Addressing emotional negative perceptions of vaccines. Part 2

In part 1 of this post, I tried to demonstrate that a categorical rejection of vaccines in general is not only socially irresponsible, but does not make sense from a medical point of view. The reason for this is that vaccines (and the diseases that they prevent) are very different in nature. However, if one goes beyond this general argument, certain details of a particular vaccine can still provoke two sorts of individual concerns: medical and ethical. And while most rational people will probably agree that immunization is good for society, one still has to admit that individual freedom of choice based on informed consent remains an issue in vaccination practices in most countries.

I am not going to go into the details of the scientific studies of the impact of certain substances that can cause concern (such as formaldehyde, embryo cells, egg protein, gelatin, thimerosal) for human health. This subject is widely covered elsewhere and is easily accessible. Rather, I would like to focus here on the lack of any routine procedures that could help medical professionals inform in an accessible way about any potential concerns to patients and their parents. Doctors still posses an aura of "sacred knowledge" that is considered inaccessible to patients. This practice perhaps goes back to the times when medical community was closed, and doctors for thousands of years swore the Hippocratic Oath to "not share knowledge outside of the guild". Whatever the origins of this practice are, in modern times the individual should get information about what is happening in his own organism. Such secretive practices are also contra-productive because they can feed conspiracy theories and give arguments to the general anti-vaccine sentiment.

The information given by the medical community should be simple. Personally, as a user of the pediatric services in France, I would generally be satisfied with the following table that I have put together: 

Example of Immunisation Information for Patient Consent (France)
Represents vaccines approve in EU and USA, for other countries information might be different.

Whatever my concerns will be after seeing this table, I would want to be able to openly discuss all of them with my doctor. In the absence of real scientific evidence of any harmful nature of the substances that could be of concern, I and probably most parents and patients could accept these vaccines.

As for the ethical concern about the use of human embryos in the production of certain vaccines, most religious leaders (for example the Pope, The Supreme leader of Iran, etc.) have approved the use of vaccines produced using stem cells. Doctors should also be trained to talk about such subjects with patients.

To summarise, the search for balance between individual freedom and the social good should enter also the realm of medical practice, and informed consent about immunisation should become the part of the routine medical process. Such measure could help not only to reduce the conspiratorial hipe around immunisation, but also indirectly lead to a more responsible individual attitude towards health, as well as the changing the nature of doctor/patient relationships for good.

References: 

European Centre for Diseases Prevention and Control http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspx

Addressing Parents’ Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants, Additives, or Residuals? http://pediatrics.aappublications.org/content/112/6/1394.full

Addressing emotional negative perceptions of vaccines. Part 1

Vaccines are good for society. Apart from sanitation, vaccines have been the most effective healthcare measure that has ever been introduced. However, when I mention this, there is always someone who starts to attack vaccines, using shock phrases such as "corpse formaldehyde", "scandalous use of aborted embryos", "allergenic egg proteins and gelatins", "use of autism-inducing thimerosal", etc. Being neither a biologist nor a medical doctor, I am not able to answer such attacks easily. In the end, the discussion just turns into an exchange of opinion, which is useless and unproductive in this case. 

Therefore, I decided to dig into the subject of vaccines and vaccine production, for any future such confrontations. I am not going to present in this post the review of the history of vaccine scares - the 19th century smallpox fear, the Lancet autism publication, etc. - all them are well documented by now, and can be found on Wikipedia. Rather, the purpose of this post is to provide an overview of vaccines and vaccine production types.

First of all, the diseases that are currently preventable by vaccines, are very different in nature. If we look at the 26 diseases that are present in the WHO routine vaccination list, I think they can be roughly classified into three classes, according to the nature of their harmful mechanisms (how the disease is causing harm to the organism): 

1) bacteria - the bacteria itself attacks the body and lives there at the body's expense; 

2) bacterial toxins - toxins that are produced by bacteria and that harm the human body;  

3) viruses - viruses use human cells to live and reproduce, and thereby harm the body by corrupting the normal function of human cells. 

These three completely different mechanisms require completely different types of vaccines. It is therefore not possible to generalize about vaccines.

