Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 402

country. MacDonald et al. ( 2012 ) cite polio outbreaks in Europe and pertussis out-
breaks with infants dying in California as communication opportunities, as well as
the possibility to highlight the link between outbreaks and a drop in the vaccination
rate. Downward counterfactual messaging (Epstude and Roese 2008 ; e.g., “without
vaccination, X children would have died”) could also be employed.
The quasi-absence of a targeted disease reduces the perceived disease risk and,
thereby, also the direct benefi ts of vaccination. Raising the total vaccination benefi ts
through emphasizing the indirect social and altruistic benefi ts of vaccination is
another possible strategy (Hershey et al. 1994 ; Skea et al. 2008 ; Reyna 2012 ; Caplan
2011 ). As Weinreb ( 2011 ) argues, “getting vaccinated … is just another important
social responsibility.” Altruism has been found to be an important motivator for par-
ticipation in HIV vaccine trials, in addition to personal benefi ts (Balfour et al. 2010 ;
Dhalla and Poole 2011 ).
Communicating that vaccination is a norm represents a third strategy. Hershey
et al. ( 1994 ) recommend that communications should stress high vaccination rates,
thus using descriptive norms (Smith-McLallen and Fishbein 2008 ) or social proof
(Cialdini 2009 ).
Evidence on the relative effectiveness of the different possible strategies is lacking.

13.7.2 How to Reduce the Percentage of People Who Refuse

or Delay Vaccination

Increasing numbers of parents refuse or delay vaccination for their children, mainly
because safety concerns associated with vaccines loom larger than their benefi ts
(Omer et al. 2009 ; Smith et al. 2011b ; Salmon et al. 2005 ). Moreover, the many
parents who let their children be vaccinated despite harboring signifi cant safety
concerns might join the camp of refusers and delayers unless their concerns are
effectively addressed (Freed et al. 2010 ; Kennedy et al. 2011a , b ).
Reyna ( 2012 ) emphasizes the importance of understanding how individuals
represent the gist or meaning of risk messages and recommends two strategies for
making the perceived risk of non-vaccination higher than that of vaccination.
The “categorical (nominal)” strategy makes not vaccinating the risky choice (“gam-
bling on avoiding the disease”) by conveying that the risks of vaccination are “nil.”
The “ordinal” strategy compares the larger risks of disease to the lower risks of the
vaccine. She also suggests raising the risks of non-vaccination by adding indirect
risks to the community to the personal risks, a loss-framing of the social conse-
quences (e.g., “by not getting vaccinated you are a socially irresponsible person”). 40
However, because many consumers lack an understanding of herd immunity (Downs
et al. 2008 ), increasing their background knowledge may be necessary.

40 In Skea et al.'s ( 2008 ) study, some parents were quite critical of other parents who did not
vaccinate healthy children.