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Sunday, May 12, 2024

Wait, Vaccine Lotteries Actually Work?

United Airlines would very much like people to start flying on airplanes again. They stopped during the pandemic—nearly 10 times as many people flew in the United States on Memorial Day weekend in 2019, the Before Times, as on the same three days in 2020. That’s a problem for United, because air travel is, like, United’s whole thing.

That company would also very much like the people who do fly on airplanes to be vaccinated against Covid-19. Not that planes and airports are crucibles of infection! Definitely not, probably. But vaccinations are, let’s agree, a social good. Pretty much everyone wins, except germs.

But United doesn’t want to require vaccination. People get so mad. So earlier this year, corporate bigwigs started brainstorming ideas to encourage people to get vaccinated and also fly United. Their idea: Give everyone who gets their shots a reward. Maybe a few thousand miles’ worth of frequent-flier points? It’s the airline equivalent of a doughnut, or a beer. You can have it, as a treat.

But no. “There were a number of us involved who, I would say, lean heavily from the marketing sciences group within United who said, ‘Actually, that’s not the right path,” says Luc Bondar, the vice president of marketing at United and president of the airline’s frequent-flier program, MileagePlus. “I may have crashed an executive meeting to say that there’s a different way. And out of some healthy discussion, we agreed on an approach that’s very aligned with behavioral science.”

That approach is a big damn lottery. Prove you’re vaccinated and join MileagePlus, and you could win a year of travel for two in first class. Now, you probably won’t win. But still, that’s a high-value target. They have warm nuts. “It was that trade-off. Do we want to give something certain but small,” Bondar says, “versus going out with a sweepstakes?”

Bondar proposed a Willy Wonka-esque golden-ticket experience, “and the fact that you and I are talking, I think, is evidence that we got it right,” he says. In the first 48 hours, United had over 400,000 entrants and more than 100,000 new sign-ups for MileagePlus. While Bondar hasn’t crunched the data yet, he thinks the dates on the vaccine cards the newbies uploaded will show that some significant number got their shots after the prize was announced. It’s a good guess, since lotteries with huge cash prizes have led to similarly huge upticks in vaccination rates in half a dozen states across the US, including Republican-led Ohio, Democrat-led California, and whatever-the-hell-is-happening-in Oregon. (In Ohio, week-on-week vaccinations were declining by 25 percent before Governor Mike DeWine announced that five lucky shot-getters would win $1 million, and teenagers could get full-ride scholarships. The downslope turned into an upslope, to the tune of a 49 percent increase in vaccinations among Ohioans 16 and up.) A few life-changing prizes may turn out to be just the thing to get vaccine-hesitant Americans to roll up their sleeves. That’s just science. Well, economics. But still. It actually works.

Maybe it doesn’t sit well with you, the idea that public health officials (or airlines) are resorting to, let’s be honest, hucksterish means to drive crowds toward a scientifically wondrous shot that prevents a potentially fatal disease. You would think the big prize would be “not dying.”

In fact, that’s just not how people make these kinds of decisions. Some people are highly motivated to get vaccinated. Some people are highly motivated not to. But some folks might just see the whole thing as slightly more inconvenient for them than it is useful for society. As Richard Thaler and Cass Sunstein wrote in their book Nudge—an updated version comes out in August—when people feel that way, getting them to do the thing anyway requires making those things easy. It helps if you also make those things fun. “Lotteries are fun. It’s like a cheap dream,” says Thaler, a Nobel Prize–winning economist at the University of Chicago, when I ask about vaccine lotteries.

Lotteries actually confuse some economists. A hyperrational economist would say that a lottery ticket has an “expected value,” what it’s actually going to be worth, of hardly anything at all, because, let’s face it, you’re almost certainly not going to win. It’s barely worth the paper it’s printed on, in real dollars. But people don’t see it that way. “We know people value them much more highly than their expected value—because people buy them,” Thaler says.

Vaccine lotteries are even stranger, because the only cost to enter is time (since Covid shots are free) and the chance of side effects. Real values and expected values are hard to calculate here. “People in general assign a higher value to these opportunities, the lotto tickets, than the expected value of the lotto ticket,” says Ashby Monk, executive director of the Stanford Global Projects Center and a consultant on the Oregon vaccine lottery. “The probability of winning is very low, so the expected value doesn’t even meet the cost. So if you’re trying to get a huge bang for your buck to motivate people, this is probably a cheaper way.”

But economists who know how to party see lotteries and other inducements in a whole different way. This will sound resoundingly dumb when I say it, but some people need reasons to justify their behaviors and make decisions. That idea is called “reason-based choice.” Vaccines are scarce in most of the world but widely available in the United States. If someone hasn’t gotten one yet, maybe they’re just an anti-vaxxer, in which case, a lottery ain’t gonna help. But different kinds of hesitancy are sensitive to different kinds of interventions. Some people—like in the Black community—have historical reasons to distrust the medical establishment, and that requires a different kind of outreach to fix. And some people, maybe they’re busy, or they procrastinate, or they’re worried about side effects, or they’re anywhere else on the spectrum of hesitancy. Some motivational change might, well, nudge them to get a shot.

So why not just give people a guaranteed reward, instead of one that almost certainly won’t hit? Maybe not a doughnut, but what about, say, $100? That’s a lot.

But it’s not enough. The problem is sort of the inverse of what the economists Uri Gneezy and Aldo Rustichini meant when they wrote the article “A Fine Is a Price.” Their hypothesis says that if you charge people a penalty for bad behavior (for anything from coming late to pick up kids at daycare to, presumably, polluting waterways), that doesn’t deter them—people (and corporations) just factor the fine into their cost of doing business. The flip side is, if you give people a doughnut or $100 or 2,000 frequent-flier miles or a discounted $5 subscription to WIRED, that’s the value they assign to what they’re getting. And if that’s less, to them, than the value of getting vaccinated, it doesn’t work as a nudge. The needling isn’t worth the needle. It’s too low to overcome vaccine hesitancy—in theory.

