Behavioural nudges increase COVID-19 vaccinations

Enhancing vaccine uptake is a critical public health challenge 1 . Overcoming vaccine hesitancy 2 , 3 and failure to follow through on vaccination intentions 3 requires effective communication strategies 3 , 4 . Here we present two sequential randomized controlled trials to test the effect of behavioural interventions on the uptake of COVID-19 vaccines. We designed text-based reminders that make vaccination salient and easy, and delivered them to participants drawn from a healthcare system one day (first randomized controlled trial) ( n = 93,354 participants; clinicaltrials number NCT04800965) and eight days (second randomized controlled trial) ( n = 67,092 individuals; clinicaltrials number NCT04801524) after they received a notification of vaccine eligibility. The first reminder boosted appointment and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder had a greater effect when it was designed to make participants feel ownership of the vaccine dose. However, we found no evidence that combining the first reminder with a video-based information intervention designed to address vaccine hesitancy heightened its effect. We performed online studies ( n = 3,181 participants) to examine vaccination intentions, which revealed patterns that diverged from those of the first randomized controlled trial; this underscores the importance of pilot-testing interventions in the field. Our findings inform the design of behavioural nudges for promoting health decisions 5 , and highlight the value of making vaccination easy and inducing feelings of ownership over vaccines. Two randomized controlled trials demonstrate the ability of text-based behavioural ‘nudges’ to improve the uptake of COVID-19 vaccines, especially when designed to make participants feel ownership over their vaccine dose.