Secondly, depending on the nature of the disease, vaccines have very different mechanisms of action. In the case of diseases caused by bacteria, the role of the vaccine is to help the organism identify the "disguise," to use a lay term, that the bacteria uses. The body can be fooled; bacteria are complex organisms, they consist of several types of cells, and the coating cells can be sometimes very "pleasant" for our body, like in the case of streptococcus pneumoniae that causes pneumococcus. In the case of diseases caused by bacterial toxins, it is critical to incite the body (of the child usually, in this case) to start producing antibodies against these toxins before contamination. The reason for this is that these toxins spread so quickly that harm can take place before the organism even figures out how to fight them. 

Thirdly, the production process of vaccines is radically different for different vaccines. For bacterial vaccines, one needs to grow the bacteria in a bioreactor, and (if required) weaken them by growing them in harsh living conditions. Since this process does not always lead to the desired result, once a particular colony of bacteria has been selected, it should be kept alive (for almost 100 years already, like in the case of BCG, against TB). Vaccines against bacterial toxins use toxoids which are the isolated and deactivated toxins produced by these bacteria (like for tetanus). Viruses, on the other hand, need cells to live on and spread. For some viruses it is possible to use animal cells to make vaccines (like for polio), but some live only in human cells (like for herpes). In this latter case, vaccines are produced using cell lines from two fetuses (aborted in the 1960s).

It is therefore not really possible to generalize about vaccines or about vaccine production processes, since they vary enormously with each type of disease. When vaccines are discussed, it is important to keep this in mind, and focus on a particular vaccine or disease. 

In a few days I will post a detailed table which will summarize this information for all of the 26 diseases in the WTO routine vaccination list.

Sources:

Polio Vaccine Deactivated, Sanofi Pasteur http://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm133479.pdf

Addressing Parents’ Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants, Additives, or Residuals? http://pediatrics.aappublications.org/content/112/6/1394.full

Human Fetal Links with Some Vaccines http://www.immunizationinfo.org/issues/vaccine-components/human-fetal-links-some-vaccines

Human Cell Strains in Vaccine Development http://www.historyofvaccines.org/content/articles/human-cell-strains-vaccine-development

Growth of Rotaviruses in Primary Pancreatic Cells http://jvi.asm.org/content/76/18/9537.full

The Story of WI-38, the Other Famous Cell Line http://www.ascb.org/activationenergy/index.php/component/k2/search?searchword=vaccine&categories=&format=html&t=1385567833883&tpl=search

Breakthrough of Social Impact Bonds?

On the 3rd of November 2013, the Financial Times published an article announcing that Goldman Sachs is going to launch a $250m Social Investment Bond (SIB). The return of this bond is linked to the success of different social projects (affordable housing, pre-school education, etc.) in the USA. This news did not get much attention in the social media. 

However, for all those looking at new ways of financing social improvement this is one of the most significant news of the year. Goldman Sachs had only invested very modest amounts in SIBs before. Also, they were investing their own cash into SIB projects before; but now for the first time its clients will have the opportunity to put money into the new structure. Such backing from one of the world's most well-known financial institutions could signal a shift in the general  perception of SIBs. From being a witty topic of conversation at Davos soirées, the SIB has become a real financial instrument.

So what might made Goldman Sachs open up its wallet to SIBs? One might have noticed that the news of this Goldman Sachs investment came after a series of other news on the subject. First, in September the state of Illinois became the third regional government in the US to announce the introduction of SIBs. Second, in the last week of October, the UK Ministry of Justice issued interim results claiming "success" on its Peterborough Social Impact Bond, which was the world first ever SIB. 

"Me and My Net" , RCS

Third, in same month, Sir Ronald Cohen from Big Society Capital, one the biggest advocates of SIBs, announced that Nandos, a UK based fast food company, in collaboration with African mining giant Anglo-America and Coca-Cola, will create a Mozambique Malaria Performance Bond, to fund malaria reduction efforts. Just a week ago, Nandos confirmed this news from its twitter account. So much buzz so close together regarding SIBs are uncommon outside of academic circles.

And to top it off, the New York Times have just published an article about the idea advocated by Lindsay Beck of creating a non-profit NASDAQ; a market place where NGOs performance can be traded through their related SIBs.

So what is going on? Is this just a temporary trend of social responsibility used by private corporations to create positive publicity? Or it is a real financial innovation that will make it possible practically to put the private profit interest in line with social improvement? Why are SIBs being spun only now when the idea has been circulating since the late 80s? One thing is certain: these developments are thought provoking. To be continued...

