Want Canada to Vax to the Max? Think bigger, and smaller, than a vaccine lottery

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The percentage of Canadians who’ve had their first shot of COVID-19 vaccine has rocketed this country to the top of the global charts. Yet even as Canada pivots to focusing on second doses, one-quarter of Canadian adults and teens have still not taken their first shot.

Could a lottery get them to stretch out their arms?

Last month, Ohio decided to try that approach. It’s part populism, part behavioural science.

On May 12, the governor announced that the vaccinated would be entered into a draw, with a US$1-million prize awarded weekly, for five weeks.

The behavioural science insight behind all of this is that the human brain tends to misjudge probabilities. It’s why lotteries, with their poor odds – Ohio’s grand-prize odds are roughly one in a million – are often referred to as a tax on stupidity. Ohio decided to try to harness that stupidity for a good cause, namely boosting the vaccination rate. Several other states followed its lead, as have Manitoba and Alberta.

So how are things working out?

Thanks at least in part to Vax-a-Million, Ohio’s low vaccination rate did rise – but only for a short time.

In the seven days up to and including May 12 – the day the lottery was announced – the state of nearly 12 million people administered fewer than 92,000 first shots, according to our calculations from data on Ohio’s vaccine dashboard. The next week, after the lottery launched, first-shot vaccinations more than doubled.

The following week, however, vaccinations dropped by about a quarter. The next week, they dropped by almost half. The following week, they fell some more; the week after that, they fell sharply again.

And over the five days to June 14, Ohio averaged about half as many first shots as in the five days leading up to the lottery launch.

Ohio, which has now given a first dose to 47 per cent of its population, needed to up its rate by as much as 20 percentage points. Vax-a-Million appears to have delivered a boost of perhaps two percentage points, at most.

So far, Alberta’s lotto results are even less promising. Premier Jason Kenney announced the lottery plan on Saturday; on Sunday, Alberta recorded its lowest number of first shots since February. Monday’s tally was the second lowest since February. Tuesday was even lower.

There are many reasons why a quarter of eligible Canadians are still not vaccinated. The lack of pandemic prizes is likely the least of it.

In the mad dash for jabs, with the race going to those with time on their hands and internet savvy in their pockets, some people are being left behind. In Toronto, the demographic with the highest level of first shots is not the elderly, but those aged 18 to 24. This is crazy. It’s also fixable.

Polling and experience suggest that a big chunk of those who have yet to be vaccinated are not vaccine hostile. They’re just busy, or having trouble figuring out how, when and where to get a shot. They need things to be easier, more convenient and more accessible.

It’s why we’ve repeatedly urged public-health authorities to up their ground game. Mass vaccination sites will reach most of the second-dose masses, but people still lacking a first dose must be reached one-by-one.

Offer more local clinics, more pop-up clinics and more mobile clinics. Reach people through more community and religious institutions. Go to workplaces and schools, and then go back again.

And just as Statistics Canada workers did this spring, to ensure everyone filled out their census, go knock on millions of doors, offering appointments and on-the-spot shots. Some people will be annoyed; many more will be grateful.

As for those who are vaccine hesitant or hostile, public-health authorities have to reach them, too. Listen to their concerns, respectfully, and offer the best answers possible.

In provinces having the most trouble boosting their vaccination rates – Alberta and Saskatchewan – that appears to be part of the challenge. Alberta’s data show several rural areas with very low rates of vaccine uptake; in Mackenzie County, less than 14 per cent of the population has received a shot.

If someone is dead set against vaccination, or deeply suspicious, then lotto tickets are not likely to change their mind. But talking with them, hearing them out and taking their concerns seriously just might.

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