Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 399

often means that there is a private market alongside the public market. Vaccine mar-
keters must therefore direct sales efforts at public payers, private insurers, employers
(for workplace immunization), health care professionals, and consumers. This situa-
tion and the communications strategies and tactics employed by vaccine marketers
are very similar to those of therapeutics marketers, and marketing and sales expendi-
tures also reach similar levels. For example, the communication strategies employed
by Merck for its HPV vaccine Gardasil were comparable to those used for block-
buster therapeutics, earning Gardasil the “Brand of the Year” award (Herskovitz
2007 ), the General Manager of Merck's HPV Franchise the “Marketer of the Year”
award (Applebaum 2007 ), in addition to the accusation that the campaign “undercut the
most cost-effective and appropriate use of new agents to the detriment of adolescent
health” (Rothman and Rothman 2009 ).

13.4.7 Distributing Vaccines

Vaccinations are administered in a variety of settings including physician offi ces,
pharmacies, supermarkets and other stores, the workplace, and schools. Easy access
(minimal travel time and costs) to vaccination settings is important, which is not
always the case, especially in low-income countries. In a study in rural Pakistan, only
39 % of enrolled children completed DTP3, and completion was higher among
children who were living 10 min away from an immunization center (Usman et al.

2010 ). In emergency situations such as a pandemic, public health authorities typically
expand the number and types of vaccination settings in order to increase the speed and
rate of vaccination coverage.
Vaccines vary in stability and, thus, shelf life. Maintaining a cold chain that is
robust, reliable, and routinely monitored for possible deviations is essential (Smith
et al. 2011a ). A recent report points out that vaccines that do not need refrigeration and
may be administered orally or intranasally “could dramatically transform the immu-
nization landscape, removing or considerably lessening the logistical challenges,
training requirements, and potential safety challenges related to vaccine management
and administration” (Institute of Medicine 2010 , p. 210).
When its transportation and storage requirements exceed the capabilities of
the supply chain participants, the commercial success of a vaccine is compromised.
The need to remain frozen until used represented an important handicap for the suc-
cess of MedImmune's nasal spray fl u vaccine FluMist, in addition to its high price.
Many practices were lacking freezers, and many of those who did have freezers
received FluMist in containers that were too big to fi t into them (Appleby 2004 ).
FluMist's sales increased signifi cantly once it was reformulated for storage in a
refrigerator rather than a freezer. The required supply chain capabilities concern not
only technical but also staff competencies. One of the reasons why Gardasil had a
much lower penetration among 19- to 26-year-old women was that obstetricians/
gynecologists, among the most important physician specialties for this age segment,

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