3 Things Incentivize People to Get a COVID Booster Shot, Study Finds

An illustration of a gloved hand holding a COVID-19 vaccine vial opposite a hand held up as if to say "no" on a green back ground.


Key Takeaways

  • Only about half of fully vaccinated people in the United States have gotten their COVID-19 booster shots.
  • A new study showed that a COVID shot's efficacy and manufacturer, as well as cash incentives, can influence a person’s willingness to get a booster.
  • Experts say that seeing a lot of misinformation and not feeling a sense of urgency about COVID anymore might be why people are not getting boosters.

Even though we know that the COVID-19 vaccines help lower the risks of severe illness, as of August 2022, fewer than 50% of fully vaccinated American adults have received their first booster shot, and only 34% of eligible Americans have received their second.

The Food and Drug Administration (FDA) has authorized updated versions of the Pfizer and Moderna COVID shots that offer better protection against the Omicron variants.

While the hope is that having better boosters will lead to increased uptake, people won't necessarily get the shots just because they're available.

According to a new study published in Social Science & Medicine, there are three main factors that influence a person's willingness to get a COVID booster: how well it works, who made it, and whether they'll get paid to do it.

Other factors, like how long a booster’s protection is expected to last and whether the shot could offer protection against future COVID variants had less influence.

Beth Oller, MD, FAAFP, a family physician at Solomon Valley Family Medicine, told Verywell that studies like this are important because they can help healthcare providers understand how patients make the decision to get boosted—or not.

“If I am aware of the factors that are preventing people from receiving COVID-19 boosters in my area, then I know how to have the conversation with patients that will be more likely to encourage them to get boosted,” said Oller.

What Makes a Person Willing to Get Boosted?

For the study, 548 American adults who were fully vaccinated but not boosted took a survey on COVID boosters. The researchers looked at the responses to get a sense of which factors had the most influence on a person's decision about the shots.

How Well The Boosters Work

The biggest predictor of a person’s likelihood to get a COVID booster was its efficacy in preventing a symptomatic COVID infection. The higher the efficacy, the more willing people were to get a booster.

A person's willingness was highest if the booster was 90% effective at preventing symptomatic COVID, was lower if the booster efficacy was 70%, and was lowest if it was only 50% effective.

It's unclear exactly how well the updated, Omicron BA.4/BA.5-specific boosters from Pfizer and Moderna work. While pre-clinical trial data shows they can generate a strong neutralizing antibody response against the strains, the FDA issued its authorization without complete clinical trial data from humans—the same way it does for annual flu shots.

Who Made the Booster

The study also found that a person's willingness to get a booster was highest if the booster was made by Pfizer, followed by Moderna. It was the lowest if Johnson & Johnson made the shot—a moot point, since J&J doesn't have a booster or bivalent vaccine.

“Some people have shown preferences for one vaccine over the other mostly based on personal anecdotes,” Irfan Hafiz, MD, chief medical officer and an infectious diseases expert at Northwestern Medicine McHenry Hospital, told Verywell. “There really is no data to support one mRNA vaccine over the other.”

Getting Paid to Get a Booster

A 2022 study reported that guaranteed cash payments were estimated to increase vaccine uptake by 8%. The downside? It costs a lot to pull off, so paying people to get boosted is not a realistic option for many communities.

Oller said that it makes sense that cash incentives would encourage fully vaccinated people to get a booster. If there's money on the line, people will probably be more likely to make the time to get the shot.

In fact, time is right up there with money: The people in the study were more likely to get a booster if it came with a paid day off from work rather than a $10 cash incentive.

Still, money talks. The study showed that as the financial incentives increased, so did booster uptake. People were more willing to get a booster with a $100 incentive than a $10, and overall, people were the most willing to get a booster when it come with a $1,000 incentive.

Why Aren’t People Getting Boosters?

There are likely several reasons why over half of fully vaccinated and booster-eligible people have not yet gotten their shots.

Oller pointed out that psychological "pandemic fatigue" could be one. We've been living like this for years now, and many people have just lost their sense of urgency about COVID.

Rather than reluctance to get the booster shots, Oller said that it’s possible that staying up to date with COVID vaccinations is just not a priority anymore.

According to Hafiz, availability is no longer the main barrier to boosters. Now, it's more about human behavior. Ongoing exposure to COVID misinformation and the perception that the virus is less deadly because we've seen a drop in hospitalizations are strong influences.

That's why it's important for healthcare providers to continue to educate their patients.

“Unfortunately, the effort needed to debunk misinformation is greater than the effort to put out misinformation," Hafiz said.

What This Means For You

Updated COVID-19 vaccines that offer more protection against Omicron variants are now authorized. But that doesn't mean people will take them, especially since precise efficacy information isn't yet available. Still, some protection is better than no protection. Experts want you to get your booster shot as soon as you are eligible.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. COVID-19 vaccinations in the United States.

  2. U.S. Food and Drug Administration (FDA). Coronavirus (COVID-19) update: FDA authorizes Moderna, Pfizer-BioNTech bivalent COVID-19 vaccines for use as a booster dose.

  3. Raman S, Kriner D, Ziebarth N, Simon K, Kreps S. COVID-19 booster uptake among US adults: Assessing the impact of vaccine attributes, incentives, and context in a choice-based experimentSocial Science & Medicine. 2022;310:115277. doi:10.1016/j.socscimed.2022.115277

  4. Brewer NT, Buttenheim AM, Clinton CV, et al. Incentives for COVID-19 vaccination. The Lancet Regional Health. 2022;8:100205. doi:10.1016/j.lana.2022.100205

  5. Sprengholz P, Henkel L, Betsch C. Payments and freedoms: Effects of monetary and legal incentives on COVID-19 vaccination intentions in Germany. PLoS ONE. 2022;17(5):e0268911. doi:10.1371/journal.pone.0268911

By Carla Delgado
Carla M. Delgado is a health and culture writer based in the Philippines.