Incentives Help Increase Immunization Rates Coupons For Diapers Or Ice Cream, Competition Among Clinics Work Well

The number of children being immunized against childhood diseases soared in Georgia after public health clinics began competing for plaques and barbecues.

Other states report that coupons for diapers and ice cream work pretty well, too.

In Georgia, the childhood immunization rate at the state’s public health clinics jumped from 53 percent to 89 percent in six years.

“This was a very low-cost program,” said Dr. Charles W. LeBaron, an epidemiologist with the National Immunization Program at the Centers for Disease Control and Prevention in Atlanta. “And this is the kind of thing that just cranks out vaccinated kids like a machine.”

The results of his research are published in today’s issue of The Journal of the American Medical Association.

Georgia state public health officials set out in 1985 to improve the state’s dismal vaccination rate despite having little staff, scant money and no authority over local public health clinics.

State staffers set up an information-gathering and reporting system that helped clinics identify mistakes and devise ways of correcting them. When the state ranked clinics by immunization rates and distributed the lists, a healthy rivalry sprang up.

It really caught on when the state ceremoniously awarded plaques to clinics that had attained the highest immunization rates and showed the most improvement each year. The best clinics also got a barbecue.

“They did things you’d associate with, I don’t know, summer camp,” LeBaron said. “But it’s funny how human psychology at the M.D. level responds to these kinds of public-recognition incentives.”

The clinics used strategies ranging from keeping better records to mailing reminders to parents about when their children’s next shots were due.

In Iowa, agencies that run public health clinics solicited coupons for products ranging from diapers to ice cream to increase the incentives for parents and children to get their shots on time.

The United States has been struggling for years to get its children - especially those under age 2 - immunized against sometimes fatal diseases such as measles, whooping cough and meningitis. The U.S. childhood immunization rate rose from 55 percent in 1992 to 75 percent by early last year - still below the goal of 90 percent.

About 70 percent of Georgia’s children get their shots at public clinics. Nationwide, most children are immunized in private doctors’ offices.