Three Ways to Improve Flu Shot Campaigns

Flu season is right around the corner. The COVID-19 pandemic has made it more important than ever to get the flu shot. Despite numerous efforts, flu vaccination rates in the United States have been mostly unchanged over the past decade. In fact, less than half of Americans get the vaccine each year. So, what can be done to change that?

Flu vaccination campaigns can try following these three simple steps to improve vaccination rates.

Step 1 - Focus the message on factors that drive a person’s motivation.

Most vaccination campaigns design their communication as reminders, which assumes the key barrier to getting the vaccine is forgetfulness. While it is important to make sure people are aware a vaccine is available and understand its benefits, this alone often does not dramatically improve vaccination rates. For example, in a national study of 228,000 elderly Americans, reminder letters sent by mail increased flu shot rates by just 1%.

Proven strategies from behavioral science can improve flu shot uptake. First, describe the flu shot as the standard of care, thereby providing an implicit recommendation to get vaccinated unless one opts out and accepts the risks. In a randomized trial among employees at a large University, flu vaccination rates increased by 36% for participants that were told they could opt-out of it compared to those who were told they had to opt into it.

Second, design the message to prompt action. Ask people to commit to a date and time to get the vaccine. They should either write it down and put it in a visible place (e.g. on the refrigerator) or schedule it in their electronic calendar. In a randomized trial among employees at a large company, this process increased vaccination rates by 13% on a relative basis compared to a control group.

Third, highlight the prosocial benefits of vaccination. Most messaging campaigns focus solely on the benefits of vaccination to the individual. Incorporating the benefits to others can help harness altruism. For example, the campaign could include the following: The flu shot can reduce the risk of getting and spreading the flu. This can protect both you as well as your close family members and friends.

Step 2 – Target your message.

People often ask: Can I design a single message that will appeal to many different audiences. The answer is usually - No. You are much more likely to be successful by delivering different campaigns to different groups.

Let’s use the elderly population as an example. The Centers for Disease Control and Prevention recommend that anyone age 65 or older get the ‘high dose’ of the flu shot. Since many flu shots are obtained from local pharmacies, it’s important patients know to check for the correct dose. Why not include this message in campaigns being sent to everyone? Well, there are at least two reasons.

First, it’s not relevant to younger people. It could distract from the main message or action step. The longer the message, the less likely one is to finish reading it. So you want to keep your text on point.

Second, it could lead to something know as the ‘boomerang effect’ - in which one is persuaded to do exactly the opposite of what was intended. Consider the case of a younger individual who learns that the elderly are particularly vulnerable and have higher benefits from receiving the flu shot. That person might infer that he or she is at lower risk or unlikely to get sick – and they might think of themselves as a “young invincible.”

When thinking about targeting your campaign, be careful not to rely solely on demographic information (e.g. gender, race/ethnicity). Instead focus on ways to identify different in risk and behavior.

Risk can be identified in different ways. For influenza, age is a key factor with elderly persons at higher risk. However, younger people who have weakened immune systems or respiratory conditions such as asthma are also at higher risk than a healthy person at the same age.

Previous behavior can help identify differences in motivation or barriers to vaccination. For example, someone who had a doctors visits last year and got the flu shot is much more likely to get it again this year than someone who didn’t. Messaging could be tailored to reinforce the former behavior (e.g. keep the streak going) or address the latter (e.g. make a change for the better).

Step 3 – Reinforce the message

Most flu shot campaigns are either delivered at one time or repeat the same message again as a reminder. Take the opportunity to reinforce your message but with new information or by prompting action.

For example, you might offer a new piece of data to demonstrate the risk such as: Did you know that last year in the US, nearly half a million people were hospitalized because of the flu.

Or you might time your message with the beginning of the month of October and leverage what’s know as the ‘fresh start effect.’ This is the tendency for people to engage in more aspirational behavior around temporal landmarks like the start of a new year, month, or week.


Flu vaccine campaigns are more important than ever to get right. It is possible to achieve higher vaccination rates by carefully designing the message. Focus on motivational drivers, target the message rather than sending the same content to everyone, and don’t forget to reinforce the message in a meaningful way.

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