Economic Incentives for COVID‐19 Vaccination Among Employees of a Safety‐Net Health System and Medical Center in Southern California: A Cross‐Sectional Study

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Background and Aims: Healthcare workers (HCWs) were pivotal in delivering care during the COVID-19 pandemic, yet vaccination uptake in the United States was lower than anticipated. This study investigated whether economic incentives, paid time off (PTO), raffle entry, or a direct financial incentive could influence vaccine uptake among HCWs exhibiting greater vaccine hesitancy. Methods: We conducted a cross-sectional survey in a large integrated safety-net health system. Using an adapted Vaccine Hesitancy Scale (VHS), employees were classified as "more" vs "less" hesitant. For each incentive, respondents indicated whether it would influence their vaccination decision. Multivariable logistic regression estimated associations between demographic (age, gender, race/ethnicity, household income, education, marital status) and employment factors (job type, COVID-19 exposure, pandemic impact on income/employment) and reported influence. Results: Of 684 respondents with complete hesitancy data, 282 (41.2%) were classified as more hesitant. Within this group, 41.4% reported PTO would influence their decision, 28.5% a financial incentive, and 20.3% a raffle. Employees < 50 years had higher odds of reporting influence for a financial incentive (aOR = 3.52; 95% CI: 1.64-8.23), raffle (aOR = 2.34; 1.01-5.41), and PTO (aOR = 1.89; 1.00-3.62). Nonclinical staff were more likely to report influence from a financial incentive than clinical staff (aOR = 2.16; 1.07-4.46). Those reporting negative pandemic-related income/employment impact showed a borderline association with financial incentives (aOR = 2.12; 0.99-4.59). Conclusion: Economic incentives are an effective strategy for improving vaccine uptake among younger HCWs, nonclinical staff, and those negatively affected financially by the pandemic. A targeted application of financial incentives may help address vaccine hesitancy in healthcare settings.

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