(This idea is actually hard to study. Thaler says he and Katy Milkman, a behavior researcher at the Wharton School and author of How to Change, once thought about running an experiment to give some people $3 lottery tickets to induce them to get flu vaccines. “It would’ve been a nice thing to have done two years ago,” Thaler says. And proposals to give people $100 to get vaccines have run into trouble with university institutional review boards, the groups that monitor the treatment of human subjects in scientific research. One fundamental ethical tenet is that you’re not supposed to coerce or bribe people to participate.)

But when it comes to Covid vaccines, free beers haven’t moved numbers as well as the irrational but fabulous prizes. “Economists think there’s no such thing as a free beer,” Thaler says. “Real people think free beers are good.” But they think even a scant chance at $1 million is better.

In marketing, this overvaluing of the distant win is called “prospect theory”; in gaming terms, it’s an “extrinsic reward,” something fun or useful that’s not inherent to the act. “A fully rational economist from Chicago can’t figure out why people buy lottery tickets,” Monk says. “It’s the same thing happening here. The expected value that people assign to the potential to win $1 million is far higher than the cost to the state.”

This motivational thinking applies to a lot more than vaccines. Monk, who’s also cofounder of the gamified bank Long Game Savings, says “variable-reward prizes” (that’s lotteries) motivate people to increase their savings and improve their personal finances. In one trial, telling people that enrolling in a savings account also enrolls them in a raffle increased savings account enrollments by 40 percent. And auto-enrollment—opt-out instead of opt-in, as is the case for many of the state vaccine lotteries—has an even bigger effect. If you have to opt out of a retirement savings program, 90 percent of people stay in one. Opt in, it’s 50 percent. (That’s called “status-quo bias.”)

A free ride to a vaccination site, and maybe better websites to sign up? Those all help, too, for sure. Again, different kinds of hesitancy have different solutions. When things are easy, people are more likely to do them. That’s “effort bias.” “Do what it takes to give people no excuse for not doing it, and a justification for doing it—in addition to the obvious one, which is, we don’t want to get sick,” Thaler says.

The wild part here is that giving out a few million-dollar prizes is actually cheaper than, say, giving $50 per vaccinated person. The benefits of the behavior change are enormous, of course—more vaccinated people means fewer people in hospitals and a quicker economic recovery. But even at the dollar-on-dollar level, lotteries cost less and have a bigger impact. Ohio spent about $5.6 million on its “Vax-a-Million” program—5 million-dollar prizes and $600,000 for a bunch of scholarships to teenagers who get vaccinated. The lottery turns out to be a force multiplier. “If you had to buy that time on CNN and ABC and NBC and local stations, what would that cost?” Dan Tierney, press secretary for Ohio governor Mike DeWine, told me just a few minutes before the state announced the first winner last week. “Vax-a-Million has been covered in earned media to the tune of $25.8 million. We couldn’t have bought that amount of publicity with just $5 million.”

The same principle holds at United. MileagePlus points don’t expire—a change Bondar made to the program pre-Covid. That’s good if you want a loyalty program to build actual loyalty. But “we would have been giving out, let’s say, 5,000 miles to every customer, and those miles would have sat out there until the customers used them or they disengaged,” Bondar says. “There’s a cost, a liability associated with that.” It wouldn’t have encouraged people to travel now, and United would have risked the chance of everyone redeeming miles at once—a run on the airline. “The cost of running a sweepstakes versus the potential cost of giving every customer a small, certain prize is different,” Bondar says. A small award to every MileagePlus member versus really big awards to just a few? “The latter approach, from an economic standpoint, is a better outcome.”

United’s also running smaller, regular prizes every day—just as California is both running a lottery and giving away smaller gifts. That makes sure everyone knows someone else is winning, a “regret lottery” to make the impossible dream seem slightly more possible. FOMO is tough to ignore.

If a lottery gets people to get vaccinated, and it’s economical for the institutions running it, that feels like a win-win. For that matter, why not get all lotteried up in here? Attach them as nudges for every dutiful, goody-two-shoes societal need. Governments, agencies, and companies could set up opt-out, million-dollar lotteries for voting, or getting an annual physical, or buying earthquake insurance. (Actually, wait, buying insurance is already kind of a lottery, except if you lose, you win. But still.)

Except the idea of nudging people to do something they might not have otherwise done is still ethically fraught—even more so when you do it via the otherwise joyful mechanisms of games. “That’s why a lot of people don’t trust government and science, because they feel they’re being manipulated all the time,” says Celia Hodent, a psychologist and game-user-experience strategist. Cultural values are at work here. A nudge can be benevolent, or it can be part of a “dark pattern,” exploiting attention and habit to change behaviors online. “A chance to win something that’s valuable—we know that it works, but ethically it’s debatable,” Hodent says. “It’d be easier if, like, you go somewhere and, hey, you can get the jab if you want.” Do it in shopping malls. Drive an ice cream truck around, but it’s vaccine shots. That’d be a less complicated, make-it-easy type nudge.

That concern is legitimate, but it’s a far cry from the argument that people used to have about the usefulness of massive but basically unwinnable prizes. Now they seem like a bipartisan solution to getting people vaccinated. While Ohio was first out of the gate with a lottery, at the same time, state Republicans like Governor DeWine are also trying to pass a law abolishing vaccine requirements in places like nursing homes and schools. Clearly inducements are more popular than mandates. Lotteries might seem messy, irrational, or of dubious moral character—but at this point, as the saying goes, they seem worth a shot.

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