Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 371

In the United States, 10.5 % of all children under 18 years had no health care visit
to an offi ce or clinic within the past 12 months, rising to 43 % among uninsured
children (National Center for Health Statistics 2011 ).
Vaccination discussion . Every health care visit is an opportunity to discuss vaccination.
But while most physicians routinely check immunization at wellness or health mainte-
nance visits, far fewer discuss vaccination during illness or acute care visits, in which
urgent concerns dominate (Schaffer et al. 2001 ; Szilagyi et al. 2005 , 2008 ; Humiston
et al. 2009 ). And wellness visits are less frequent than illness visits, especially among
adolescents, for whom only 9 % of visits were for preventive care (Rand et al. 2007 ).
The effectiveness of patient reminder and recall systems for improving vaccination
rates in primary care is reviewed by Jacobson and Szilagyi ( 2005 ).
Vaccination decision . A vaccination discussion may or may not result in a decision to
get vaccinated. Among adolescent girls (11-17 years) in the United States, 26 %
were recommended to receive the HPV vaccine by their health care provider, but
only 49 % of them actually received the HPV vaccine (Palli et al. 2010 ).
Vaccination can be voluntary or mandatory. Mandatory vaccination may be
imposed by legislation and private organizations. All 50 US states require certain
vaccinations for children entering public schools. 7 State mandates also exist for
entry to colleges and universities, 8 long-term facilities, health care workers, 9 and
other groups. However, many jurisdictions allow exemptions from vaccination
requirements for medical or religious reasons, or when parents have philosophical
or personal belief objections to vaccination. 10
Compliance . Compliance is an issue whenever two or more doses and correspond-
ing visits are required for effective vaccination. A study in the context of the three-
dose HPV vaccination found that 72 % of US female adolescents (11-21 years)
would need to make three visits in addition to their habitual physician visits if the
vaccine were initiated at a preventive visit (Rand et al. 2007 ). Another study among
young women (18-24 years) recruited by a university health clinic who were offered
the three-dose HPV vaccine series for free found that just over half (50.7 %) received
the fi rst dose, 78.3 % of whom returned to receive the second dose, and 55.7 % of
these returned for the third dose (Moore et al. 2010 ).
7 Depending on the state, children must be vaccinated against some or all of the following diseases:
mumps, measles, rubella, diphtheria, pertussis, tetanus, and polio .
8 For example, state legislation in California requires that all students 19 years in state universities and
the UC system provide proof of hepatitis B vaccination or a waiver. http://www.immunize.org/
laws/hepbcollege.asp , accessed June 13, 2011.
9 For example, New Hampshire requires that all hospital employees and inmates receive fl u
vaccination.
10 http://www.vaccinesafety.edu/cc-exem.htm , accessed June 13, 2011.