| Krispy Kreme and the governor of West Virginia have one thing in common: They're both trying to persuade unvaccinated people to get inoculated against Covid-19 by offering something in return. (Glazed donuts and $100 savings bonds, respectively.) While more than half of U.S. adults have now received at least one vaccine dose, a new poll shows that only 9% who haven't yet been inoculated planned to do so. Finding out what would motivate those fence-sitters to change their minds has become an urgent task. Tangible perks, like food, beer, and gift cards, appear to be the new frontier. The question is, for those who are vaccine-hesitant, how much do such freebies change their calculus, and which kinds work best? Deploying economic nudges to influence public health behavior isn't new. One 2015 trial analyzed how people's behavior might change if they got money to lower their cholesterol, or how doctors' guidance might change if they were compensated based on their patients' cholesterol levels. It showed significant health benefits when both patient and doctor were paid. Cash payments have also been used to encourage HIV prevention through consistent testing and treatment among at-risk populations, with more mixed results.  f you're reluctant to get a shot, would a free beer change your mind? How about $50? Photographer: Genaro Molina/Los Angeles Times So far, research on how cash influences people's Covid-19 vaccine uptake has shown some promise. This month, results from a randomized survey conducted by the UCLA Covid-19 Health and Politics Project found that a third of unvaccinated respondents said that they'd be more likely to get a shot if they were given $100; a little less than a third would be more likely to get one for $50, or even $25. The $100 financial incentive had a greater impact on Democrats than Republicans.
But there are potential drawbacks to such initiatives, researchers say. For those already nervous about vaccine side effects or safety, payments could make the shot seem more risky. And introducing financial motivations could erode one of the clearest, most fundamental arguments for vaccination—that personal immunity benefits the collective good—in favor of a more selfish perk. Nancy Jecker, a professor of bioethics at the University of Washington School of Medicine, is concerned that the practice may also have an outsized coercive effect on lower-income groups and reinforce societal inequities. But based on one recent natural experiment at a bar in Buffalo, New York, which saw more than 100 people arrive to get their first vaccine dose after it offered them a free drink, the perks are worth a shot.—Sarah Holder | 
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