Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 374

(23 %), relaxed (34 %), and unconvinced (10 %). Gust et al. ( 2005 ) identifi ed fi ve
parent segments: immunization advocates (33.0 %), go along to get alongs (26.4 %),
health advocates (24.8 %), fence-sitters (13.2 %), and worrieds (2.6 %).
Most studies have been conducted about attitudes toward vaccination against
specifi c diseases, and have generally found strong associations between attitudes,
underlying beliefs, and vaccination intentions and behaviors. These associations
hold both for persons who are not health care professionals (see, e.g., Dekker 2006 ;
Flood et al. 2010 ; Galarce et al. 2011 ; Raude et al. 2010 ), and for decisions of health
care professionals to get vaccinated (e.g., Maltezou et al. 2010 ; To et al. 2010 ;
Betsch et al. 2011 ).
Attitudes toward vaccination are based on perceived positive (benefi ts) and nega-
tive (barriers) outcomes of vaccination, and their importance. Positive perceived
outcomes include the effi cacy of the vaccine to prevent the disease, avoid its spread
to others, reduce its severity and school and work absenteeism. Negative perceived
outcomes include the possibility that the vaccine itself may cause the disease which
it should prevent, cause side effects such as transient swelling, redness, or fever,
alleged but unfounded side effects such as autism or multiple sclerosis, 12 weaken the
immune system, is painful, costly, and inconvenient (nonfi nancial costs).
One generally fi nds that persons who perceive more positive and less negative
outcomes show higher vaccination intentions and behaviors than persons with less
positive and more negative beliefs. For example, parents who delayed and refused
vaccines for their children were perceiving fewer vaccine benefi ts and were more
likely to have vaccine safety concerns compared with parents who neither refused
nor delayed vaccines (Smith et al. 2011b ; see also Salmon et al. 2005 ). The belief
that products may cause the very harm they are supposed to prevent violates
consumers' trust and represents a “safety product betrayal.” Safety product
betrayals have been shown to cause negative emotions such as anger, resentment,
anxiety, fear, sadness, disgust, and increase the tendency to choose options that
provide less overall protection in order to eliminate a very small probability of
harm due to safety product betrayal (Koehler and Gershoff 2003 ; Gershoff and
Koehler 2011 ).
The perceived risk of a vaccine can vary across different ethnic groups
(Timmermans et al. 2005 ). Different cultural values can generate divergent percep-
tions of the risks and benefi ts of a vaccine (Kahan et al. 2010 ), and disease preva-
lence may change the relative importance of effi cacy and side effect beliefs. When
prevalence is low (high), people worry more about the side effects (effi cacy) than
about effi cacy (side effects) (Lantos et al. 2010 ).
The perceived fi nancial costs of vaccination are directly infl uenced by a con-
sumer's reimbursement regime. HPV vaccination initiation was higher for girls with
more generous reimbursement regimes, and for girls that were informed personally
about the reimbursement rules (Lefevere et al. 2011 ).
12 A comprehensive review by the IOM (Institute of Medicine) ( 2011 ) concluded that the evidence
favors rejection of a causal relationship between measles-mumps-rubella (MMR) vaccine and
autism, and that there is inadequate evidence to accept or reject a causal relationship between hepa-
titis B vaccine and multiple sclerosis.