Pay-it-forward intervention increased pneumococcal vaccine uptake among older adults in China

This peer-reviewed journal article, published in BMC Medicine, evaluates the effectiveness and cost-effectiveness of a pay-it-forward intervention to increase uptake of the 23-valent pneumococcal polysaccharide vaccine (PPSV-23) among adults aged 60 years and older in China. The study reports findings from a two-arm parallel randomized controlled trial conducted in community health service centers in Nanning, Guangxi, China, comparing a pay-it-forward model—where participants received a partial vaccine subsidy funded by prior donations and could voluntarily donate for future participants—with standard self-paid vaccination.

Key findings

• The pay-it-forward intervention substantially increased pneumococcal vaccination uptake, with 70.9% coverage in the intervention group compared to 13.5% under standard self-paid care.

• Uptake of influenza vaccination, which was not subsidized, was also higher in the pay-it-forward group (30.0% vs. 17.1%), indicating positive spillover effects.

• Participants in the pay-it-forward arm reported significantly higher confidence in vaccine safety, importance, and effectiveness.

• More than half of participants in the pay-it-forward group voluntarily donated to support future vaccinations, despite modest individual contribution amounts.

• From the provider perspective, the pay-it-forward model resulted in a substantially lower economic cost per person vaccinated (US$95.67) than the standard-of-care approach (US$278.56).

• The intervention was particularly effective among urban residents, higher-income participants, those living with a spouse, and individuals with chronic conditions.

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