On June 26, just over two months ago, Buncombe County recorded just one new case of COVID-19. The county’s coronavirus state of emergency had ended earlier that month, and just 16 people were hospitalized due to the disease across Western North Carolina.
As of Aug. 18, the emergency is back. WNC hospitals are caring for nearly 250 COVID-19 patients. Buncombe has reinstated a mask mandate for public indoor spaces. And local health officials have redoubled their pleas for residents to get vaccinated against the coronavirus — but this time, they’re offering more than just protection from disease.
Area governments, schools and businesses are providing proverbial carrots, including bus passes, Xboxes, gift cards and cash, to unvaccinated people who get their shot. The moves follow the lead of the state government and Gov. Roy Cooper, who gave away $1 million prizes to four North Carolina residents who received their COVID-19 vaccinations through Aug. 1.
Moving the needles
According to the N.C. Department of Health and Human Services, 59% of Buncombe County’s total population was fully vaccinated against COVID-19 as of Aug. 26, with 63% partially vaccinated. Those numbers are higher than the statewide averages of 49% and 53%, respectively, but Stacie Saunders, the county’s public health director, has called for all eligible residents to get their shots as a way to reduce transmission of the coronavirus’s more contagious delta variant.
Polling from the national nonprofit Kaiser Family Foundation suggests that a variety of reasons underlie the choice not to be vaccinated against COVID-19. About two-thirds of unvaccinated respondents to a July survey said they weren’t confident in the safety of available vaccines, with over half believing that getting a vaccine posed a greater risk to their health than contracting the disease. Additionally, over a third of the unvaccinated weren’t confident that the vaccines are effective at preventing severe illness, hospitalization and death.
(The federal Food and Drug Administration issued full approval for the Pfizer COVID-19 vaccine on Aug. 23, while the Moderna and Johnson & Johnson vaccines remain available under emergency use authorization, which takes into account safety data from thousands of recipients. According to the federal Centers for Disease Control and Prevention, the Pfizer and Moderna vaccines reduce the risk of severe illness in those fully vaccinated by at least 90%.)
To address those concerns, says Adrienne Ammerman, public health experts rely on theories of behavior change when formulating their messaging. The public health communicator at the nonprofit WNC Health Network has been working to support regional public vaccination efforts.
One motivation to get vaccinated, for example, could be a person’s understanding of how likely they are to experience negative consequences from COVID-19. A prompt to take action is another motivation, she continues, and that’s where incentives come in.
“It’s one of the tools in our public health toolbox of how we’re trying to help motivate people,” Ammerman says. “For some people, it’s going to work, and that’s amazing. And for some people, that’s not what they need. … It’s trying to meet people where they’re at, because there’s no one answer. Humans are very complex in how we make decisions.”
More for your shot
The most widely available incentive came through a program spearheaded by NCDHHS and administered by Buncombe County. From Aug. 4-31, residents ages 18 and older received a $100 gift card for getting their first dose of a COVID-19 vaccine and a $25 gift card for transporting someone to receive their first dose. According to county spokesperson Lillian Govus, Buncombe gave those rewards to 314 people for getting vaccinated and 53 people for providing transport to the county Health and Human Services clinic at 40 Coxe Ave. or one of 21 outreach events.
BCHHS also offered incentives to get vaccinated at the Asheville Rides Transit station on Asheland Avenue. A June 21 clinic vaccinated 71 people, and a July 26 clinic vaccinated 78 people, said Polly McDaniel, a city of Asheville spokesperson. Each received a free bus pass for ART for the remainder of 2021.
“The city of Asheville continues to coordinate its response to COVID-19 with Buncombe County and state officials,” wrote McDaniel in a statement to Xpress. “Our actions are designed with public health in mind, as we pull together to slow the spread of the COVID-19 pandemic.”
One large local employer is incentivizing employees to get vaccinated as well. Black Mountain-based Ingles will pay employees who take time off to recover after vaccination, which is offered for free at the grocery chain’s pharmacies. Ronald B. Freeman, the company’s chief financial officer, declined to share the number of Ingles associates who had taken advantage of that benefit.
The Eastern Band of Cherokee Indians Public Health and Human Services Division may have offered the most unique incentive. In an Aug. 16 Facebook post, the department advertised “three brand-new Xbox systems” to be raffled off to anyone vaccinated at a clinic at the Cherokee Youth Center. The Xboxes, the post noted, were donated by the Boys & Girls Club of America.
Many financial incentives to get vaccinated are being offered at area colleges. Students at UNC Asheville who completed a voluntary vaccine survey were automatically entered into a drawing for a chance to win money, says spokesperson Sarah Broberg. Five students won $500 credits on their campus OneCard, a student ID and debit card that can be used at the bookstore, campus dining and other places.
A-B Tech debuted an incentive program on Aug. 5, the community college’s New Student Welcome Day. The school will add $150 to the bookstore accounts of students who provide proof of full vaccination. (Full vaccination means the first and second doses of the Pfizer or Moderna vaccines or the only dose of the Johnson & Johnson vaccine.) And on Aug. 12, the school announced it would add $300 to the payroll accounts of employees who could provide proof of full vaccination.
As of Aug. 23, 546 employees had received $300 for providing proof of a vaccine, and 836 students had received the bookstore incentive, according to Kerri Glover, A-B Tech spokesperson. The college has allocated $700,000 to finance the vaccine incentives from the $24.5 million it received in COVID-19 relief funds from the U.S. Department of Education, she explained.The employee and student programs remain in place through Friday, Oct. 15.
Western Carolina University is also using money as an incentive. Until Friday, Oct. 1, vaccinated employees and students will be automatically entered in a contest for prize money from multiple pools, grouped by the month in which they received their shot. Random drawings will award two staffers and four students from each pool with $500 cash, says WCU spokesperson Geoff Cantrell, with funding taken from the institution’s trust fund.
In the coming weeks, Brevard College will hold four drawings of $500 in cash for students who have shown proof of vaccination, said Debora D’Anna, dean for students. A requirement of vaccination for students will take effect on Jan. 2. For faculty and staff, that vaccination requirement goes into effect immediately. Faculty, staff, and students can apply for a medical or religious exemption, D’Anna said.
But not every school is offering rewards for getting vaccinated. “Montreat has chosen to focus on education (on vaccinations) and encouraging personal health decisions based on the well-being of the individual and the community,” wrote Ashley C. Bond, Montreat College spokesperson, in an email. The college has also hosted two vaccine clinics on campus on April 12 and Aug. 23, she said.
Warren Wilson College also isn’t offering incentives, but for a different reason. “Warren Wilson hasn’t needed to create vaccination incentives like other colleges have (typically financial incentives in the form of cash or gift cards) for students because it is already requiring students to be vaccinated unless they’re eligible for exemptions under state law,” said spokesperson Mary Bates in an Aug. 25 email.
On Aug. 27, Warren Wilson added a vaccination requirement for employees, to be completed by Thursday, Sept. 30, unless they provide a religious or medical exemption.