Pharmacy Focus : Episode 78

Pharmacy Focus: Limited Series - Celebrity Endorsements in Vaccine Hesitancy

Commentary
Podcast

This episode highlights how celebrity endorsements and local influencers can be leveraged to address vaccine hesitancy by shaping attitudes, but also must account for factors like audience trust and the potential for both benefits and limitations.

The Pharmacy Times podcast "Star Power: Celebrity Endorsements in Pharma" featured a discussion on the role of celebrity endorsements and trusted local figures in addressing vaccine hesitancy. Experts commented on studies examining how peer influencers and endorsements from figures like Dr. Fauci can increase vaccine acceptance by making the issues more relatable. However, they also noted the need to understand different factors contributing to hesitancy as well as ensuring endorsements match the right target audience and local context to be most effective. The podcast explored both the potential and limitations of celebrity marketing in public health issues.

Timestamps

0:01:05 - Vaccine hesitancy among demographics

0:04:27 - Influence of personal beliefs and social networks

0:04:41 - Role of social networks and online misinformation

0:08:48 - Trends in conversations with patients about COVID vaccines

0:11:43 - Addressing subgroups within vaccine hesitancy

0:13:29 - Travis Kelce ad targeting NFL and Taylor Swift fans

0:14:04 - Impact of celebrity endorsements on fans

0:15:43 - Effectiveness of celebrity endorsements

0:17:57 - Role of local influencers like pharmacists

0:25:23 - Dr. Fauci as a trusted celebrity figure

0:27:44 - Importance of local trust centers

Experts Include:

Sean Young, PhD, executive director of the University of California Institute for Prediction Technology; Alfred L’Altrelli, PharmD, CFMC, MBA, the senior director of pharmacy at UPMC Presbyterian-Shadyside; and Troy Trygstad, PharmD, PhD, MBA, the executive director of CPESN USA.

Key Takeaways

  1. The podcast discussed vaccine hesitancy and how celebrity endorsements can be used to address it. Experts commented on factors like personal beliefs, social networks, and online misinformation that contribute to hesitancy.
  2. Pharmacists noted that conversations with patients have shifted from vaccine development to side effects and efficacy as awareness has increased. Misinformation remains a challenge.
  3. Studies found that peer-led online communities and celebrity endorsements, like from Dr. Fauci, can increase vaccine acceptance and confidence. Experts emphasized matching the right celebrity to the target audience.
  4. While celebrity endorsements may not directly drive people to pharmacies, they can make vaccination more relatable and impact attitudes. Local media personalities were suggested as alternative endorsers.
  5. The podcast explored both the potential benefits but also limitations of celebrity endorsements in influencing public health decisions around vaccines. Understanding audience trust was a key consideration.

Ashley Gallagher

Hello, I'm Ashley Gallagher from Pharmacy Times and you're listening to the Pharmacy Focus mini-series Star Power: Celebrity Endorsements in Pharma, a four-part series, including pharmaceuticals, vaccines, Ozempic, and public health. In this week's episode, we talked about vaccine hesitancy and the role celebrity endorsements can play in addressing it.

Vaccine hesitancy encompasses more than COVID-19, though that is a huge focus of today's episode. To start, Dr. Sean Young, the executive director of the University of California Institute for Prediction Technology, said vaccine hesitancy has been prominent in certain locations, and includes various childhood vaccines.

Sean Young

Vaccine hesitancy it's been around for a while, and it's interesting that it occurs differently among different demographics, so in some locations, there's going to be greater vaccine hesitancy, then in other locations. Among some people based on socioeconomic status or education or income, it's going to be different than other than among the other groups, and so it's important to be aware of that and in just understanding where it comes from and how it plays out.

There has been vaccine hesitancy around childhood vaccinations, around questions around the effects that that might have and negative implications or problems that might have occurred. And through that, what happens is that when there's a lack of information or lack of education, or questions, people may start coming up with new ideas or incorrect information either because they're not aware of it, or maybe they start becoming angry or purposely trying to spread misinformation.

A lot of times it could come from people having personal tragedies or difficulties, just the discomfort and difficulty and in dealing with problems in daily life and in wanting to put blame on to something or somebody and to understand how, how things like that happened. There have been theories and ideas of how vaccines can cause problems, which aren't, haven't been proven in science to be true. Not to put blame on the people who are feeling this way either, it just means we as scientific community need to do a better job of both studying science behind vaccines and communicating, really communicating, that science in a way that's easy to understand for people to try to get them to be supportive of science and because science is really the way to move forward and public health.

