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At this time last year, Wynfred Russell strongly believed in offering incentives to marginalized communities as encouragement to take the COVID-19 vaccine.
Today, one year into the vaccine rollout, he’s less enthusiastic about this strategy.
“I’m conflicted because of what I’ve seen,” said Russell, who works as the director of health equity for African Career, Education and Resources (ACER) and serves as a city council member in Brooklyn Park. “The incentive has become a double-edged sword.”
Vaccine incentives are essentially monetary rewards or perks meant to nudge hold-outs to get the shots. They’ve worked successfully to boost vaccination numbers against other diseases, such as polio shots for children in Ghana, according to a peer-reviewed scientific study published earlier this year. This past summer, the federal government and states across the country decided to use this approach to curb COVID-19.
Minnesota started offering COVID-19 vaccine incentives last May, as the number of people getting their first shots began to drop. During the month of June, the Minnesota Department of Health offered unvaccinated people $25 Visa gift cards or free fishing licenses, state parks passes, or State Fair tickets. Once August rolled around, the incentive increased to $100 gift cards.
As the fall Delta wave led to a resurgence of new infections, Governor Tim Walz went further by offering $200 gift cards to children aged 12–17. The state also gave families the chance to enter kids into a lottery for five $100,000 college scholarships.
Currently, the state runs a lottery for $200 flight vouchers for people who get vaccinated at the Minneapolis–St. Paul International Airport. The state also provides $100 on-site incentives at community vaccine events and community health clinics aimed at underserved populations, including for booster shots.
But as of this writing, roughly 1.5 million eligible Minnesotans remain unvaccinated. The Delta wave continues to hammer the state and hospitals continue to be overrun with patients—most unvaccinated—suffering from the virus.
Just over 100,000 of the roughly 3.7 million Minnesotans who have received at least one dose of a COVID-19 vaccine collected incentives this year, according to MDH. Sahan Journal reached out to experts who work on vaccine equity, and heard mixed reviews for how incentives have been working.
On the plus side, practitioners and health officials say incentives have led to more Minnesotans getting vaccinated over the past several months. At the same time, a large segment of the population remains skeptical about the vaccine, and the idea of incentives only adds to their skepticism.
“I give it a net positive, with an asterisk,” said Teto Wilson, who runs Wilson’s Image Barbers & Stylists in the Jordan neighborhood of north Minneapolis. Wilson’s business holds weekly community vaccine events, which has given him the opportunity to hear from countless customers.
“If people don’t believe in the vaccine, but they’re willing to do it for $50, then that speaks to a whole set of problems that need to be addressed,” Wilson said.
State officials are signaling incentives for the COVID-19 vaccines will carry on into 2022.
“We are continuing to identify other opportunities to encourage Minnesotans to get their vaccine and to thank them for doing so,” said Erin McHenry, a spokesperson for the Minnesota Department of Health.
Convincing skeptics incentives are not bribes
The state paid for the incentives throughout 2021 mostly with federal coronavirus relief money. The state tapped at $16.3 million in federal relief funds during the summer, and another $12.2 million in federal money for the “Kids Deserve a Shot” campaign during the fall.
To pay for the on-site incentives at community vaccine events and community health clinics, the state used $4 million of this federal COVID-19 stimulus money and $400,000 from private foundations.
Years before the COVID-19 pandemic, Russell managed a polio vaccination drive in Nigeria for the Bill and Melinda Gates Foundation, which administered 3 million shots. He credited the sharing of free supplies like groceries and medicine as a key to that program’s success.
But to him, COVID-19 vaccine incentives seem more complex. “There are folks who say, ‘If it is so safe and sound, why are you bribing us to take the vaccine?’” Russell said. “That’s caused a lot of people to pause.”
This dynamic can be especially true in communities of color, said Dr. Sean Ennevor, a retired pediatric anesthesiologist.
“Some people are quite offended by the incentive, particularly when it’s targeted to underserved communities,” Ennevor said. “Like, ‘Why is this necessary?’”
This puts people like Russell and Ennevor, who are both Black and have worked all year at community vaccine events, in the position of convincing some people that the incentives are not bribes.
When he gets questions like these, Ennevor said he answers that the decision came from politicians and policymakers who decided incentives would be an effective way to attract more people to the shots. They did not necessarily come from the recommendations of scientists or health experts, he will add.
A high fade with a shot on the side
Since the summer, Wilson’s Image has been holding weekly vaccine events through a partnership with the state department of health and several other health organizations. In that time, Wilson estimates between 600 to 1,000 people got vaccinated in his barbershop.
On a recent Friday morning, as a winter storm loomed, a handful of people trickled into Wilson’s barbershop. Donny Hathaway’s “This Christmas” played in the background as a crew of health professionals occupied tables where customers could register for the shot. Ennevor handled the shot supplies, while a nurse took people into a backroom for their vaccination.
Getting the shots out into the community was especially important for Lily Thomas, a registered nurse helping with the event. Thomas works in a Twin Cities area hospital—she didn’t want to name which one. As of that week, 89 people at the facility were hospitalized with COVID-19. Out of the 89, Thomas said, three were vaccinated.
“We’re at capacity,” she said.
In terms of whether incentives work at getting more people vaccinated, Thomas said she often comes across three types of people. First, the people who are already hesitant can become more skeptical.
“I hear that from the community, ‘Why are they giving us money to get the vaccine?’” Thomas said.
“Then you have some that say, ‘OK, they’re giving it, I’ll go get the vaccine.’ And then you have some who say, ‘I don’t care what y’all do, I’m not getting it.’”
Mandez Ransom, one of the master barbers at Wilson’s Image, said incentives seem to work best on people who are just dropping by the barbershop. Dragging an e-cigarette on a short break outside, Ransom, a burly man with long dreadlocks, described a typical conversation:
“Do you want a vaccine?”
“I’m not sure.”
“OK, well, here are all of the health benefits, and on top of that you’ll get $50.”
“Fifty dollars? OK.”
‘Plenty of friends got the virus and turned out fine’
Ransom himself felt skeptical about the vaccine for months after the shot became widely available to the public. He feels like he’s got a good immune system: Ransom doesn’t often get sick, and when he does, he likes treating himself with home remedies. Plenty of friends got the virus and turned out fine, he added.
“Besides that, it’s just the fact that people of color, we just don’t have that trust there for vaccines and healthcare,” he said.
Incentives didn’t change his mind on getting the shot. Instead, that mostly came from his mother, who works in healthcare and consistently urged Ransom to get vaccinated.
“After a while, with the spread and all of these variants, I felt I’d just rather not risk it,” he said.
Ransom got his first shot in August.
Wilson said the community familiarity of his barbershop can provide a setting for similar conversations to happen—which he attributed as the biggest factor behind the hundreds of vaccinations administered at his business.
“We’re an African American barbershop,” he said. “The nurses and the doctors administering the shots are African American, as well. So there’s a bit of a comfort level there.”
On this day, most people getting vaccinated at Wilson’s Image were coming in for their boosters. Among them was Matthew Urban, who lives in the neighborhood and has been getting his hair cut here for a decade. He opted to donate his $50 incentive, feeling that it would better go to people who needed it.
“That’s the way it should be,” Urban said.