Babydog, Gov. Justice's English bulldog – and the vaccination lottery's mascot – is walked to the capitol steps on West Virginia Day. Photo by Ian Karbal

For nearly a year, West Virginia Gov. Jim Justice has had a problem: how to convince more West Virginians to get vaccinated against COVID-19. For the governor, his preferred method has been giveaways, all named after his English bulldog.

Justice’s most widely-touted programs have been lotteries, where he traveled the state giving out trucks and guns and money to West Virginians who were vaccinated. But studies have shown these kinds of incentive programs rarely move the needle on vaccination rates. 

However, experts say this latest iteration of “Do it for Babydog,” which will give older West Virginians $50 when they get booster shots, has potential — if it ever gets off the ground. Even though part of the program involves holding booster clinics at senior centers across the state,  only 9 days before the program is supposed to end, senior centers are still in the dark about the governor’s plan. 

“We have not received any additional information,” said Jennifer Brown, President of the West Virginia Directors of Senior and Community Services in an email.

Meanwhile, half of West Virginians still aren’t vaccinated, and doctors are warning there could be a one-two punch of both the delta and omicron COVID variants this winter.  

Most incentive programs don’t work

The governor has been shrugging off criticism of his vaccine incentive programs since the first one kicked off in May. 

“Well, you know, of all things, I’m telling you, that program has been really, really successful no matter what anybody tries to say or throw mud, that program has really worked and we’ve been very, very, very happy and very fortunate to be able to do that program, to have the dollars to be able to do it,” the governor said earlier this month.

But researchers who have studied vaccine incentive programs say otherwise, specifically when it comes to lottery programs. Allen Walkey, professor at Boston University Medical School, looked at Ohio’s lottery incentive and found that it didn’t have a large impact on vaccinations when compared to national trends in vaccinations.

While Walkey’s study looked at vaccination rates in retrospect, UCLA professor Tom Chang,  and his co-authors tried something different: They recruited unvaccinated participants to see whether informational videos, emails and financial incentives would motivate them to get vaccinated. 

Then they followed up. “Because we’ve learned long ago not to trust what people say they’re going to do, but to actually see what they actually do,” he said. 

Chang says the results were both depressing and surprising. While messaging affected whether someone told the researchers they were likely to go get vaccinated, ultimately “nothing moved actual vaccinations.”

Worse, Chang says, is that offering nudges and financial incentives may have turned some people away from getting vaccinated. 

“I think if you are already sort of suspicious of the vaccine, then having someone come around and offer you money for it makes it even more suspicious and the sense of like, ‘if this is a good thing, why do you have to pay people to take it?’ and so it sort of feeds into that line of thinking,” he said.

In particular, two of the groups who were turned off by financial incentives for vaccines were Donald Trump supporters and people over 40 — two demographics that represent the majority of West Virginians. But Chang says the state’s latest attempt, focusing on boosters and guaranteed payments, could work better because these people have already shown a willingness to get vaccinated. 

“It could be very well that these incentives work in that they might have gotten it done anyway, they’re sort of sitting on the fence and the [incentive] sort of carries them over the line,” he said. 

Trusted messengers 

From the beginning, experts have urged using trusted community messengers to overcome vaccine skepticism. University of California, San Francisco professor Monica Gandhi says at this point, people are “pretty dug in” when it comes to getting their initial doses, which is why they’re more likely to be convinced by a neighbor, doctor or community member they already trust.

In West Virginia, there have been grassroots efforts to recruit local doctors and nurses to urge their neighbors to get vaccinated. But Justice and Babydog have remained the face of the state’s vaccination efforts.

This latest effort targets West Virginians 50 and older who are already vaccinated, but didn’t have booster shots as of Dec. 7. And in urging these people to get booster shots at their local senior center, it taps into some of the influence senior centers have in reaching the people who already trust them.

Gandhi says this is crucial because lack of trust in the government and medical establishment has contributed to vaccine hesitancy. This push is different, because senior centers are “trusted forces” within their communities, Gandhi said.

And it offers another incentive for them to do this well: according to the governor, the four senior centers with the highest booster rates will be awarded $100,000 each. 

According to Chang, giving senior centers more skin in the game may increase vaccine uptake. “Sometimes the most cost effective and most effective way, period, to get people to adopt things that are better for their health is not to incentivize them, but to actually incentivize the provider — the doctors — to promote certain behaviors,” Chang said. 

In Preston and Harrison counties, the senior center directors agree that a chance at $100,000 is definitely an incentive. 

Beth Fitzgerald, the director of the Harrison County senior center, says she would use the money to open an adult day care. And Janie Lou White, the executive director of the center in Preston County, said she’s similarly motivated to try to win that money. 

“I’ve been doing this work for decades and I can assure you that when you put incentives like this in for senior centers, we can turn things on a dime,” she said.

But turning on that dime is getting more and more difficult by the day as the Dec. 27 deadline for Justice’s program draws nearer. 

Initially, there were questions and confusion. Multiple senior center directors interviewed for this story were unaware of the program before the governor announced it at the COVID press conference. The following day, the Bureau of Senior Services held a virtual meeting for senior centers around the state to give more details. Senior center staff on the call were informed that the National Guard would be going to counties to help host booster clinics, but that they needed to happen quickly — by Christmas. 

Fitzgerald left the meeting with questions: Mainly, when will these clinics happen and who could get the money?

“I have seniors in my county calling me saying ‘Do we get the card too if we already got the booster? Or are we rewarding procrastinators?’” Fitzgerald said.  

Requests for comment and clarification to the governor’s office weren’t returned, and a representative at the Bureau of Senior Services said they didn’t have any details either. 

Even less than two weeks before the program was supposed to end, four different county senior centers said they had no more information, and didn’t have any clinics scheduled. A spokesman for the National Guard said there hadn’t been any requests for assistance. And on the program’s website, it says details are still to come.

Quenton King is a native West Virginian, born and raised in Charles Town in the Eastern Panhandle. He previously worked as a policy analyst for the West Virginia Center on Budget and Policy and the National...