Cash for COVID-19 Vaccines in Africa: A Financial Incentives Trial in Rural Ghana (preprint)

We implemented a clustered randomized controlled trial with 7,227 residents in six rural Ghana Districts to determine whether financial incentives produce substantial increases in COVID-19 vaccine uptake. Villages were randomly assigned to receive one of four video treatment arms: a placebo, a standard health message, a high cash incentive ($10) and a low cash incentive ($3). Non-vaccinated subjects, assigned to the Cash incentive treatments had an average COVID-19 vaccine intention rate of 81% compared to the 71% for those in the Placebo treatment arm. Two months after the initial intervention the average self-reported vaccination rates for subjects in the Cash treatment were 3.5% higher than those for subjects in the Placebo treatment (95% CI: 0.001, 6.9; P < 0.03) - 40% versus 36.5%. We verified the 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 Placebo - a difference of 6.3% (95% CI: 2.4, 10.2; P < 0.0001). For all three outcomes, the low cash incentive ($3.00) had a larger positive effect on COVID-19 vaccine uptake than the high cash incentive ($10.00). There is no evidence of spillover effects of the financial incentives that depress the vaccine uptake of subjects in non-financial treatment arms nor of non-treated proximate residents.

Impact of the COVID-19 pandemic on community antibiotic prescribing and stewardship: a qualitative interview study with general practitioners in England (preprint)

The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners (GPs) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations), and the changing patient presentations and GP workload as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. While the pandemic disrupted the usual ways of working, it also produced opportunities, e.g., for re-organising ways of managing infections and AMS in the future.

Cash versus Lotteries: COVID-19 Vaccine Incentives Experiment (preprint)

Governments are considering financial incentives to increase vaccine uptake to end the COVID-19 pandemic. Incentives being offered include cash-equivalents such as vouchers or being entered into lotteries. Our experiment involved random assignment of 1,628 unvaccinated participants in the United States to one of three 45 second informational videos promoting vaccination with messages about: (a) health benefits of COVID-19 vaccines (control); (b) being entered into lotteries; or (c) receiving cash equivalent vouchers. After seeing the control health information video, 16% of individuals wanted information on where to get vaccinated. This compared with 14% of those assigned to the lottery video (odds ratio of 0.82 relative to control: 95% credible interval 0.57-1.17) and 22% of those assigned to the cash voucher video (odds ratio of 1.53 relative to control: 95% credible interval 1.11-2.11). These results support greater use of cash vouchers to promote COVID-19 vaccine uptake and do not support the use of lottery incentives.