Add post: People just go straight for the green button (#274)

Co-authored-by: Caroline Finucane <[email protected]>

Author: frankieroberto

app/vaccinations/2025/10/how-we-responded-to-the-covid-19-booster-confusion/NBS.png

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+---
+title: How we responded to the COVID-19 booster confusion
+date: 2025-10-23
+---
+
+**This autumn, as the COVID-19 vaccination programme launched, our digital services team needed to move quickly to respond to confusion around eligibility.**
+
+Many patients turned up at pharmacies expecting to receive a booster, but had to be turned away.
+
+![Screenshot of a news headline with the title 'Pharmacies acing angry patients over COVOD-19 jab'](headline.jpg)
+
+We needed to act fast to help reduce pressure on community pharmacies and offer clarity for patients.
+
+Many of the ineligible people coming forward had likely come through our own booking service, which is intentionally designed to let people self-refer if they believe they are eligible. 
+
+## Why this confusion happened
+
+This year, the Joint Committee on Vaccination and Immunisation (JCVI) changed eligibility rules for COVID-19 boosters.
+
+The age threshold rose from **65 to 75**, meaning many people who had qualified last year were no longer eligible.
+
+[We published guidance on NHS.UK](https://www.nhs.uk/vaccinations/covid-19-vaccine/) and GOV.UK, but the shift caught many off guard. Here's what some users told us in the booking exit survey (1 Sept to 5 October):
+
+> I do not understand why I do not qualify too, especially as I am 67
+
+> If something has changed, it would be kind to inform people that they are no longer at significant risk
+
+## What we did
+
+We - Vaccination Digital Services - acted quickly to support patients and pharmacy teams, by:
+
+- **sending targeted follow-up messages** to around 250,000 people under 75 with upcoming bookings, explaining the updated eligibility rules and setting expectations
+- **updating confirmation messages** in the booking service to reinforce the change
+- **working with Community Pharmacy England** to create [resources to help pharmacy teams](https://cpe.org.uk/our-news/c-19-vac-eligibility-resources-to-help-pharmacy-teams/)
+- **adding a warning to the** [flu booking start page](https://www.nhs.uk/nhs-services/vaccination-and-booking-services/book-flu-vaccination/), reminding users to check COVID-19 eligibility before booking
+- **updating national invitations** to make the change in eligibility clearer
+
+Mindful of the frustration people were feeling, we wanted the tone of our email to reflect that. It was a slight shift from our [usual voice](https://service-manual.nhs.uk/content/voice-and-tone) - more empathetic, more human - and it felt right for the moment:
+
+> We understand this might be confusing, especially if you had the vaccine last year.
+
+![Screenshot of the targeted follow-up messages we sent out](comms.png "The follow-up messages we sent, to set expectations")
+
+![Screenshot of the amended booking service start page](flu-start-page.png "Our warning on the flu booking start page")
+
+## What we know
+### Many people go straight for the green button
+
+While the COVID-19 vaccination booking service automatically screens out users who are not eligible by age, the [flu vaccination booking service](https://www.nhs.uk/nhs-services/vaccination-and-booking-services/book-flu-vaccination/) allows users to **self-refer** for a COVID-19 booster if they believe they meet the criteria.
+
+This is needed because many people want the convenience of arranging both vaccinations in one go - ideally to have at the same appointment. We need to make that process as smooth as possible for those who are eligible.
+
+We made the criteria as clear as possible, using a prominent yellow [warning callout](https://service-manual.nhs.uk/design-system/components/warning-callout). But it's possible many people simply didn't read this or understand it, or just clicked through anyway.
+
+> No proper information on eligibility. Just a yes/no question
+
+> I wanted to see more detail on eligibility criteria
+
+We're waiting for more data to back this assumption - but this is something researchers see time and again: users skip the content and head straight for the green button — and designers always have to plan for it.
+
+![Screenshot of the self-referral screen](NBS.png "Our flu booking service asks users if they'd also like a COVID-19 vaccine. We think many ineligible people clicked through.")
+
+[We saw this pattern in the COVID testing service too](https://digital.nhs.uk/blog/design-matters/2022/covid-19-testing-tackling-eligibility): once users are familiar with a digital service and have seen an interruption screen before, they're more likely to ignore it, even if content has changed. They assume they've read it before.
+
+### 'Immunosuppressed' is a grey area
+
+But it's likely the confusion wasn't *just* about age.
+
+Every season, it seems that some patients self-refer believing they have a weakened immune system that qualifies them for the jab -  but in fact they do not, or no longer, meet the criteria. For example, someone who recently came off treatment might not realise they're no longer eligible.
+
+> I’m asthmatic. Got to the time section. Got thrown off. Filled out details and said not eligible. I've had it every year for as long as I remember.
+
+> I have to rank as very [disappointed] as I find I am not eligible despite a number of health conditions including cardiac, respiratory and diabetes.
+
+> Incomplete list of immune conditions left me uncertain as to whether I am eligible or not
+
+It's always a challenge to help people determine whether they have a [weakened immune system because of a health condition or treatment](https://www.nhs.uk/vaccinations/covid-19-vaccine/), because this is ultimately determined by a clinician. We can't publish a definitive list for people to check agains.
+
+## What we've learned - and what we'll do next time
+
+But let's focus on what we can do.
+
+Now we know: **when eligibility rules change, clarity matters more than ever.**
+
+We've learned that:
+- people often don’t read content, especially if they’ve seen similar screens before
+- even well-placed messaging can be missed or misunderstood
+- many people don't know if they qualify for an NHS vaccination
+
+And next time, we will:
+- **make it clear that things have *changed***, not just what the new rules are
+- **personalise communications** where possible (e.g. “Because you’re under 75…”)
+- **align national messaging and digital services** more closely to set expectations
+
+These lessons will shape how we communicate eligibility in future campaigns, and in the upcoming [Check and book an RSV vaccination service](https://www.service-catalogue.nhs.uk/services/check-my-vaccination-record) in the NHS App, currently in alpha.
+
+We're constantly learning and improving how we design digital services. As we work to increase uptake of seasonal vaccinations, we also have a responsibility to support those who are no longer eligible - with clear, compassionate communication that helps everyone understand where they stand.
+
+