80%9Cshot-and-a-beer%E2%80%9D-program-what-
breweries-are-participating
5 State W. Liquor and Cannabis Board media release: LCB allows “Joints for Jabs” promotions to
support vaccinations. 2021. https://content.govdelivery.com/accounts/WALCB/bulletins/2e303d6
6 The Greenhouse of Walled Lake. The Greenhouse of Walled Lake “Pot for Shots” sponsored by
UBaked. Press Release. 2021. https://www.greenhousemi.com/pot-for-shots
7 State of West Virginia. COVID-19 UPDATE: Gov. Justice announces big cash, trucks, and
scholarships among top prizes in upcoming vaccination incentive lottery. 2021. https://gover-
nor.wv.gov/News/press-releases/2021/Pages/COVID-19-UPDATE-Gov.-Justice-announces-big-
cash,-trucks,-and-scholarships-among-top-prizes-in-upcoming-vaccination-lottery.aspx
8 Draaisma M. Over 2500 doses of COVID-19 vaccine issued at pop-up clinic held at Toronto city
hall. CBC 2021. https://www.cbc.ca/news/canada/toronto/toronto-covid-19-vaccine-clinic-city-
hall-rotunda-1.6038133
9 Henley J. Netherlands offers free herring as Covid jab incentive. Guardian 2021.
https://www.theguardian.com/world/2021/jun/17/netherlands-offers-free-pickled-herring-as-
covid-jab-incentive
10 Thepgumpanat P. Cattle for raffle gets Thai town in mood for vaccines. Reuters 2021.
https://www.reuters.com/world/asia-pacific/thai-town-offers-free-cows-boost-vaccine-campaign-
2021-05-20/
11 Tam F. Tesla, gold bars added to Hong Kong’s $15 million vaccine incentive prizes. Bloomberg
2021. https://www.bloomberg.com/news/articles/2021-06-09/tesla-gold-bars-added-to-hong-
kong-s-15-million-vaccine-prizes
12 Ilie L. Dracula’s castle lures visitors with COVID-19 jabs. Reuters 2021.
https://www.reuters.com/world/europe/vlad-vaccinator-draculas-castle-lures-visitors-with-covid-
19-jabs-2021-05-08/
13 Santos Rutschman A. Why the government shouldn’t pay people to get vaccinated against
COVID-19. Bill of Health, Petrie-Flom Center at Harvard Law School 2020.
https://blog.petrieflom.law.harvard.edu/2020/12/01/payment-covid-vaccine-incentive/
14 Goldenberg MJ. Vaccine hesitancy: public trust, expertise, and the war on science. University of
Pittsburgh Press, 2021. https://www.bibliovault.org/BV.book.epl?ISBN=9780822946557
15 KFF. COVID-19 vaccine monitor: June 2021. https://www.kff.org/coronavirus-covid-19/poll-find-
ing/kff-covid-19-vaccine-monitor-june-2021/

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