Cash for COVID-19 Vaccines in Africa: A Financial Incentives Clustered Randomized Trial in Rural Ghana

We implemented a clustered randomized controlled trial with 6,963 residents in six rural Ghana Districts confirming that financial incentives increased COVID-19 vaccine uptake.  Villages randomly received one of four video treatment arms:  a placebo, a standard health message, a high cash incentive ($10) and a low cash incentive ($3).  For one primary outcome, COVID-19 vaccination intentions, non-vaccinated subjects assigned to the Cash incentive treatments had an average rate of 81% compared to 71% for those in the Placebo treatment arm.  For the second primary outcome, self-reported vaccinations two months after the initial intervention, the average rate for subjects in the Cash treatment was 3.5% higher than for subjects in the Placebo treatment (95% CI: 0.001, 6.9; P = .045) - 40% versus 36.5%.  A third primary outcome is the verified vaccination status of subjects:  in the Cash treatment arm, 36.6% of verified subjects had at least one dose of the COVID-19 vaccine compared to 30.3% for those in the Placebo - a difference of 6.3% (95% CI: 2.4, 10.2; P = .001). For all three primary outcomes, the low cash incentive ($3.00) had a larger positive effect on COVID-19 vaccine uptake than the high cash incentive ($10.00).  

Raymond Duch is the co-founder and Director of the Centre for Experimental Social Sciences (CESS) at Nuffield College University of Oxford. He established and directed similar CESS centers in Chile, China, and India. He is also co-Director of the Candour Project that assembles a global team of research scholars with expertise in behavioral economics and data analytics addressing challenging health policy issues. His research focuses on the application of experimental methods to understanding individual decision making related to politics, finance, health, and economics. His publications have appeared in leading social science journals including, American Political Science Review, Proceedings of the National Academy of Sciences, Journal of Economic Behavior and Organization, American Journal of Political Science, Political Analysis, Applied Economics, Journal of Politics, and Nature Medicine. Ray Duch has held visiting appointments at IAST-Toulouse School of Economics, Stanford Graduate School of Business, WZB-Berlin, Université de Montréal, and Pompeo- Fabra University , Barcelona. His research is funded by leading social science funding agencies including the NSF, ESRC, FONDECYT, and SSHRC. He frequently advises governments, international organizations, law firms and corporations.

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