The importance of vaccine perceptions in self-pay markets

Rachel Howard
Rachel Howard

A core area of Research Partnership's specialist emerging market division involves assessing the opportunity for new vaccines. In self-pay markets (i.e., those where the cost of the vaccine will not be reimbursed or included on the government's national immunization program), a common starting point involves a simple stratification of the population of the market based on consumer income levels. In this way, the proportion of the population who earn above a certain threshold – and therefore have the ability to pay for the vaccine – can be determined.

However, I argue instead that the opportunity for vaccines in self-pay markets is determined by much more than consumer affordability. In fact, our research with consumers and healthcare professionals shows us that when vaccines are not reimbursed, considering the vaccine market purely from a consumer income point of view is dangerously reductive.

What I find fascinating about the vaccine market is the huge importance psychology and media discourse play in shaping the opportunity. Take the recent Ebola outbreak, for example. The media eagerly heralded the development of a potentially effective vaccine to such an extent that one vaccine developer, GlaxoSmithKline, had to rein in reporters by pointing out that the vaccine was not yet in Phase I clinical trials.

On the other hand, vaccines for less widely-reported or topical conditions face the challenge of creating a market. This involves a double-pronged approach, as two groups of stakeholders need to be activated, Healthcare professionals need to be convinced to recommend the vaccine, and consumers need to be enticed to request the vaccine.

Activation of these stakeholders necessitates demonstration of not only the vaccine's efficacy, but also the burden of disease it is designed to prevent, in terms of prevalence and severity. The connecting argument to bring these together involves demonstrating the relevance of avoiding this disease for the specific patient in question. In addition, as vaccination is more about wellness than illness, HCPs and consumers alike need to be convinced about the safety as much as the efficacy.

Even if a vaccine has no direct competitors, it is competing alongside other discretionary spending for a share of the consumer's wallet. Unlike ad hoc and unplanned spending in the event of illness, vaccines – along with other “wellness” purchases, such as vitamins and supplements – are more like discretionary purchases. To put it another way: just because a consumer can afford to purchase a vaccine, it does not necessarily follow that he or she will want to do so.

For example, if I believe that I am at high risk of contracting a painful and debilitating disease, and the treatment options are limited or costly, I am likely to be willing to pay a considerable amount to protect myself through vaccination. In contrast, someone with the mindset of “it is never going to happen to me” (and even if it does, the available treatment options are adequate and affordable) is far less likely to be willing to pay out-of-pocket to purchase a vaccine.

The experience of interviewing consumers has shown me that the risk/benefit beliefs we hold in relation to such issues are both deeply rooted in our psychology and rarely rational. The considerations are magnified when assessing the opportunity for pediatric vaccines or vaccines that are most relevant for the elderly, where the intended recipient is not the decision maker (or payer), and a parent or caregiver must make the ultimate decision.

There are so many factors that determine whether a consumer ultimately receives a vaccine, and multiple inflection points that can have a bearing on the outcome. As an example, in some emerging markets, certain vaccine-preventable conditions may be so stigmatized that for a healthcare professional to even suggest a vaccine is to cast judgment on the patient's lifestyle. Other healthcare professionals hesitate to recommend high-priced vaccines to their patients for fear it will position them as salespeople rather than medical professionals.

The power of the anti-vaccine movement can also influence decisions. For example, despite being completely discredited, the hypothesized link between MMR (measles, mumps, and rubella) and autism led millions of parents in the UK to refuse to allow their children to be vaccinated. This has left a damaging legacy on the British vaccine market. Other markets have their own discursive hype around particular vaccines, often based on little or no clinical evidence. Some consumers renounce vaccines altogether, either because they believe them to be unnatural or simply because they are afraid of needles.

In conclusion, when it comes to self-pay vaccines, the relevant place to start when assessing the market opportunity is not so much the number of consumers who are able to afford them, but a more relative assessment of willingness to pay. Effective market research analysing the opportunity for a vaccine therefore requires a broader consideration of the noise around the vaccine and the condition, and an understanding of how less tangible, perceptual and psychological factors may potentially impact uptake.

Rachel Howard is a research manager at the Research Partnership.