More U.S. States Try Lotteries to Tackle Vaccine Hesitancy

Like many states in the South, Louisiana’s vaccination rate has lagged significantly behind the national average, particularly among older adults, a trend that has troubled public health officials.

Some 22 percent of adults 65 and older still have not been vaccinated, compared with 12 percent nationally, according to a New York Times database. Just 34 percent of the state’s population has been fully vaccinated, compared with 46 percent nationally.

Louisiana is one of the latest states to resort to dangling financial incentives to get more shots into arms, a strategy that has kindled a broader debate over the effectiveness and wisdom of monetary enticements. It is holding a lottery, which will be paid for with federal coronavirus relief funds.

At the lottery’s unveiling last week, a jazz band played the state song, “You Are My Sunshine,” and Louisiana’s governor, John Bel Edwards, revealed a giant check for $1 million.

Mr. Edwards said amid the festivities that the money would go to a Louisiana adult who had received at least one dose of a Covid-19 vaccine. He said that the state would give away a total of $2.3 million in cash prizes and scholarships over a month. Registration for the lottery — marketed as “Shot at a Million” — began this week.

“Before launching our own program, we wanted to see how well it worked in other states, and, quite frankly, we’ve been impressed by the success that they’ve had,” Mr. Edwards said in announcing the lottery.

Louisiana’s vaccination rate, as a share of its population, is lower than every state but Mississippi. Six of the bottom eight states are in the South: They include Alabama, Arkansas, Georgia and Tennessee.

The Biden administration has made a concerted push to overcome vaccine hesitancy, particularly in the South. This week, the first lady, Jill Biden, visited Tennessee and Mississippi to encourage people to get vaccinated, while President Biden visited a mobile vaccination site in North Carolina on Thursday.

Mr. Edwards, a Democrat, cited Ohio’s lottery program. Gov. Mike DeWine of Ohio announced in May that five people would each win $1 million; the last winners were announced on Wednesday. On Thursday, Mr. DeWine said the state would focus on smaller incentives, like $25 DoorDash gift cards at select locations, and on expanding outreach and access to shots.

“We want our people to be protected,” Mr. Edwards said. “This is the way that we accomplish that. It is the way we can make sure that we return to normalcy and are able to safely gather.”

Dr. A. Mark Fendrick, the director of the University of Michigan Center for Value-Based Insurance Design, said in an interview that there was a compelling case for conducting lotteries but that they should be open only to people who were fully vaccinated.

“The people that we need to reach to get vaccinated, independent of their political affiliation, have been shown to be those populations who are likely to buy lottery tickets,” he said.

Dr. Fendrick, a primary-care physician who has studied consumer incentives for health care behavior for three decades, said it was too early to determine the effectiveness of the lotteries. In some states, he said, the lotteries coincided with making the vaccine available to teenagers, which could skew the numbers. He suggested comparing the vaccination rates in states with lotteries to those without them.

“I really want to see Michigan versus Ohio,” he said.

On Wednesday, North Carolina will hold its first lottery drawing as part of a similar vaccination push. Every other week, it will give away $1 million and a $125,000 scholarship to an adult and a teenager who get the vaccine.

Similar initiatives have been promoted by California, Illinois, Maryland, New Mexico and Washington.

In Oregon, however, the pace of vaccinations slipped since May, when Gov. Kate Brown announced a $1 million giveaway, The Oregonian reported this month.

Charles Boyle, a spokesman for Ms. Brown, said in an email on Tuesday night that the drop-off in vaccinations was to be expected as more residents had the shot. Oregon, he said, needed to inoculate less than 42,000 people to reach its target of at least 70 percent of adults having received at least one shot.

Mr. Boyle said that the “Take Your Shot, Oregon” campaign was part of a broader strategy that included using more and smaller vaccine clinics to lift the vaccination rate.

“No individual strategy is expected to have a singularly massive impact or to wholly reverse vaccination rate trends,” he said. “Each strategy adds a little energy to the overall effort.”

Daniel E. Slotnik contributed reporting.

