Inclusion and ethics statement
The initial concept of a Ghana COVID-19 Vaccine Incentive research project was the product of conversations between Professor Asiedu (University of Ghana) and Raymond Duch (University of Oxford). Asiedu and Duch have been working together for many years on field experiment projects in Ghana. The actual study design—including, most importantly, selection of target population, sampling strategy, video treatments, financial incentives and vaccination outcome measures—was developed in close collaboration with Professor Asiedu and his PhD student, Dorcas Sowah. All of the data and intellectual property associated with the project are shared with Professor Asiedu and the University of Ghana. Both Professor Asiedu and Ms. Sowah are co-authors on resulting publications.Our local partners in the project are the Health District Offices in the six regional districts where the research was conducted. We were able to implement the Ghana COVID-19 Vaccine Incentive research project because our local partners considered it extremely relevant to the challenges faced in vaccinating their rural populations. More broadly, though, the goal of assessing whether financial incentives could significantly increase vaccine uptake was very much relevant for health policymakers in Ghana and Africa overall because of the relatively slow pace of vaccine uptake in the region. Several leading policymakers advocated exploring the role that financial incentives could play, and there was very little evidence from LMICs regarding the impact that such a policy might have.To ensure that the project design and roll-out incorporated maximum input from local partners, Raymond Duch met regularly in person with the district health officials to report the ongoing results and to determine what changes in the design and implementation were necessary to ensure maximum local relevance of the study results. The local University of Ghana team and the other regional research teams met weekly to ensure, again, that our design and implementation were locally relevant.The roles and responsibilities among collaborators were agreed upon ahead of the research project. These were outlined in documents jointly prepared by the University of Ghana and University of Oxford teams. They included roles and responsibilities for the Ghana academic team, the Oxford academic team, the other regional academic teams and the local Ghana health district teams. Capacity building was an important feature of the research implementation strategy. The project included support for capacity building at the individual Ghana health district level; resources and funding for building the research infrastructure of the University of Ghana team (which includes a large team of student enumerators and researchers); and career development opportunities for the senior members of the University of Ghana research team.The research would not have been severely restricted or prohibited in the Ghana setting where the research took place. As we pointed out in our ethics submission to the University of Oxford, the treatments consisted only of encouragements for the treated individuals to get a COVID-19 vaccine. All participants in the study were compensated for their participation.Because of time constraints, given the urgency of having our study go into the field as the COVID-19 vaccines were being distributed in our targeted rural districts, we opted for only a single high-intensity ethics review at the University of Oxford (CUREC 2). This was a joint decision of the local research team and the Oxford research team. Professor Asiedu from the University of Ghana was one of the co-principal investigators included in the University of Oxford ethics submission.The research resulted in no stigmatization, incrimination, discrimination or other personal risks to participants. In addition, we adopted very strict measures to ensure that the information we collected was anonymized and that we followed strict University of Oxford procedures for data protection.The research was implemented during the COVID-19 pandemic, and we reviewed with local partners and Ghana district health officials the appropriate measures that needed to be put into place to protect both the enumerators who were conducting the interventions and the study participants. We have a detailed discussion of these measures in our ethics submission to the University of Oxford. In addition, we provided detailed instructions to enumerators regarding COVID-19 symptoms and COVID-19 protection measures; these were provided in initial documents on the tablet surveys that were administered. Raymond Duch also briefed enumerators in person on the necessary COVID-19 measures that needed to be adopted. Participants were also provided with COVID-19 instructions; for example, they were questioned about COVID-19 symptoms and instructed regarding masking and social distancing.In preparing this manuscript, the authors were very careful to ensure that all local and regional research relevant to the study and its results were taken into account in citations.