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Nudging COVID-19 Vaccine Uptake by Changing the Default: A Randomized Controlled Trial

Author

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  • Katya Tentori

    (Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
    Centre for Medical Sciences (CISMed), University of Trento, Trento, Italy)

  • Stefania Pighin

    (Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy)

  • Giulia Giovanazzi

    (Provincial Authority for Health Services (APSS), Autonomous Province of Trento, Italy)

  • Andrea Grignolio

    (International MD Program, Vita-Salute San Raffaele University, Milan, Italy
    Interdepartmental Center for Research Ethics and Integrity, National Research Council (CNR))

  • Benjamin Timberlake

    (Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy)

  • Antonio Ferro

    (Provincial Authority for Health Services (APSS), Autonomous Province of Trento, Italy)

Abstract

Background Although vaccination against SARS-CoV-2 is considered the central strategy against the pandemic, uptake lags behind target rates. Method To explore whether this rate could be enhanced by a nudging strategy that exploits the status quo bias, we conducted a randomized controlled trial in northern Italy comparing vaccination acceptance among 2000 adults, ages 50 to 59 years, who were either invited to set an appointment (opt-in group) or assigned an individual appointment (opt-out group). Results Results indicate a difference of 3.2 percentage points, which represents a 32% relative increase in the vaccination rate for the opt-out group compared with the opt-in group. Conclusions A significant portion of those who remain unvaccinated may not hold strong beliefs against vaccination but rather tend to inaction and may therefore be nudged toward vaccination with a reduction of action required. Highlights Reluctant adults (50-59 years), who had not yet received vaccines against COVID-19, were sent letters announcing appointment availability In an RCT, the status quo option in the notices influenced the rate of vaccine acceptance Nudging via pre-scheduled appointments encouraged vaccine uptake more than invitations to schedule did Switching the default option yielded a 32% relative increase (13.1% vs. 9.9%) in vaccination

Suggested Citation

  • Katya Tentori & Stefania Pighin & Giulia Giovanazzi & Andrea Grignolio & Benjamin Timberlake & Antonio Ferro, 2022. "Nudging COVID-19 Vaccine Uptake by Changing the Default: A Randomized Controlled Trial," Medical Decision Making, , vol. 42(6), pages 837-841, August.
    • Handle: RePEc:sae:medema:v:42:y:2022:i:6:p:837-841
    DOI: 10.1177/0272989X221101536
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    Cited by:

    1. Jakob Moeller & Martin Halla & Tobias Thomas, 2026. "Pre-Booked Vaccination Appointments as a Nudge: Evidence from a Nationwide Intervention," Graz Economics Papers 2026-10, University of Graz, Department of Economics.
    2. de Ridder, Denise & Adriaanse, Marieke & van Gestel, Laurens & Wachner, Jonas, 2023. "How does nudging the COVID-19 vaccine play out in people who are in doubt about vaccination?," Health Policy, Elsevier, vol. 134(C).
    3. Moeller, Jakob & Halla, Martin & Thomas, Tobias, 2026. "Pre-booked vaccination appointments as a nudge: Evidence from a nationwide intervention," DICE Discussion Papers 436, Heinrich Heine University Düsseldorf, Düsseldorf Institute for Competition Economics (DICE).
    4. Serhiy Inozemtsev, 2025. "Integration of behavioural insights into a general theory of health economic policy," E-Forum Working Papers, Economic Forum, vol. 15(3), pages 97-111, September.

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