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Nationwide demonstration of improved COVID-19 vaccination uptake through behavioural reminders

Nature Human Behaviour (2025)Cite this article

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Abstract

Here we report the results of two nationwide randomized controlled trials. By refining behavioural-science-informed text messages notifying patients of their vaccine eligibility, we observed improvements in vaccination rates. The randomized controlled trials involved adults aged 40–44 years (n = 1,825,937) and 24–29 years (n = 2,174,064) in England. Messages emphasizing ‘Top of queue’ status led to small, but policy-relevant, increases in vaccination rates in both the 40–44 age group (odds ratio 1.02, 95% confidence interval 1.01–1.03) and the 24–29 age group (odds ratio 1.02, 95% confidence interval 1.01–1.04). Consequently, the ‘Top of queue’ message was nationally rolled out to other age groups. These findings demonstrate the potential of ‘queue’ framing in relevant contexts and the value of rigorous testing of public health messaging.

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Fig. 1: Trial profile for study 1.
Fig. 2: Adjusted percentage point change in vaccination rate within 14 days for each treatment text message reminder compared with control text message reminder in study 1, with 95% CIs.
Fig. 3: Trial profile for study 2.
Fig. 4: Adjusted percentage point change in vaccination rate within 14 days for each treatment text message reminder compared with control text message reminder in study 2, with 95% CIs.

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Data availability

All data requests should be submitted to NHS England (the data controller) for consideration. Access to the raw anonymized data may be granted for non-commercial research at the discretion of NHS England. Further information can be obtained from the corresponding author.

Code availability

Custom code that supports the findings of this study is available via GitHub at https://github.com/BehaviouralInsights/Nature-Human-Behaviour-Beherendt-et-al-2005.

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Acknowledgements

The trials were funded by the UK Department of Health and Social Care and NHS England and NHS Improvement. We thank C. Bemand, M. Egan, H. Fowler, C. Gilbert, Z. Goozee, M. Hallsworth, I. Ifeacho, M. Kane, B. King, C. Kume-Holland, J. Lawrence, I. McAloon, T. McMaster, S. Merriam, R. Rackham, B. Reitsma, A. Sandrawich, P. Shrestha, V. Susanina, A. Sutherland, J. Tilbury, J. Whitwell-Mak, D. Wilson, A. Worsley and F. Young for their contributions.

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Authors and Affiliations

  1. The Behavioural Insights Team, London, UK

    Hannah Behrendt, Giulia Tagliaferri, Lev Tankelevitch, Yihan Xu & Hugo Harper

  2. London School of Economics and Political Science, London, UK

    Natalie Gold

  3. Behavioural Practice, Verian, London, UK

    Natalie Gold

  4. UK Health Security Agency, London, UK

    Dale Weston

  5. NHS England, London, UK

    Rachel Rosen & Robert Scott

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  1. Hannah Behrendt
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Contributions

H.B., G.T., Y.X., H.H., N.G., D.W., R.R. and R.S. conceived the study and contributed to the study design. H.B., G.T. and Y.X. developed the trial protocol. H.B. and G.T. were responsible for the study implementation and project management for studies 1 and 2. G.T., L.T. and Y.X. conducted the statistical analysis for study 1. G.T. and Y.X. conducted the statistical analysis for study 1. H.B., G.T., L.T. and Y.X. contributed to the interpretation of the data and the writing of the paper. All authors were responsible for editing and approving the paper.

Corresponding author

Correspondence to Hannah Behrendt.

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The authors declare no competing interests.

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Nature Human Behaviour thanks Gretchen Chapman and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary information

Supplementary Information

Supplementary methods, results, Figs. 1 and 2 and Tables 1–16.

Supplementary Table 1

Supplementary tables—exploratory analysis of heterogeneous treatment effects.

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Behrendt, H., Tagliaferri, G., Tankelevitch, L. et al. Nationwide demonstration of improved COVID-19 vaccination uptake through behavioural reminders. Nat Hum Behav (2025). https://doi.org/10.1038/s41562-025-02165-x

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