Ashley Gallagher

But how are patients influenced by vaccine hesitancy? Dr. Young added that personal beliefs, social networks, and exposure to online information plays an important role in vaccine hesitancy.

Sean Young

So personal beliefs1 are beliefs that we already have that exists that maybe came from upbringing, or other educational systems or structural factors, like maybe safety concerns about vaccines, or maybe there's skepticism about whether it will actually work. Then social networks are our social environment, our friends, our family, others, and the effect that they have on our beliefs and interactions, and then exposure to misinformation online. That could be through doing a search on Google could be looking at or seeing videos, and these aren't distinct categories necessarily they are influenced by each other and so exposure to information online. As we're on social media, our social networks can influence our exposure to misinformation online. These are kind of broad factors that have been identified in in research, but they're not mutually exclusive.

Ashley Gallagher

Dr. Young elaborated on social medias role, especially in the COVID 19 pandemic.

Sean Young

People often have said social media is bad, it's harmful. It's causing so many problems. Social media, just like any other technology, it's just a way to scale and allow people to share information and do things faster than they could without social media by doing it in person. What I'm going to talk about is not necessarily the problem with social media, if you get a group of people together, they'll be doing the same things that they're doing on social media, more or less. But there have been a lot of anti-vaccination, movements on social media that have gained millions of followers, and it continues to increase. COVID really brought about dramatic changes and increase discussions around social media, with 10s of millions of people on Facebook and on YouTube and Twitter (X), following accounts that were talking about the problems of vaccinations and often spreading a lot of misinformation.

When you have 10s of millions of people following this information, it continues to spread, and they'll start sharing that with others, and they'll start believing it because this is what they're seeing. This is what they're told to believe. They often don't have the background or training to dig in and question what they're told and question that science. That can ultimately lead to not just beliefs, not just questions and concerns around vaccination, but it can lead actually to people being less likely to get vaccinated because they're getting this information and their beliefs about the problems with vaccines and problems with government administrating, administering vaccines can reduce their willingness to get vaccinated. We saw that happening a lot with COVID, and that's why public health departments were really trying to figure out what they could do to counter that misinformation and counter the effects of people viewing this on social media.

Ashley Gallagher

Dr. Alfred L'altrelli from UPMC Presbyterian Shadyside discussed the trends of the COVID-19 vaccines, and how it influenced the conversation around vaccine hesitancy.

Alfred L'altrelli

As a pharmacist, I've observed several trends in the conversations surrounding trust, vaccine hesitancy, obviously, because things have changed so much from the beginning and to where we are now. First, I would say probably that the increased awareness and education has been a really big factor. There's been a notable increase in public awareness of COVID vaccination, through education, as well as that continued drive for people to understand COVID and other vaccines better. The evolution of these concerns that patients seek to clarify is really shifted from where vaccine hesitancy concerns were originally focused on the rapid development of vaccines. And how did we develop this out of nothing? What about these unknowns about what these vaccines might do in the most obscure ways? From the beginning days to now over time, more data is available, and the discussions that we've been seeing are shifting towards what are the vaccine side effects? How can I space these? How can I make my experience of getting vaccinated by this more pleasant? What are the long-term effects? What about efficacy? Am I going to have to get this annually? Am I going to have to get a booster? Those types of things. So really the education and awareness piece that conversations in that realm have shifted.

Misinformation does exist and has since the vaccines first became available, so this really sort of has stayed the same. Trusted health care providers, including pharmacists played a crucial role in disseminating accurate information about vaccine efficacy, safety, the importance of getting vaccinated. Despite these efforts to combat the misinformation with accurate data, it still remains a significant challenge for the health care community. Misinformation on social media or other platforms, they can really influence individuals decision making and contribute to increase vaccine hesitancy, ;ots of different information out there conflicting information. What do you believe? What don't you? Makes you unsure. So, conversations around trust and vaccine hesitancy are also influenced by community peer dynamics. People are more likely to get vaccinated if they see friends, family, community members doing so. On the flipside, hesitancy may persist in communities where vaccine skepticism is much more prevalent. Counteracting any misinformation with evidence-based information continues to be a priority for us all so that people have what they need to be able to make informed decisions.