Global Vaccine Market: Main Players and Questions of Price

Today I start a series of posts dedicated to the commercial aspects of the UN drug market; that is, the companies who produce and develop drugs and other medical substances that are essential for health development and relief programs. I will start by focusing on the areas that are currently declared by the UN (WHO, UNICEF) as main priority areas: malaria, HIV, maternal and infant health programs.

Although I acknowledge that there is a lot of debate about why the UN has decided to include precisely these ones into its Millennium Goals, for the moment I prefer to use them as the starting point of my research. Later, I plan to write a similar post on non-communicative diseases and emergency medications.

The current post is a short overview of the global vaccine market. Here I would like to share a table which shows the vaccine product mix of the top 5 global vaccine producers. It is no surprise that these are 5 of the biggest pharmaceutical companies - Sanofi, Merck, GSK, Pfizer and Novartis - whose cumulated proceeds from vaccine sales in 2012 exceeded $21 Bln, accounting for 80% of the global vaccines market. 

Around 7.5% of this revenue accounts for the so called UN Market (vaccines purchased for WHO and UNICEF programs) through governmental and institutional funding (including big NGOs such as Bill and Melinda Gates foundation), which means that these companies received around $1.5 Bln from development funds. However, if we look at dose volumes, the UN Market accounts for more than 50% of EPI vaccines produced (WHO Expanded Program of Immunization BCG, diphtheria-tetanus-pertussis (DPT), oral polio, and measles for all and Hepatitis B (HepB), yellow fever and Haemophilus influenza meningitis (Hib) for some countries). 

Top 5 Vaccine Producers and their product mix

The difference in pricing for industrialized countries and UN projects (for vaccines these prices are negotiated by the GAVI alliance) can reach up to 99%, like in the case of Prevnar 13, which is priced at $150 in the USA and supplied by $3.5 to GAVI (source: GAVI).

What do these figures mean for vaccine manufacturers and for consumers? For instance, does it mean that consumers in wealthy countries, who contribute 80% of vaccine revenue, are de facto subsidising these UN development programs? If yes, can this fact be better communicated and used for marketing purposes both by governments (who are the main customers in most countries) and by the drug companies, who try to maximize prices? Should these numbers by taken into consideration when calculating the indirect contributions of the wealthy nations to these development programs? How does this impact economic development models? 

I will try to dig deeper into these subjects in the following posts, but above is the promised table.

Case of MSF: Thoughts on marketing efforts evaluation in humanitarian organisation.

Reaction paper on the article "Meassuring Marketing Productivity: Current Knowledge and Future Directions" by Roland T. Rust, Tim Ambler. Gregory S. Carpenter, V. Kumar. & Rajendra K. Srivastava

The article deals with the question of evaluating marketing efforts and actions. The basic idea is that all marketing "investments" should contribute to a company short-term profit, provide potential growth and sustain profits in the long term. It is required for the successful company to have a business model that assesses both financial and non-financial impacts of its marketing efforts. The financial impact is tracked by the assessment of the financial performance measures, such as sales, profits and shareholders value in both the short and long run. The non-financial impact is the influence on what the customers know, believe, feel and how they behave. The article further deals with the different short and long term aspects of marketing evaluation technique: ROI and market assessment as well as brand equity and customer awareness among others.

Although this model is relatively straight-forward if you see it through the prism of a profit oriented company (though in different industry, methods and tactics of marketing evaluation may differ dramatically), it becomes much less obvious in the case of non-profit oriented organisations.

To illustrate my thought, I will take the case of Médecins Sans Frontières (MSF), the French humanitarian organisation focused on providing medical aid, and well known for their work in war zones and areas affected by natural disasters. MSF's promotional spendings are not significant and constitutes only 2% of the organisation's budget (total 2012 budget $762 million; marketing expenses = promotional expenses + communication + publications = $18 million). This is a small number compared to the marketing budget of most commercial companies. However if one puts it in the perspective of MSF, $18 million is the cost of one medium large MSF country mission, such as Ethiopia, Zimbabwe, Nigeria, Central African Republic or Afghanistan. So despite the relatively small part of the entire budget, MSF will probably find itself needing to assess its marketing efforts. However, if one decides to apply a business marketing model to this task, one may face multiple difficulties.