Dr. Suhendro Sastrowiwoho was fully vaccinated and eager to help this month as Indonesia faced a new and deadly wave of Delta variant coronavirus cases. His daughter and son-in-law, both trained as doctors, told him to rest. He was 74 years old, they warned, and the virus was evolving in unexpected ways.

On June 18, Dr. Suhendro died just days after testing positive for Covid-19. Like other frontline medical workers in the small town of Kudus, on the island of Java, he had received a double dose of Sinovac Biotech, the Chinese-made vaccine.

“His love was taking care of his patients and helping people,” said Angeline Dewi Suhendro, his daughter, whose husband is now also hospitalized with Covid. “We forbade him to practice because Covid cases were shooting up, but he insisted.”

While the West appears to be recovering from the worst of the coronavirus pandemic, some countries without access to plentiful vaccines are facing their most devastating outbreaks yet, as more contagious variants spread quickly. Other countries are discovering that certain vaccines may not be as effective as others in preventing infections caused by these variants.

Indonesia, the world’s fourth-most populous country, is facing both problems at the same time. On Thursday, the country recorded more than 20,000 cases of Covid-19, the highest number since the pandemic began. Oxygen is again running out at hospitals in the capital, Jakarta, and the national percentage of positive Covid tests reached 14.6 percent this past week. By comparison, the weekly positivity rate in the United States is now 1.8 percent, according to the Centers for Disease Control and Prevention.

Since the pandemic began, 401 doctors in Indonesia have died, according to the risk mitigation team of the Indonesian Medical Association. At least 20 of them were fully vaccinated with Sinovac. (The vaccination status of another 31 doctors who died between Feb. 1 and June 24 is still being investigated.)

The Delta variant is playing a significant role in a resurgence of the coronavirus in Africa, where the peak of a third wave of new cases is set to surpass previous ones, all at a time when nations are struggling to vaccinate their populations.

The Delta variant, which is highly contagious and was first identified in India, has so far been detected in 13 African countries, according to the Africa Centers for Disease Control and Prevention. In some of those countries — including the Democratic Republic of Congo, Uganda and Zambia — the battle against the virus has left hospitals stretched, depleted oxygen stocks, and overwhelmed health care workers.

John Nkengasong, director of the Africa C.D.C., said in a news conference on Thursday, “It’s frightening to see what’s happening across the continent.”

“This third wave is extremely brutal,” he added.

Africa has now recorded more than five million coronavirus cases and almost 140,000 deaths, despite the continent’s largely having been spared the worst of earlier waves of the pandemic. Since May, Covid cases have risen consistently, and the World Health Organization has predicted that the current wave could be the region’s worst yet.

“The third wave is picking up speed, spreading faster, hitting harder,” Matshidiso Moeti, the W.H.O.’s regional director for Africa, warned in a statement.

The global health organization has detected the Delta variant in most of the samples it has sequenced in the past month. In Uganda, 97 percent of the cases were attributed to the Delta variant, and in Zambia, that version accounted for 77 percent, according to Nicksy Gumede-Moeletsi, a virologist at the W.H.O.’s regional office for Africa.

The W.H.O. said it was deploying experts to the worst-affected nations to monitor and analyze cases of the variant.

In Uganda, where more than a dozen lawmakers have tested positive, the drastic rise in deaths and new infections has pushed President Yoweri Museveni to close schools and ban travel between districts.

In Kenya, hospitals in the western county of Kisumu where the Delta variant was first reported have been stretched, causing the authorities to impose a partial lockdown and extend an overnight curfew. Hospitals in Zambia have also been stressed and new restrictions imposed as the country fights to curb rising new infections — the second-highest on the continent, after South Africa, for the week ending June 20, according to the Africa C.D.C.

“This third wave has come with a severity that many countries were not prepared for,” Dr. Nkengasong of the C.D.C. said.

Health care more broadly is also suffering, including maternal and pediatric services, as hospitals face a strain on resources and as many people avoid them for fear of the virus, said Dr. Catherine Kyobutungi, the executive director of the African Population and Health Research Center in Nairobi, the Kenyan capital.