Ashley Gallagher

Dr. Troy Trygstad from CPESN USA said that COVID-19 vaccines can be tricky to market around because of the politicization around them. He said that there are a lot of subgroups within vaccine hesitancy that should be addressed.

Troy Trygstad

COVID is different. Vaccines are probably different because there's some politicization around them, but I would also argue that we should have been creating distinctions with a difference in the various audiences that exist and existed with COVID-19 and vaccines. For instance, we lumped a whole lot of folks into a category we call vaccine hesitancy when really there was there's a lot of subgroups within that group. There's vaccine resistance is not hesitancy, vaccine awareness, or low awareness, is different from hesitancy, and certainly different from resistance, vaccine literacy, right? And so, again, finding the audience, finding the trust center that meets what that audience's needs are, and then finding the modality and the celebrity or the medium within which to speak to that audience is important. There's a lot more heterogeneity in vaccine hesitancy, quote unquote, than I think folks recognized or planned for or tried to resolve, and that if you tried speaking to one type of audience, and with one type of celebrity and one type of modality, you were going to miss opportunities with segments within that group that was to generically call a vaccine hesitant.

Ashley Gallagher

Recently, Pfizer released an ad with Travis Kelce, about receiving the updated COVID-19 influenza vaccines at a local pharmacy. For those that don't know, Travis Kelce is a tight end for the NFL’s Kansas City Chiefs, and has been a very hot topic of conversation, since he's been publicly linked with pop superstar Taylor Swift. This makes him a perfect spokesperson right now because he can speak to two subsets of patients: NFL fans and Swifties. Dr. L’altrelli addressed the television ad and trust in celebrity endorsements.

Alfred L'altrelli

I think that ads featuring celebrity endorsements like this can bring value to the public health efforts. I think it impacts some people who may relate to that celebrity getting comforted knowing that they received a treatment. We see this with different medications used to treat different conditions, where there's a celebrity talking about taking it themselves, and how it helped them, and now we're seeing it with, you know, prevention through vaccines with Travis. We know that celebrities have a substantial fan base, so their endorsement can create a sense of trust and relatability to that fan base. Many fans may trust the celebrity person, and therefore, by that nature, they trust the information more hearing it from them because they can relate to them, but they might to somebody in a white coat like me talking and using sometimes bigger words, that sort of thing.

I believe that it can lead to action with vaccines, because we've seen this occur with different treatment medications. Also, whenever I say it can lead to action, I mean that could be a person that's looking into being vaccinated more, or seriously considering a vaccine, talking to a health care provider, or actually receiving it, as opposed to kind of being stagnant in the community, not having a thought or opinion and not even pursuing what might be the right option for them. If we think of action is more of a spectrum, I think that really helps people with a mindset and with their approach.

Ashley Gallagher

Dr. Trygstad said that it's also important to understand that what the celebrity is not saying is just as important as what they are saying.

Troy Trygstad

I think what's also important is what he's not saying. “Hey, you're being immoral or you're going to kill somebody by not getting the shot.” He's not saying “hey, you're less of a person if you don't get one.” So, it feels like to me that it’s the audience, the messenger, and the message is important too when we look at other examples of this. Do we believe that Katie Couric help folks get colon cancer screenings? I suspect until I'm showing a well-done study that says that that didn't take place. That if you have the right data, I suspect that that did have effect on folks because she's a celebrity and she was affected. She's saying, “Look, this is important. And let me tell you why, and I want you to believe me” Right?

I think what's challenging with vaccines generally, is you're trying to endorse something that is a protective or preventative, which is always a more challenging kind of a concept. The Katie Couric colonoscopy is that, I think it's that we have a sphere where folks that people know, if they're a trust center, can play a really important role in speaking to folks that is their audience that they feel like they can relate to. I mean it's a very natural thing for us here in the US. The fact that somebody like Michael J. Fox, for instance, that already has a condition, right, and says, if he ever did, right, “hey, I use this product, I use that product.” It's a very meaningful thing, because it's, oh, I can see that you have it's not, oh, you're getting this just because you might get COVID. Why are you doing this, and so on and so forth. So I think different situations for different conditions, different situations for different celebrities, different situations for different trust centers. And frankly, that is the art of marketing is not?