The first difficulty will come as soon as the word "customer" will appear in the marketing model. For, who are the customers of MSF? And who are the beneficiaries? There is no single answer to this question, but many different ones, depending on the context. If one looks at it from the point of view of donations attractions, then the customers are the donators, both institutional, governmental and individual, and the people who receive medical help from MSF on the ground are the beneficiaries. If one looks at it from the perspective of human resources, the picture looks different. MSF considers its biggest asset to be medical personnel who commit for minimum 9 months of field work with an average monthly salary of 800 euros during this time. In this case it is the medical community that becomes the customer of MSF since MSF needs to attract resources from qualified and committed medical personnel, and the people in need become the beneficiaries. If we look at the MSF mission in-country, people who work in the mission see patients as the main customers and if those people working on a project with a local community or the government, see these latter ones as customers.

Example of MSF brand awareness campaign: 

White Flag campaign, Italy, Agency Lowe Pitella Fronzoni, 2010

The second difficulty lies in the identification of short term and long term marketing goals. If we agree that the main marketing goal is to attract donations, than the marketing ROI of MSF will be very low. The main donators of the organisation remain institutional and governmental organisations, and marketing is doubtfully the most effective way of dealing with them (perhaps a combination of PR and lobbing is more appropriate). Individual donations contribute only to around $3 million (out of $684 million in contributions). Targeting these private individuals with a $18 million marketing budget does not look very cost effective to say the least. Perhaps the most appropriate in this situation is to talk about long term non-financial impacts of marketing investments, such as brand awareness and recognition. These are undoubtedly beneficial for both tactical (operations on the ground, negotiations with governments and communities, attracting medical professionals, etc.) as well as strategical (inclusion of MSF in the governmental and intergovernmental plans and policies, etc.) reasons.

Thus when trying to apply business marketing evaluation models to humanitarian organisations, there are difficulties that should be considered. Additional research and innovation is particularly required in this field.

1001 nights value proposition

Reaction paper to the article "Customer Value Proposition in Business Markets" by James C. Anderson, James A. Narus, and Wouter van Rossum. The article in the famous magazine deals with the challenge of understanding the customer and defining the value proposition that will speak to his personal needs. It identifies 4 steps in this process: Understanding Customers business, Substantiate your value claims, Documenting value delivered and Making customer value proposition a central business skill.

Difficult Customer

".... As soon as they had entered the palace, Shahriyar caused his wife to be beheaded, and in like manner the women and black slaves; and thenceforth he made it his regular custom, every time that he took a virgin to his bed, to kill her at the expiration of the night. Thus he continued to do during a period of three years; and the people raised an outcry against him, and fled with their daughters, and there remained not a virgin in the city of a sufficient age for marriage. Such was the case when the King ordered the Wezir to bring him a virgin according to his custom; and the Wezir went forth and searched, and found none; and he went back to his house enraged and vexed, fearing what the King might do to him...."

Edouard Frédérich Wilhelm Richter (French, 1844-1913) 
Shéhérazade

Understanding Customers Business

Understand unique requirements and preferences of the customer and his attitude towards your services/ products in general

"...The story of the cheated wife and the following words of Efrit stuck in Shahriyar's mind:

Never trust in women; nor rely upon their vows;

For their pleasure and displeasure depend upon their passions.

They offer a false affection; for perfidy lurks within their clothing.

By the tale of Yusuf be admonished, and guard against their stratagems.

Dost thou not consider that Iblis ejected Adam by means of woman?

Abstain from censure; for it will strengthen the censured, and increase desire into violent passion.

If I suffer such passion, my case is but the same that as of many a man before me:

For greatly indeed to be wondered at is he who hath kept himself safe from women’s artifice..."

Substantiate Your Value Claims and Document Value Delivered

Back up your value claims with accessible, persuasive language that describe the difference between your offerings and rivals. Create a written account of added value that existing customer have actually captured by using your offerings.

"But this, said Shahrazad, is not more wonderful than the story of the fisherman. The King asked her, And what is the story of the fisherman? And she related it as follows...Shall I continue?"

Make Customer Value Proposition a Central Business Skill

Improve manager's ability to craft compelling customer value propositions.

"... Now the Wezir had two daughters; the elder of whom was named Shahrazad; and the younger, Dunyzad. The former had read various books of histories, and the lives of preceding kings, and stories of past generations: it is asserted that she had collected together a thousand books of histories, relating to preceding generations and kings, and works of the poets..."

