Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 370

characteristics of the vaccine target group (e.g., age and risk status), the country or
region, and the disease threat. In the United States, purchases through public sector
programs account for slightly more than half of the market (in number of doses) for
pediatric vaccines (for children 0-6 years of age), decline to one-third for adoles-
cent vaccines (7-18 years of age) (Shen et al. 2009a , b ), with public fi nancing for
adult vaccines lagging behind (Orenstein et al. 2007 ). When a vaccine is indicated
for multiple age groups, who pays often depends on the age of the vaccinated per-
son. For example, public programs pay for HPV vaccines for many adolescent
women but not for uninsured adult women (KFF 2011 ). The importance of private
vs. public buyers and payers also varies across countries and regions. In the Africa-
Middle East-Eastern Europe region, the private/public shares are estimated at
26/74, compared to 55/45 for the Asia-Pacifi c region (Sanofi Pasteur 2009 ). Public
players generally dominate when there are pandemic disease threats, as was the case
for the 2009/2010 H1N1 infl uenza. Decisions made by public customers infl uence
decisions in the private market. For example, private insurers in the United States
tend to cover vaccines recommended for public purchase.

13.3.2 Consumers

Global vaccination rates for some vaccines and subgroups infants and children
are high, e.g., 85 % for DTP, 86 % for polio, 85 % for measles, and 75 % for
hepatitis B. But vaccination rates vary greatly across regions, countries (WHO
2011 ), and within countries. For example, the 2009 pandemic fl u vaccination rate
ranged between 4.8 and 92 % across 12 countries and different population sub-
groups (Brien et al. 2012 ). The 2010 US national vaccination rate of children
aged 19-35 months with pneumococcal conjugate vaccine was 83.3 %, ranging
from 70.8 % in Nevada to 91.1 % in Connecticut (Centers for Disease Control
and Prevention 2011 ). Similar disparities in vaccination rates exist for other
types of vaccines.

13.3.2.1 The Consumer Vaccination Decision Process

Why do some people get vaccinated and others not? To get vaccinated, an individual
must engage in a number of behaviors including (1) accessing the health care sys-
tem, (2) discussing vaccination with a health care professional, (3) deciding to get
vaccinated, and (4) complying with vaccination.

Health care system access . Whereas children in high-income countries typically
undergo a series of routine visits with health care professionals such as pediatri-
cians, many children in low-income countries do not have access to the health
care system. But even in high-income countries not everybody receives health care.