Financial incentives for COVID-19 vaccination are effective, finds evaluation of NC program by NCDHHS, NCCU and UNC-Chapel Hill

October 25, 2021

The $25 Summer Card pilot program operated by North Carolina Department of Health and Human Services (NCDHHS) was successful in encouraging COVID-19 vaccination, according to a published research letter by authors from NCDHHS, the Advanced Center for COVID-19 Related Disparities (ACCORD) at the Julius L. Chambers Biomedical Biotechnology Research Institute at North Carolina Central University (NCCU), and the Department of Biostatistics and Department of Health Behavior at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill (UNC-Chapel Hill).

A research letter published in JAMA Internal Medicine highlights the effectiveness of the $25 Summer Card program. The letter is one of the first to provide data on guaranteed financial incentives for COVID-19 vaccination.

Dr. Noel Brewer

Dr. Noel Brewer

“Within a week, this well-designed incentive program halved the drop in COVID-19 vaccination that North Carolina was experiencing,” said Noel T. Brewer, PhD, Gillings Distinguished Professor in Public Health at the UNC-Chapel Hill Gillings School. “Using guaranteed cash incentives is a best practice, recommended by the CDC. It builds on 70 years of psychological research showing that rewards are most effective when delivered immediately after the behavior.”

During the one-week review period, COVID-19 vaccinations decreased by just 26% in clinics offering the $25 cards, but declined by 51% elsewhere in the four counties where the program was tested. During the same period, vaccination decreased statewide by 49%.

The incentive program study guaranteed a $25 card to adults who either received their first dose of COVID-19 vaccine at, or drove someone to, participating providers in four North Carolina counties. The pilot program distributed 2,890 cards to vaccine recipients and 1,374 to drivers. The $25 Summer Card program switched to providing $100 cards after this evaluation was conducted, meaning data on the $100 Summer Card program are not included in the authors’ review.

“Providing guaranteed small financial incentives is a promising strategy to increase COVID-19 vaccination uptake,” said Charlene Wong, MD, NCDHHS chief health policy officer for COVID-19. “The design of our $25 incentive pilot program in North Carolina helped alleviate transportation and other cost barriers to vaccination, particularly for low-income, Latinx and Black individuals.”

“North Carolina Central University was pleased to be a key partner in North Carolina’s effort to increase COVID-19 vaccination rates through incentive vaccination clinics,” said William Pilkington, DPA, MPA, MA, H.O.P.E. co-program director at NCCU. “The university’s staff developed and administered surveys at the clinics that produced results clearly demonstrating the value of incentives to promote more equitable distribution of the COVID-19 vaccinations.”

Of 401 vaccine recipients surveyed, 41% reported the $25 card was an important reason why they decided to get vaccinated. The cards were more important to respondents who were not white as well as respondents with lower incomes.

Additionally, “someone driving me here today” was an important reason for 49% of respondents — more commonly among Black, Hispanic and respondents with lower incomes. Lower-income and older individuals, especially, were more likely to have been brought by a driver who received a cash card.

The letter on the study findings is titled “Guaranteed financial incentives for COVID-19 vaccination: A pilot program in North Carolina, US” and was co-authored by Wong; Pilkington; Brewer; Ziliang Zhu (UNC-Chapel Hill); Irene A. Doherty, PhD (NCCU); Hattie Gawande (NCDHHS); and Deepak Kumar, PhD (NCCU). NCDHHS provided vaccine data and funding for the program; UNC-Chapel Hill analyzed the vaccine data; and NCCU conducted surveys and survey analyses.

All research articles published in JAMA Internal Medicine are made available via free public access for 12 months after publication at

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