Ashley Gallagher

In an article written for Pharmacy Times,2 an expert said that celebrity endorsements don't necessarily drive patients to the pharmacy. But Dr. Trygstad said,

Troy Trygstad

I believe that that's the case, I think COVID response is particularly difficult to use as an exemplar or to use as a harbinger, or a litmus test or a predictor, for how this works generally, because unlike colon cancer, or unlike even stigmatized disease states like schizophrenia, COVID response got pulled into the political realm. There's attitudes and belief systems about all kinds of conditions and all kinds of interventions with without question, but COVID is a little bit of an anomaly in the sense that I mean, it became really a front and center political item, and so how we look at, I think, COVID 19, specifically and trust centers associated with it, and hesitancy, is probably a little bit different and unique compared to other disease states and interventions that go with them. For Travis Kelce, as a health care provider, I applaud him, I think it's totally okay, if Travis Kelce went on to a late night show and expressed, “hey, I'm okay with not having mandates” or “here's the reason why, here's the reason why I understand why people can be hesitant.” “I don't think ill of people that are hesitant.” Just because you say I think the idea is “look, I got this vaccine. Certainly, I'm a paid endorse endorser.”

There’s that obviously, but a lot of the essence of this is, “hey, I've got this intervention myself.” And there's nothing stopping him from expressing how he may or may not feel about policy, but he doesn't have to. There's a certain segment of the population that that's going to reach. Right. I don't think you dismiss celebrity endorsements out of hand. I think the idea is that if you believe there are multiple trust centers and segments of the population that respond to different trust centers, what you're looking for is a celebrity that matches with that trust center. That's what you're always doing in marketing is. What's my target audience and who am I trying to speak to? And marketing has a pretty long history now of knowing what they're doing when they're trying to speak to an audience. It's a whole profession, right?

Ashley Gallagher

Dr. Young echoed that celebrity endorsements can be effective.

Sean Young

Celebrities just like celebrities being hesitant to get vaccines and promoting information on what they think are the problems with vaccination. You can use similar strategies to promote vaccination among celebrities. We conducted a study, just maybe as a background, and this is an important question for me, as my background in social psychology, where if you can leverage social networks and in our peers, that's a really powerful way to change people's attitudes and behaviors. We have something called the HOPE intervention, which stands for harnessing online peer education, where we have trained peer role models in certain areas to change people's health behaviors. These aren't celebrities because we want it to be scalable, and it's hard to identify or get support from really high-level celebrities. But these are just other patient peers. We've done this with people at risk for HIV, or patients suffering from chronic pain or from opioid use disorder. We'll find peer leaders who were who are experienced with these conditions and who've been successful overcoming them or changing their behavior in a certain way.

Like with the HIV example, these will be people who are consistently getting HIV tests, and then we'll train these peer leaders in the science of how do you build organic communities and teach people how to change their behavior, and change their attitudes and behavior. We find pretty consistently that our interventions compared to what's called the control group of people who were of groups that don't have these peer leaders, that are groups with peer leaders are about 2 to 3 times more likely to change their behavior. People are more likely to get an HIV test or, whatever it is, and we conducted well to 2 COVID-related HOPE studies. One for anxiety and trying to reduce people's anxiety around COVID, and found we were able to successfully our peer led online communities helped reduce people's anxiety around COVID.

Then second, we did another one around vaccination and published that scientific paper, where we took health care workers, first responders, because they were the first group to where there was offered for a vaccination. We identified first responders who are reluctant to get vaccinated, and then we randomly assigned them. We took half of them and added them to just a regular online community group. The other half were added to an online community group with trained peer leaders. These were other first responders who had gotten vaccinated, even though they were initially reluctant to do it, and then we train these the peer leaders in science behind vaccines and science in psychology of how to get others willing to accept vaccine information and learn more about it. We did that study, and we found that, not surprisingly I guess, nobody in the control group was willing to get information around vaccines, because we then offered them information around vaccines, where we could teach them more about it. It's not surprisingly in the control group, since they were already hesitant, no one was interested. We had a lot of people in the more than 1 in 6 people in the intervention group were now willing to get information around vaccines and listen to learn about the science behind it. It was really, really helpful and effective in changing people's attitudes and behaviors around vaccines.

Ashley Gallagher

In a study published in Vaccine,3 the author stated that when Dr. Anthony Fauci endorsed the COVID-19 vaccines, the confidence and uptake of the vaccines increase among all partisan subgroups. Despite endorsing the vaccine before the election. Dr. Young discussed Dr. Fauci as a celebrity endorser in the COVID-19 pandemic.