Health experts said it was important to deploy vaccines to beat back the virus. Even as the third wave surges, only about 1 percent of Africa’s population of 1.3 billion people have been fully immunized.

“We have to vaccinate at speed and at scale,” Dr. Nkengasong said. “We are racing against time.”

JERUSALEM — Israel has been a trailblazer in the post-pandemic world, largely returning to normal in May following one of the world’s fastest vaccination drives.

But dozens of new cases recently emerged at schools in two cities, Modiin and Binyamina, leading to hundreds of people being quarantined. Israel has made 12- to 15-year-olds eligible for vaccination, but many have yet to get shots.

Despite the new outbreak, the country’s current death rate remains close to zero, and only 26 of 729 active coronavirus patients were hospitalized, according to data released by the Health Ministry. And the overall daily caseload remains far from the country’s peak in mid-January, when the average hit more than 8,000 daily cases.

The containment effort has struggled to have an impact as the virus continues to spread through several cities. Many of those who contracted the virus had been vaccinated, according to the director general of the Health Ministry, Prof. Chezy Levy, though he did not specify if they had had one or two doses.

The Delta variant is unlikely to pose much risk to people who have been fully vaccinated, experts have said. The country has relied on the two-dose mRNA vaccines made by Pfizer-BioNTech and Moderna.

Some Israeli officials and health experts have attributed the outbreaks to the Delta variant, and point to international travelers as a potential source of the outbreaks.

According to Anat Danieli, a Health Ministry spokeswoman, the Delta variant had been identified in 180 samples as of last Sunday. But it was unclear how many of the new cases involved the variant, as the testing can take up to 10 days.

Since last Saturday, the country’s rolling seven-day average of new cases has grown from fewer than 25 to more than 72, according to the Our World in Data project at Oxford University.

Before the recent outbreak, the daily caseload had fallen close to zero. About 57 percent of the country’s population has already been given two shots of Covid vaccine.

To deal with the sudden outbreak, the Israeli prime minister, Naftali Bennett, reinstated a ministerial crisis committee, known as the coronavirus cabinet. On Wednesday, Israel’s Tourism Ministry said that it would postpone its resumption of issuing individual tourist visas from July 1 to Aug. 1.

Israeli officials fear the country may have eased too many of its antivirus restrictions too quickly, and on Thursday, the Health Ministry said that the government would assess whether to reintroduce a requirement to wear masks in indoor public places should the daily caseload exceed 100.

The announcement came less than two weeks after the country’s indoor mask mandate was lifted and less than a month after the end of capacity restrictions in public spaces, as well as the requirement to show proof of full vaccination against the coronavirus.

Nachman Ash, a senior official overseeing the Israeli pandemic response, also asked residents to avoid unnecessary international travel.

Global Roundup

With the Tokyo Olympics set to begin next month after a yearlong delay, some athletes are hesitating about whether to get vaccinated.

Andy Anson, the head of the British Olympic Association, said that although most British athletes would have their second doses of a coronavirus vaccine before the start of the Games, a minority did not want to be immunized.

Mr. Anson, in an interview with the BBC, said that “nearly everyone” would have at least one dose and that “well over 90 percent” would be fully vaccinated by July 23 when the Olympics begin. But, he added, there were still some holdouts.

“There are individuals who didn’t want to be vaccinated, and we’re trying to convince them it’s the right thing to do,” he said. “But again, it’s not mandatory. People have got the right to choose, and we have to respect that. But it’s not necessarily that helpful.”

A spokesman for the British Olympic Association said that fewer than half a dozen members of the country’s delegation to the Games did not want to take the vaccine, adding that those cases involved “isolated issues of time scale, location and performance in respect of athletes’ activities.”

The challenge of bringing together thousands of athletes and support staff who will travel to Japan from around the world for the Games — as well as some domestic spectators — has been a cause for concern in the weeks leading up to the event.

Cases among athletes who have arrived in Japan have already been detected. Two members of the Ugandan Olympic team tested positive for the coronavirus this week, despite having been fully vaccinated and having tested negative before their departure.

