COVID-19 vaccination mandates and requirements can be effective in increasing vaccination rates, but their success depends on being targeted and on building trust, says a new rapid expert consultation from the National Academies of Sciences, Engineering, and Medicine. Offering incentives for vaccination — such as cash payments or entry into a prize lottery — may be able to increase booster rates, but it also carries risks.

Before implementing COVID-19 vaccine requirements, the consultation says, it is best for vaccination requirement programs to ensure that: they have already transparently communicated information about vaccine safety; other strategies have not worked; barriers to accessing vaccines have been removed; and voluntary uptake of the vaccines has not reached sufficient levels.

Vaccine requirements are more effective when they strike a balance between excessive leniency, which allows people to exempt themselves easily, and excessive strictness, which does not allow any exemptions. The relationship between the forcefulness of a vaccine mandate policy and the rate of vaccination is not linear, and excessive strictness risks promoting anti-vaccination sentiments.

The consultation says targeted requirements that focus on specific subpopulations — such as school or employer mandates — are more likely to succeed, as they are easier to implement and enforce.

The consultation also outlines considerations for using incentives to promote COVID-19 boosters:

• Incentives provided right after vaccination, such as gift cards distributed at the vaccination site, are more likely to be effective than those given later.
• The more valuable the incentive is to the recipient, the more impact it will have. Cash payments, for example, can be more effective than coupons or vouchers because cash can be used toward whatever a person values most.
• Target populations need to be aware of the availability of incentives. Targeted marketing through ads and media coverage are important, and wider advertising can help set vaccination as the social norm.
• Incentive programs need to be designed to not disadvantage any vulnerable group, and to help advance health equity.
• The decision to use a financial incentive for COVID-19 vaccination programs needs to weigh cost-effectiveness and the availability of other, more cost-effective strategies.

DETAILS: Increasing Uptake of COVID-19 Vaccination through Requirement and Incentive Programs is available for immediate release. Media inquiries should be directed to the National Academies’ Office of News and Public Information; tel. 202-334-2138 or e-mail news@nas.edu.