A World Bank working paper presents surprising evidence that monetary incentives can reduce—rather than increase—COVID-19 vaccination intentions in some settings. Conducted in Kazakhstan, Uzbekistan, and Tajikistan, the study used nationally representative, randomized controlled surveys to evaluate the effects of offering hypothetical cash payments in exchange for vaccination. Contrary to common expectations and prior evidence from other regions, incentive offers reduced vaccination intentions by up to 22% in Kazakhstan and Uzbekistan. Only in Tajikistan was no statistically significant effect found. Follow-up questions revealed that most respondents in the countries where incentives backfired also disapproved of the idea of being paid to vaccinate.
The study cautions against assuming universal effectiveness of financial incentives in driving vaccination uptake. The authors suggest that in some contexts, cash payments may unintentionally signal that the vaccine is undesirable, triggering skepticism and lower willingness to vaccinate. The results underscore the importance of pre-testing behavior change strategies and tailoring interventions to local perceptions and trust environments. With many governments exploring incentive-based programs to boost immunization, these findings provide critical insights into the nuanced and context-specific nature of public response to extrinsic motivators.
Thumbnail image credit: The World Bank
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