Electronic messages shown to improve influenza vaccination rates in nationwide Danish study

Roughly one billion persons are contaminated with influenza world wide annually, with greater than half 1,000,000 deaths estimated to outcome from the illness. Regardless of the illness’s potential severity, particularly amongst older populations and people with cardiometabolic threat components, roughly 30 p.c of U.S. adults over age 65 weren’t vaccinated through the 2019-2020 flu season.

To guage greatest methods for growing vaccination charges, researchers from Brigham and Girls’s Hospital, a founding member of the Mass Normal Brigham healthcare system, collaborated with Danish researchers to develop and implement a nationwide trial in Denmark testing 9 totally different digital messaging ways amongst adults over age 65.

Their findings, revealed in The Lancet, establish two forms of digital letters that resulted in modest however statistically important will increase in vaccination charges, particularly amongst sufferers who had not acquired the flu vaccine the earlier 12 months.

“This was a first-of-its-kind nationwide implementation trial to assist deal with the very topical subject of overcoming vaccine hesitancy at a nationwide stage,” mentioned co-author Muthiah Vaduganathan, MD, MPH, of the Division of Cardiovascular Medication. “Digital letters are a low-cost intervention that may attain throughout a inhabitants and have significant implications. Our efforts present that mass communication methods are possible and may be rigorously examined, and we imagine comparable fashions ought to be examined within the US and different nations as properly.”

Specifically, the trial discovered that emphasizing the potential cardiovascular advantages of vaccination and a repeat-letter technique with a 14-day follow-up letter resulted in 0.89 p.c and 0.73 p.c will increase in vaccinations, respectively, in contrast with a usual-care group. The standard-care group acquired a letter sometimes despatched by the Danish Well being Authority underneath Denmark’s common well being system, which supplies free influenza vaccines.

Notably, these with out influenza vaccination within the prior season had a 2.46 p.c absolute enhance in vaccine uptake with the cardiovascular-themed letter, highlighting that this messaging technique could possibly be an efficient intervention in a vaccine-hesitant group.

Vaduganathan, as co-director of the Brigham’s Heart for Cardiometabolic Implementation Science, labored with different Brigham researchers, investigators on the College of Copenhagen and others to design the research’s digital messages based on behavioral science ideas.

In the course of the 2022-2023 influenza season, the research group labored immediately with the Danish Well being Knowledge Authority and Statens Serum Institute, the Danish authority accountable for infectious illness preparedness, to implement the trial, known as the Nationwide Utilization of Danish Authorities Digital Letter System for Rising InFLUenza Vaccine Uptake (NUDGE-FLU) trial.

“Even small will increase in influenza vaccination charges could have necessary public well being implications when utilized at a inhabitants stage, together with prevention of quite a few deaths, hospitalizations and diseases,” mentioned first writer and coordinating investigator Niklas Dyrby Johansen, MD, of the Heart for Translational Cardiology and Pragmatic Randomized Trials on the College of Copenhagen.

Whereas the noticed enchancment in vaccine uptake was slight, its potential affect is excessive whereas being extraordinarily low-cost. In accordance with U.S. Facilities for Illness Management and Prevention information, a 0.89 p.c absolute enhance in vaccination charge may forestall 7,849 diseases, 4,395 medical visits, 714 hospitalizations, and 66 deaths annually within the U.S. If 112 digital letters are wanted to encourage one extra vaccine, the price of encouraging every extra vaccine is lower than 5 {dollars}.

Of observe, necessary variations between Denmark’s common well being system and the U.S. well being system could restrict the interpretation of those outcomes. At baseline, Denmark’s vaccination charges in adults over 65 are roughly 75 p.c, increased than within the U.S., and attitudes towards vaccination could differ. Moreover, the U.S. doesn’t have a centralized communication platform analogous to the one utilized by the Danish authorities for precedence notifications.

Nonetheless, the authors observe that a big proportion of the U.S. inhabitants could possibly be reached with text-message platforms sometimes used to alert populations of native emergencies, in addition to messages deployed by giant insurers to their lined populations.

“NUDGE-FLU underscored the feasibility of conducting large-scale nationwide implementation trials within the common Danish well being system,” mentioned chief investigator and senior writer Professor Tor Biering-Sørensen, MD, MSc, MPH, Ph.D., of the Heart for Translational Cardiology and Pragmatic Randomized Trials on the College of Copenhagen. “Hopefully, it will set the stage for future NUDGE trials in different affected person populations.”