Text reminders about COVID-19 boosters are as effective as free rides, new research shows

In the first 10 months of availability, COVID-19 vaccines prevented approximately 235,000 deaths and 1.6 million hospitalizations in the US. However, as of April 2023, 19% of Americans had still not received their first vaccine dose and 65% had not received all of their vaccinations. recommended boosters, leading to tens of thousands of preventable deaths. With annual booster recommendations likely, increasing booster intake is essential to prevent future hospitalizations and deaths.

New research led by Katy Milkman of the University of Pennsylvania looks at the effectiveness of vaccination efforts against COVID-19.

“For our megastudy, we partnered with CVS and purchased rides from Lyft to see if reducing the friction associated with getting to and from a vaccination appointment could make a difference,” said Milkman, the James G. Dinan Professor at Penn’s Wharton School. and co-director of the Behavior Change for Good Initiative at Penn, where this study was conducted. “And to our surprise, there was no additional benefit of the free transportation besides sending a reminder.”

The studypublished in the magazine Nature, included a large-scale field experiment involving 3.66 million CVS Pharmacy patients who had previously received their primary COVID-19 vaccination series. Participants received various text reminders encouraging them to get the recommended COVID-19 booster, with some also being offered free Lyft rides to their vaccination appointments.

Despite high expectations from behavioral science experts and lay forecasters alike, results showed that offering free transportation to vaccination sites did not increase vaccination rates more than simply sending well-designed reminder messages. Milkman and her team found that their text message reminders increased uptake of the 30-day COVID-19 booster by an average of 21% and had a positive spillover effect, increasing flu vaccinations by 8% after 30 days.

The researchers identified three types of reminder messages that were most useful in increasing vaccination rates: messages that encouraged recipients to create a vaccination plan that suggested a specific date, time and location based on their last vaccination; messages highlighting high local transmission rates of COVID-19; and messages sent on behalf of the patient’s local pharmacy team.

Milkman says that if, for example, someone’s last vaccine was at a specific CVS ​​on Tuesday at 3 p.m., the next reminder would be closely tied to that time and location, assuming that’s likely an appropriate time and place.

“Another message highlighted the high infection rates in their country, and the third message was intended to give the feeling that it came from their local pharmacy team, letting them know a vaccine had been reserved for them,” Milkman said.

The study’s data analysis found that while all text message reminders increased vaccination rates, the messages offering free Lyft rides to and from vaccination sites did not provide any measurable benefit over the reminders alone, indicating that the main barrier to the COVID booster vaccination is not transportation.

“This kind of science is very important because the government has invested heavily in free-ride programs,” says Milkman. “It is critical to understand what works and what doesn’t so we can avoid wasting resources and better address the problem. Our study contributes to this by showing that reducing transportation barriers is not the most important lever which we must use now.”

Looking ahead, Milkman and her team at the Behavior Change for Good Initiative believe that future research should explore more varied strategies to increase vaccination rates. For example, it might be worth exploring the value of mobile vaccination units that bring vaccines directly to communities, especially in underserved areas.

Furthermore, studying more personalized communication methods from a variety of trusted sources, alternative incentives, and other behavioral impulses designed to address specific barriers to vaccination could provide valuable new insights.

“There is always more to learn about what motivates people and how we can effectively encourage health-promoting behaviors,” says Milkman.