Result

And so the King kept Scheherazade alive day by day, as he eagerly anticipated the finishing of last night's story. At the end of 1,001 nights, and 1,000 stories, Scheherazade told the King that she had no more tales to tell him. During these 1,001 nights, the King had fallen in love with Scheherazade, and had three sons with her. So, having been made a wiser and kinder man by Scheherazade and her tales, he spared her life, and made her his Queen.

Service-Dominant Marketing Logic

Reaction Paper to the article "Evolving to a New Dominant Logic for Marketing" by Vargo, Stephen L. and Lusch, Robert F. (2004a) Journal of Marketing 68 

Overview

What is the main theme of the article?

The article deals with the Service - Dominant marketing paradigm, as opposed to the Goods-Dominant paradigm.

What is important or interesting (or worth writing)? /  What is the main point or argument or the paper?/ What is the main theoretical/managerial theme the paper contributes to?

Vargo and Morgan provide a historical overview of economic and marketing thought that led to the goods-dominant logic.

• Goods-dominant (G-D) logic focuses on tangible resources and embedded value.
• G-D logic clearly separates two participants of the economic transation: seller (or producer) and the customer.
• During the last 40 years many economists started to focus on the new prospectives on the systems of exchange ( intangible resources, co-creation of value). A lot of these economist have observed the transformation of the nature of economic exchange (or transformation of the thinking about it), where services, rather than goods, are the basic units of this exchange.
• Vargo and Morgan apply these recent economic theories for marketing and come up with the theory of Service-Dominant (S-D) paradigm.

Article explains the main characteristics of the S-D paradigm where

• Service is the fundamental unit of exchange.
• All economies are service economies (authors provide their own definition of the service economy, opposed the one most commonly used these days)
• Basics of the economic exchange are hidden, because of the complexity and interconnectedness of our society (as opposed to the commodities driven exchange, where a unit of exchange can be always traced back)
• Knowledge and competence (to provide a service) is the fundament of the competitive advantage.
• Because of the relationship nature of the services, value creation is also rooted in the relationship and therefore is interactional in nature. Therefore companies can not create the value of their product independently, but only in cooperation with their consumers.

Vargo and Morgan push the S-D paradigm idea forward and speculate that: 

1

Resources are basic unit of exchange.

Now services/competences are the basic of exchange

Therefore Services/Competences =Resources

2

Services/Competences =Resources

All economic actors are involved in service/competence exchange.

Therefore all economic actors are involved in the exchange of resources.

3

Services/Competences =Resources

Services are created (by economic actors).

Therefore resources are created by economic actors.

=

Therefore all economic actors participate in the creation of resources.

What king of research methods (eg gathering and analyzing data are used in the paper?

Authors use primary 2 deductive methods in their work - modus ponens and syllogism.

Reaction

What king reaction did you have to the paper? What did you learn from reading the article?

Article provides very valuable and comprehensive overview of the marketing and related to marketing economic literature of the past decades and is very useful source of references of the books and articles to those students or scholars who wish to explore the subject further.

S-D paradigm proposed by the authors provides a valuable ground for innovative thought for marketing professionals, who often are in need of innovative proposals, but find themselves unknowingly bound to the dominant logic learned at university or proposed by their company (especially in big marketing oriented companies, such as P&G, J&J, etc). By erasing the clear boundaries between producer and the customer, it questions the 4P market mix and might be especially valuable in the industries where the interaction between the company and the clients uses a lot of social media and if open to active dialog (i.e. not very regulated industries such as entertainment, new technologies, etc.)

Despite the valuable insights that I have mentioned above, I would like also to point out that this article has, in my opinion, certain flaws.

One of these flaws, is the desire of the authors (which is typical for academicians in general) to come up with the universal theory that explains all phenomena in the field that they work with. However, in the case of marketing, it is not only impossible, but counterproductive. Marketing is not science, but a set of tools. There can never be a "universal" solution or method for success, but many different methods. In marketing, what works is good, and not what seems true.

Another flaw, in my opinion, is that the article attempts to go into the fields of social and philosophical thought that authors, due to the limited size of the article, are unable to fully cover: creation of value, exchange, financial success of firms, etc.

What kind of expectations do you have to the course/business game?

I hope to have a good understanding of the latest trends in marketing at the end of the course. As for the business game, I see it as a great occasion to practice one's leadership and other skills.