Mr. Anson said that it would be “naïve” not to anticipate new cases of coronavirus infections involving British athletes in the Olympic Village, which has a capacity of 18,000, and that “contingency plans” were necessary to manage any outbreaks.

In other news from around the world:

• Travelers who enter Taiwan will no longer be allowed to complete their mandatory two-week quarantine at home, the island’s government said on Friday. Instead, they must do so in designated hotels or centralized facilities. And if they have spent time in the two weeks before entering in any of seven “high-risk” countries — Bangladesh, Brazil, Britain, India, Indonesia, Israel and Peru — they must stay in quarantine centers, not in hotels. The new rules, which take effect on Sunday, are meant to keep out the Delta variant of the coronavirus. Taiwan’s daily case counts have fallen somewhat over the past few weeks, though health officials say caution is needed to prevent a resurgence.

• The Balearic Islands of Spain have been added to Britain’s list of destinations from which travelers do not have to quarantine upon return. The move is a boost to the summer season on the islands, including Majorca, Ibiza and Minorca, which are major tourism destinations in the Mediterranean. The revised British travel list also included Malta and will come into effect on June 30, London said.

The central business district and eastern suburbs of Sydney, Australia, will be locked down for at least a week after another daily surge in coronavirus cases linked to the Delta variant.

Officials in New South Wales, which includes Sydney and is Australia’s most populous state, announced an additional 22 cases on Friday, bringing the total number of cases to 65, the city’s largest outbreak in six months. They warned that many more cases were likely to emerge in the coming days because of a cluster centered on a hair salon that some 900 clients visited while several employees were infectious.

The lockdown will affect a large portion of Sydney’s five million residents since it applies to anyone who works in the city center. It comes on top of a return to mandatory mask wearing and a ban on travel outside the city, which were announced this week.

The new restrictions reflect a mix of widening concern about the infectiousness of the Delta variant — many of the confirmed infections appear to have occurred after only a few seconds of contact — and an effort to keep the outbreak contained.

Under the lockdown rules, anyone who works or lives in the affected areas must stay at home for all but essential activities, such as exercise and shopping for food. All businesses will be closed except those that provide essential services.

“We don’t want to see this situation linger for weeks,” the premier of New South Wales, Gladys Berejiklian, said on Friday. “We would like to see this situation end sooner rather than later.”

Officials are especially worried about a handful of possible superspreader locations, including a child’s birthday party last weekend where at least 17 attendees had tested positive as of Thursday evening. The rest of the people at the party are also expected to be infected, along with the household contacts of nearly everyone there.

The hair salon has the potential to add dozens or hundreds more cases. Everyone who passed through over the past several days has been asked to get tested and to isolate.

Astrid and Omar Thorpe, the owners of an ice cream shop in Brooklyn, have been holding on for this moment. New York City has been flung open.

The Thorpes, husband-and-wife owners of an ice cream shop in Brooklyn, were lucky enough to survive the uncertainty of the past 18 months. In some areas of Brooklyn, as many as 25 percent of businesses have closed permanently, according to Randy Peers, who works for the borough’s chamber of commerce.

For storefronts like Crème and Cocoa Creamery, the Thorpes’ shop, this is the summer of make or break.

The Thorpes exhausted much of their savings to stay open. Health emergencies — her brain aneurysm, his detached retina — sent them spinning. Parenting Josiah, 19; Ajani, 13; and Amara, 4, amplified the stress.

Finally, this spring, things began to look up. Restaurants asked to sell Crème and Cocoa’s products. Companies called about catering ice cream socials. VH1, on a recommendation from the digital publication Black-Owned Brooklyn, gave a small-business grant to the Thorpes.

This has all helped the Thorpes stay afloat while they churn out new flavors, like berry sangria sorbet and strawberry guava cocktail, bolster their social media game and research expansion possibilities. They are currently building a floating deck on a patch of dirt in the back for outdoor seating.

“Ice cream comes with an ambience; families want to come out and sit,” Mr. Thorpe said.