Marketing a Total Response to H1N1

‘What does social marketing offer us to improve the nation’s preparedness activities for H1N1?’ was the question posed to a group of social marketers at the CDC National Conference on Health Communication, Marketing & Media. Nancy Lee picked it up first and talked about the need to establish a new brand for H1N1…starting with perhaps a new name. I could not jump onto that more quickly: ‘H1N1 already has a brand, and it sucks’ I said. I went on to talk about how most brands happen while we’re busy doing something else, and that a new brand (or name) was not going to change things in the next few months (certainly not before October-November). ‘As a marketing problem, I would focus on logistics and distribution. No matter what the communication strategy is, if the vaccine isn’t where it’s needed when it’s needed, if the health professionals don’t trust its safety and that it will be there when they need it, NO communication effort is going to ultimately be successful. Word-of-mouth will rule the day.’

Mike Rothschild jumped in and agreed that marketing distribution and logistics were the crux of the issue facing H1N1 preparedness. Bill Smith managed to agree with everyone.

It is remarkable to me that ‘marketers’ jump to the communication solution so easily and quickly – despite all the evidence to the contrary. Having personally been through or debriefed on innumerable planning scenarios for infectious biologic agent outbreaks, and planning national and statewide responses to them, communication programs become important when every thing else is going wrong: there are not enough stockpiles of vaccine or drugs to treat the problem, surge capacity of the health care system is quickly overwhelmed, people can't afford to NOT go to work, health care workers and first responders stay at home (often times because their spouse insists on it), and local news stations see the opportunity to dramatize and drive up viewership. These things quickly escalate not because ‘we had a communication problem,’ but because we had a significant disregard of the marketing mix and the problems we unearth when we talk with people who are important for success, not the planners in conference rooms and offices.

I was in Connecticut last week for some social media workshops and started asking health care professionals who were there about their perspective on H1N1 readiness. After listening to the cracks about changing the name from swine flu to H1N1 to satisfy the pork producers and politicians (and the irony was palpable when they said it), ‘brand sucks’ fits rather well. Then when I asked them what they are most concerned about – supply and distribution were uniformly the number one answer. It was also interesting to hear that colleges and universities had to demand guidelines for how to be prepared – they had somehow been overlooked.

Now I realize that a lot of commercial businesses don’t get that coordinated and integrated product, distribution, pricing and communications are marketing. They, like most public health agencies, see marketing as the messages, sales brochures, television and radio ads, publicity events and, oh yes, a Twitter account. But when facing the task of trying to mobilize a complacent nation – as HHS Secretary Sibelius put it yesterday – re-making ‘brands’ and refining talking points and risk communication messages is not going to do it. Show us you mean business!

Over a month ago when talking with some colleagues late one night, they asked me about the H1N1 vaccine being ready for the announced date of early October. Though I don’t have the inside track on what is happening with this current vaccine testing and production effort, knowing enough about it led me to state unequivocally that there was no way that would happen in any meaningful way. It was a pipe dream. The CDC is now publicly revising their shipment dates.

July 30, 2009 - The CDC expects about 120 million doses of the vaccine to be available by the end of October, obviously not enough to cover all of the recommended groups. Los Angeles Times

August 17, 2009 - Health officials had predicted having 120 million doses of vaccine ready by mid October. Now they say it will be more like 45 million. And with two doses needed to be effective, the nation's protection blanket will start out much smaller than the experts hoped. CBS News

August 24, 2009 – [HHS Secretary] Sebelius said it will take until Thanksgiving to fully immunize people against H1N1 because most will need to undergo two vaccinations. The first would be given in mid-October; the second would be administered three weeks later and it takes about two weeks after the second shot to build up full immunity to the virus. FOX News

August 24, 2009 - CDC officials say they expect between 45 million and 52 million doses of vaccine by mid-October, followed by roughly 195 million doses by the end of the year. FOX News

Confused? Poor ‘branding’? Is what we have here is a problem to communicate?

Now we could assume that once availability of the vaccine is solved, we can rest easy. But look again. Consider this story from The Globe and Mail yesterday: Canada does not have the manpower to deliver the H1N1 influenza vaccine as quickly as it becomes available, despite ordering enough doses to inject all of its citizens.

At least they are starting to focus on the rest of the marketing issues, and not the horse race as to when the vaccines will be in the starting gate. That’s when you’ll see the real problems start. (Then again, Canada has done their planning after a real-life response with SARS).

What I suggest is that the entire marketing complex (whether you think that includes you or not) for the H1N1 response to get into the room and integrate logistics with in-the-arm delivery points (not hospital and clinic refrigerators), distribution systems mapped onto the locations of high priority groups, and communication messages that enhance and compliment local capacities and plans. And stop trying to control the message from top down if they are being used to manage expectations rather than to be honest and transparent. Every time 'the message’ changes from government sources, another measure of trust is tapped from the well. Judging from what I hear, that well is already running dry. Setting and changing expectations for whatever reasons is setting the stage for more complacency and failure to adopt appropriate precautions.

It all comes down to a matter of trust. If health care providers and the informed public cannot trust what is being said one week to another, they are certainly conveying that sense in ways large and small to their patients, colleagues, friends and neighbors. They are where brand building needs to begin. They are the critical element for the success of the vaccination effort – not the perceived risk and susceptibility of the person-in-the-street. They need to feel confident and able to receive and deliver vaccines to as many people as are in need of it without the begging, waiting, cajoling and fielding questions from frightened parents, worried well and local reporters who ‘thought everything was under control.’

And as for renaming H1N1, maybe CDC should adopt the NOAA policy and name each new flu variant with a person’s name (I suggested ‘Bob’ for this one in a conversation later). Then maybe the rest of us can look forward each year to having a relationship with our ‘flu brand.' [And I love this from the NOAA site: Experience shows that the use of short, distinctive given names in written as well as spoken communications is quicker and less subject to error… The use of easily remembered names greatly reduces confusion when two or more tropical storms (read ‘flu strains’) occur at the same time.]

Today’s updates on ‘swine flu’ from Kaiser Health News is filed with more sobering news - 50% may be affected, a call to get vaccines into the field by mid-September, intensive care units' limited surge capacity, and packaging problems. So many people in public health keep saying that 'we don't DO marketing' like it is beneath them. Perhaps it really is beyond them?

Photo from Getty Images with permission.

Comments

[Craig]

Thanks for the note Marya, I am sure a number of readers would be interested in your bottom line estimates for ICU needs vs capacity. I know that there were some public engagement sessions going on around the country in the past month or so, but I am not aware of how priority-setting and community support for those actions are coming along. Any others care to share?

[evimedgroup.blogspot.com]

Hi, Craig,

An interesting post indeed. I linked to you from the BIL:PIL site, where your name appears right below mine. My group just came up with some ICU predictions for H1N1 in the US, and they are rather shocking. One of the aspects where social marketing could really help as well, it seems to me, is in spreading the message about the need for prioritization protocols and getting community participation and buy in.

So, 2 questions:
1. Are you aware of such efforts?
2. If not, what can we do to prepare the people at this late hour?

Thanks.
Marya