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

Cash for COVID-19 Vaccines in Africa: A Financial Incentives Trial in Rural Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Cash for COVID-19 Vaccines in Africa: A Financial Incentives Trial in Rural Ghana Raymond Duch, Edward Asiedu, Ryota Nakamura, Thomas Rouyard, Alberto Mayol, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2845647/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Nov, 2023 Read the published version in Nature Medicine → Version 1 posted You are reading this latest preprint version Abstract 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. Scientific community and society/Social sciences Health sciences/Diseases/Infectious diseases Full Text Additional Declarations There is NO Competing Interest. Supplementary Files statementinclusion27423.docx Inclusion and ethics PAPGhanaVaccinationIncentivesIII.pdf Protocol CONSORT2010ChecklistDuch.pdf CONSORT Checklist flatDuchepc.pdf Editorial Policy Checklist flatDuchrs.pdf Reporting Summary Cite Share Download PDF Status: Published Journal Publication published 27 Nov, 2023 Read the published version in Nature Medicine → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2845647","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":196583461,"identity":"f2c79b21-69f3-4663-9a37-8787944e7fc1","order_by":0,"name":"Raymond Duch","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABIklEQVRIie2RP0vDQBiHf+EgcXjtrReUfoZAMEVS8atYAsmSruIkgnAuiquFfggn6ZhyoEs+QIpLRMiUIR3dzHUoxcQ/o8M9w/Hy3j383pcDDIb/CwMy2GgA7lzDymh7k/2sWA+Ae6va+s8KI61kvyijm/zocb0IMSii6v1koQQ5LMtqjCdXjioZ5R3lME+D1SxP4BbxyJ/mrcLss+UcsQ+KPUZFRxFIg9d9qeAVqX0wlerylJGnCGoIpGDUdBVe7yjHUqfwRisEXvcrYjfF2iib922K0Ck9g4nqfDWTCbl5Fbh3MtG7eMu5F/u2qNqiu77g0VOxluFw8BJV4kOGgrh6K+uL8eSeR23x3FGAPU+f9KXbNm1895FO2ds2GAwGw5ZPmNZmrIZoQVAAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-1166-7674","institution":"University of Oxford","correspondingAuthor":true,"prefix":"","firstName":"Raymond","middleName":"","lastName":"Duch","suffix":""},{"id":196583462,"identity":"7eb9fc44-aa41-4328-be2f-659dab6c940e","order_by":1,"name":"Edward Asiedu","email":"","orcid":"https://orcid.org/0000-0003-0840-9233","institution":"University of Ghana Business School \u0026 Chair of Development Economics, University of Passau, Germany","correspondingAuthor":false,"prefix":"","firstName":"Edward","middleName":"","lastName":"Asiedu","suffix":""},{"id":196583463,"identity":"b4213637-e2fe-4725-99da-8b07a770025b","order_by":2,"name":"Ryota Nakamura","email":"","orcid":"https://orcid.org/0000-0002-3217-6452","institution":"Hitotsubashi University","correspondingAuthor":false,"prefix":"","firstName":"Ryota","middleName":"","lastName":"Nakamura","suffix":""},{"id":196583464,"identity":"ce55019b-e48e-4f0c-b786-f1fad021811f","order_by":3,"name":"Thomas Rouyard","email":"","orcid":"https://orcid.org/0000-0001-6412-1360","institution":"Hitotsubashi University","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Rouyard","suffix":""},{"id":196583465,"identity":"e761bb27-92d5-45f0-aba8-b7fa08326768","order_by":4,"name":"Alberto Mayol","email":"","orcid":"https://orcid.org/0000-0002-2562-3285","institution":"University of Santiago Chile","correspondingAuthor":false,"prefix":"","firstName":"Alberto","middleName":"","lastName":"Mayol","suffix":""},{"id":196583466,"identity":"620134a9-95ff-4d72-b96a-2118926211ca","order_by":5,"name":"Adrian Barnett","email":"","orcid":"","institution":"Queensland University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Adrian","middleName":"","lastName":"Barnett","suffix":""},{"id":196583467,"identity":"dcde4a44-a3da-4c0c-b115-7cd8a21efa71","order_by":6,"name":"Laurence Roope","email":"","orcid":"https://orcid.org/0000-0001-9098-9331","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Laurence","middleName":"","lastName":"Roope","suffix":""},{"id":196583468,"identity":"51d0bd4e-362c-4143-a9a1-a1c7c2c40d67","order_by":7,"name":"Mara Violato","email":"","orcid":"https://orcid.org/0000-0002-0484-7706","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Mara","middleName":"","lastName":"Violato","suffix":""},{"id":196583469,"identity":"9d6bf06d-33b3-4924-8114-5f59c9d0776d","order_by":8,"name":"Piotr Kotlarz","email":"","orcid":"https://orcid.org/0000-0003-1652-5082","institution":"University of Liechtenstein","correspondingAuthor":false,"prefix":"","firstName":"Piotr","middleName":"","lastName":"Kotlarz","suffix":""},{"id":196583470,"identity":"9672fbdd-ad47-46df-a14f-d49e9f3df528","order_by":9,"name":"Dorcas Sowah","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Dorcas","middleName":"","lastName":"Sowah","suffix":""},{"id":196583471,"identity":"82eb7189-2fd3-4763-b557-cb5b8bae60f5","order_by":10,"name":"Philip Clarke","email":"","orcid":"https://orcid.org/0000-0002-7555-5348","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Philip","middleName":"","lastName":"Clarke","suffix":""}],"badges":[],"createdAt":"2023-04-21 13:36:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2845647/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2845647/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41591-023-02670-4","type":"published","date":"2023-11-27T05:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":47183908,"identity":"5fe92b14-84d1-4f27-9567-e9c0f4b75ba5","added_by":"auto","created_at":"2023-11-28 08:09:28","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":818822,"visible":true,"origin":"","legend":"","description":"","filename":"NatureMedicineGhanaVaccinationIncentivesver25.