Sean Young

So being the leader in government around this area, around mass vaccines, Dr. Fauci played an important role, kind of like a president helping to endorse things that are good for their country. It's important to have your heads of public health endorsing the things that science is saying is good for public health. He is a celebrity, he's not a movie star but has celebrity status as a scientist and as a physician, and so it's really important to have his support. I think one thing that was missing was integrated support and communication. Across [National Association of Information Destruction] and the CDC and state and local public health officials and consistency over time.

Also, it's important to have a marketing plan, public health, just like anything else, it needs to be sold to the public, and when you're selling something, it's important to have a marketing plan that you have thought out beforehand is consistent over time. So leveraging celebrities’ insight and getting them all together and having a consistent plan that's integrated and coordinating across from federal down to local level is really important for being able to have consistency and prevent people from prevent people from distrusting or questioning what's being told or recommend.

Ashley Gallagher

Dr. Trygstad addresses the cons to celebrities as endorsers and spoke about how pharmacists are essential trust centers for patients saying:

Troy Trygstad

I think we're back to the concept of trust centers, and that you can't assume as a marketing person that a particular celebrity has a linear or static level of trust with a particular audience. To me, it's less about Anthony Fauci. It's about what trust folks had, and Anthony Fauci at what point in time when the endorsement was made, so I do set that as kind of being a valid consideration that sort of a timeline. Certainly, there's lots of examples of celebrities that have fallen out of favor with marketers because something happened in or around that celebrity person or something happened in the environment, and that trust or that affinity to that celebrity was lost by the audience of interest.The other thing, I would say, you know, going back to my rural pharmacy example is what do you consider a celebrity? We often miss the concept of what celebrity is. In some ways, I can think of the 2 physicians that practiced in the little town I grew up in Iowa. Those folks are celebrities for that town. It's a big deal that like, “oh, you're a doctor” like, tell me more. There's going to be some cachet associated with that. But what might be a generic person in a commercial to some geographies or across the country might be a celebrity to a local person, right? Local TV personalities might be celebrities to a local catchment area. So, I think when we think about celebrity, to me, it's less about celebrity and it's about what is the affinity and the trust, with what size audience and where is really the equation. Right. If I'm an Iowa and I see Matt Osterhaus, get on a commercial on KCCI in Iowa and say, “here's what we're doing and why we're doing it at Osterhaus Pharmacy in Kolkata.” I'm in Iowa, I relate to that. I may or may not know Matt might be an arm's length celebrity to me, but I'm still going to relate to it. I'm still going to listen to it versus a generic Pfizer commercial with a generic pharmacist. We like that because it's talk to your local pharmacist, but that pharmacist in that ad is not a celebrity. That pharmacist might be a celebrity in that town or in that region.

My recommendation to pharmaceutical manufacturers is that there's a lot of local media and local outlets and diversity of Facebook groups and affinity groups for which health care providers, is it one celebrity endorser across the country? Or is it 1000 or 2000 that you're engaging with as a group of on, what we call the CPESN inside luminaries, then what luminary is really a positive influencer. It’s the patients like me concept or if I'm going to be a lead in a group of, like with my own family, it was important to connect with other adoptive parents. Well, if there's somebody that everybody knows in that group, they become really important to that group. So, I'm back to trust centers, affinity audience. Where's that audience? How do you connect with them? All of this is marketing 101, right?

Ashley Gallagher

I hope you enjoyed this Pharmacy Times Pharmacy Focus mini-series, Star Power: Celebrity Endorsements in Pharma. If you haven't listened to episode 1, you can do so now wherever you get your podcasts. Next week we will be talking about unsponsored celebrity endorsements for Ozempic. Thank you for tuning in!

References

  1. Garett R, Young SD. Online misinformation and vaccine hesitancy. Transl Behav Med. 2021;11(12):2194-2199. doi:10.1093/tbm/ibab128
  2. Gallagher A. Celebrities Don’t Persuade Patients to Get Vaccinated; Pharmacists Do. Pharmacy Times. January 18, 2024. Accessed February 15, 2024. https://www.pharmacytimes.com/view/celebrities-don-t-persuade-patients-to-get-vaccinated-pharmacists-do
  3. Bokemper SE, Huber GA, Gerber AS, James EK, Omer SB. Timing of COVID-19 vaccine approval and endorsement by public figures. Vaccine. 2021;39(5):825-829. doi:10.1016/j.vaccine.2020.12.048
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