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Nature has published a large study showing that text message reminders to receive a COVID-19 booster worked to increase vaccine uptake, but that offering free rides to pharmacies did not. 

The study was based on outcomes seen among 3.66 million CVS Pharmacy patients in the United States who were offered free round-trip Lyft rides via text to CVS Pharmacies for vaccination appointments and received seven different sets of behaviorally informed vaccine reminder messages. 

Though millions of Americans took the initial series of COVID-19 vaccines, subsequent booster doses have been less popular. In the fall of 2022 and 2023, less than 20% of Americans received bivalent boosters, the authors said.

“This raises the question of how COVID-19 booster vaccination can be increased,” the authors said. “Although vaccine mandates are effective, they are not always popular or feasible, Moreover, in the United States, cash incentives for vaccination have proven surprisingly ineffective.”

Text messages resulted in additional 30,000 vaccinations 

Text messages and removing transportation hurdles to vaccination appointments were two methods suggested as possible ways to increase booster uptake. The megastudy, conducted in the autumn of 2022, looked at multiple interventions to increase vaccine update, and relied on CVS vaccine records to account for vaccine update in the 30 days post-intervention. Free Lyft rides and a series of seven text messages, all meant to convey to patients that a vaccine was ‘recommended’ and ‘waiting for you,’ were tested. 

They found text messages increased the 30-day COVID-19 booster uptake by 21% (1.05 percentage points) and spilled over to increase 30-day influenza vaccinations by 8% (0.34 percentage points), resulting in additional 33,864 COVID-19 booster vaccinations and 10,756 flu vaccinations. But when the messages included the free Lyft ride offer, no increase in uptake from the baseline message was observed.

These extra vaccinations probably prevented an estimated 1,857 infections.

“Because COVID-19 booster vaccinations reduce infections by at least 43% compared with individuals who received their last monovalent COVID-19 dose at least 8 months before, these extra vaccinations probably prevented an estimated 1,857 infections,” the authors concluded.