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2845647/v1_covered_3214a46a-ceb7-4ed3-bfca-786a572cad36.pdf"},{"id":36507690,"identity":"79328270-5177-43c6-aff4-2722eed29f5a","added_by":"auto","created_at":"2023-05-02 01:33:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18743,"visible":true,"origin":"","legend":"Inclusion and ethics","description":"","filename":"statementinclusion27423.docx","url":"https://assets-eu.researchsquare.com/files/rs-2845647/v1/5de4bff33b6ea102ba7aedb7.docx"},{"id":36507851,"identity":"d6713ee0-a28b-44a3-8dbd-d8f5c1504241","added_by":"auto","created_at":"2023-05-02 01:41:42","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":656190,"visible":true,"origin":"","legend":"Protocol","description":"","filename":"PAPGhanaVaccinationIncentivesIII.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2845647/v1/5c9bd9f70097f642708c9c5c.pdf"},{"id":36507692,"identity":"d9578b01-6bb5-4e88-8455-a882e513082c","added_by":"auto","created_at":"2023-05-02 01:33:42","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":802022,"visible":true,"origin":"","legend":"CONSORT Checklist","description":"","filename":"CONSORT2010ChecklistDuch.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2845647/v1/21ba58078a13f3d8af399c60.pdf"},{"id":36507694,"identity":"2d1dfc88-82db-4e7e-9a0a-2b52a862e971","added_by":"auto","created_at":"2023-05-02 01:33:42","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":1614180,"visible":true,"origin":"","legend":"Editorial Policy Checklist","description":"","filename":"flatDuchepc.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2845647/v1/a82f1d5537b674c4e57f059a.pdf"},{"id":36507693,"identity":"f03706cc-7bfb-4f2c-a046-4245451e1438","added_by":"auto","created_at":"2023-05-02 01:33:42","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":2301013,"visible":true,"origin":"","legend":"Reporting Summary","description":"","filename":"flatDuchrs.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2845647/v1/d51d0617deca55d1abda2952.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e Competing Interest.","formattedTitle":"Cash for COVID-19 Vaccines in Africa: A Financial Incentives Trial in Rural Ghana","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nature-portfolio","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"","title":"Nature Portfolio","twitterHandle":"","acdcEnabled":false,"dfaEnabled":false,"editorialSystem":"ejp","reportingPortfolio":"","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-2845647/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2845647/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"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 \u003c 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 \u003c 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.","manuscriptTitle":"Cash for COVID-19 Vaccines in Africa: A Financial Incentives Trial in Rural Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-02 01:33:37","doi":"10.21203/rs.3.rs-2845647/v1","editorialEvents":[],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nature-medicine","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"nm","sideBox":"Learn more about [Nature Medicine](http://www.nature.com/nm/)","snPcode":"","submissionUrl":"","title":"Nature Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature Research","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c8e95eda-b823-47d5-ac35-2d64bf1fbd0c","owner":[],"postedDate":"May 2nd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":21141321,"name":"Scientific community and society/Social sciences"},{"id":21141322,"name":"Health sciences/Diseases/Infectious diseases"}],"tags":[],"updatedAt":"2023-11-28T08:09:15+00:00","versionOfRecord":{"articleIdentity":"rs-2845647","link":"https://doi.org/10.1038/s41591-023-02670-4","journal":{"identity":"nature-medicine","isVorOnly":false,"title":"Nature Medicine"},"publishedOn":"2023-11-27 05:00:00","publishedOnDateReadable":"November 27th, 2023"},"versionCreatedAt":"2023-05-02 01:33:37","video":"","vorDoi":"10.1038/s41591-023-02670-4","vorDoiUrl":"https://doi.org/10.1038/s41591-023-02670-4","workflowStages":[]},"version":"v1","identity":"rs-2845647","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2845647","identity":"rs-2845647","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}