vaccination text effort

A recent study that was co-authored by Brigitte Madrian, BYU Marriott School dean, showed that certain text message reminders could increase vaccination rates by up to 11%. The study was done with the flu vaccine to see how text messaging could possibly aid COVID-19 vaccination efforts.

When looking at the COVID-19 vaccination rates for the state of Utah, the seven-day average has been trending downward since April 11. While this decrease may be related to the recent pause of the Johnson & Johnson vaccine, a recent study that was co-authored by a BYU professor showed that text message reminders could have an impact on vaccination rates.

The study involved flu vaccines and how people responded to messaging that might encourage them to get the flu vaccine. The goal was to help inform efforts in 2021 with the COVID-19 vaccine, aiding in the distribution and administration.

“What we’re seeing with COVID-19 vaccination rates here in the state of Utah is a peak about three weeks ago,” said Brigitte Madrian, BYU professor, Marriott School dean, and co-author of the study. “They’ve been coming down, part of that was because the Johnson & Johnson vaccine was briefly pulled off the market, but even still if you go onto the website to sign up for vaccines there are a lot of empty appointments available. The people who were really gung ho about getting the vaccine have been vaccinated and then there is this small segment of the population who will probably never get vaccinated because they object. Then there is kind of this big middle group of the population, maybe 40% of the population, that is completely open to getting vaccinated, they just haven’t gotten around to sign up for it even though we have vaccine availability in the state.”

The broader question around the study involved helping to close the gap between the good intentions people have, what would be of interest to public health, and what people actually do, according to Madrian.

While some people may want to get vaccinated, they may forget or procrastinate. So the study evaluated ways to close the gap between intention and action.

“The study examined 19 different types of text messages,” Madrian said. “Text messages are not the only way to remind people, but it turns out that this was a convenient way that leant itself to a very large study, low-cost, scalable type of intervention. Of those 19 different approaches, about half of them were effective at increasing flu vaccination rates in the fall.”

The most effective text message was one that included a message about the doctor having a flu vaccine reserved for the person, creating a feeling of obligation to help people follow through on those good intentions.

Madrian was involved with one of the text messages that included a short text message quiz where people were asked questions about some recent health behaviors. One of the questions Madrian brought up included a question about whether or not a person had enough servings of fruits that day.

After answering a number of questions, people got a text about receiving their flu vaccine and how it is an easy way to stay healthy.

As far as the similarities and differences between the two vaccines, Madrian spoke to the many similarities including the vaccines being free or very low cost and the two being given in mass quantities.

With the vaccines being free or low-costing, Madrian said it is more a matter of convincing people to get them.

“COVID-19 is much more consequential than the flu, Madrian said. “The mortality rate from contracting COVID-19 is higher than the mortality rate from the flu, so there are many more people that are highly motivated to get a COVID-19 shot than a flu shot in any given year.”

The text messaging proved that vaccination rates could be increased by up to an average of 5%.

The more narrow goal of the study, according to Madrian, was to show that there is a tool that could bump the rates up, not necessarily to 100% but it will move the needle. The broader goal and message was to show that getting people to receive the vaccine is fundamentally a behavioral problem that is about getting people to change their behavior.

“This is only one of many different approaches that might work to increase vaccination rates,” Madrian said.

She also pointed to employers that bring flu vaccine clinics to the workplace, encouraging employees to receive the vaccine while also making it easy to access. She believes this may be the move to boost vaccination rates going forward, having smaller clinics that are approximate to people’s daily activities.

It gives those people an opportunity to say, “Well, I haven’t received my COVID-19 vaccine yet, why don’t I get it right now?”

This has been shown recently through walk-in appointments being made available in the state of Utah. People don’t need to create an appointment to receive the vaccination, they only need to show up and get it.

For more information on the COVID-19 vaccine, visit