Financial Incentives and Other Nudges Do Not Increase Covid-19 Vaccinations Among the Vaccine Hesitant

Can financial incentives, public health messages and other behavioral nudges –approaches deployed by state and local governments, employers, and health systems – increase SARS-CoV-2 vaccination rates among the vaccine hesitant in the US? In mid-2021, we randomly assigned unvaccinated members of a Medicaid managed care health plan to $10 or $50 financial incentives, different public health messages, a simple appointment scheduler, or control to assess impacts on SARS-CoV-2 vaccination intentions and vaccine uptake within 30 days of intervention. While messages increased vaccination intentions, none of the treatments increased overall vaccination rates. Consistent with backlash concerns, financial incentives and negative messages decreased vaccination rates for some subgroups. Financial incentives and other behavioral nudges do not meaningfully increase SARS-CoV-2 vaccination rates amongst the vaccine hesitant