When my communications career was budding in New York City in 1983, my then employer Burson-Marsteller, the largest public relations firm in the world, was very proud of being the agency-of-record for Johnson & Johnson in handling crisis communication work for Tylenol. In fact, to this day, the poisoned Tylenol incident in 1982 continue to be a crisis-management teaching model in all communications schools and curriculums around the world.
On September 29, 1982, three people died in the Chicago area after taking cyanide-laced Tylenol at the outset of a poisoning spree that would claim seven lives by October 1. According to Time magazine, by quickly recalling all of its products from the store shelves, a move that cost Johnson & Johnson millions of dollars, the company emerged as another victim of the crime and one that put customer safety above profit. It even issued national warnings urging the public not to take Tylenol and established a hotline for worried customers to call.
The crisis shaped Johnson & Johnson’s public relations strategy from a passive to proactive approach. By skilfully handing the Tylenol crisis, the company completely recovered the market share lost during the crisis and reestablished Tylenol as one of the most trusted over-the-counter consumer products.
Fast-forward 39 years later, the two-dose AstraZeneca COVID-19 vaccine is fast becoming one of the worst examples of crisis management in the history of public relations and pharmaceutical product launches. According to André Picard, health columnist of The Globe and Mail, AstraZeneca is a good vaccine, but a public relations failure. “Its vaccine is robustly effective – 76 percent effective at preventing symptomatic illness. But the company’s repeated missteps have sown confusion and distrust,” he wrote on March 24. His views were echoed by many medical professionals. Lauren Sauer, Johns Hopkins University’s associate professor of Emergency Medicine, said in a Bloomberg Radio interview on April 9 that the company has a “communication problem” rather than a “science” problem.
Here are three public relations missteps that have clouded the shot’s reputation, left governments wary, and exacerbated vaccine hesitancy.
Perception Becomes Reality
AstraZeneca (AZ) has long lost control of its perception among the general public, most of whom are still looking for vaccine solutions in the second, third or fourth wave of the COVID-19 pandemic around the world. The two-dose vaccine, originally developed by researchers at Oxford University, was the first vaccine out of the gate. The problems first started on January 29, 2021 when the European Medicines Agency (EMA) approved the vaccine for use in all age groups in the EU. On the same day, French president Emmanuel Macron claimed that it was “quasi-ineffective” for people over 65 because the early results of the French clinical trials were not encouraging for the older age group. Following his comments, France’s Health Authority made an official recommendation that the vaccine should not be used for people over 65. It said more studies were needed before it was rolled out to older age groups. Other European countries have taken a similar position: Germany, Austria, Sweden, Norway, Denmark, Netherlands, Spain, and Poland only recommended it for people under 65, and Italy and Belgium for those under 55. Switzerland – not an EU country – has ruled against approving the vaccine for any age group. The Swiss medical regulator said there was not enough data yet on safety, effectiveness and quality to do so.
The issue for some European countries, acting upon the recommendation from their vaccine advisory bodies, was that they thought not enough of the AstraZeneca clinical trial participants aged over 65 caught the virus to make conclusions on the vaccine’s effectiveness. Other vaccine manufacturers, like Pfizer, included more older people earlier on in their trials, so have more data available. However, the UK (no longer part of the EU) and a number of other countries including India, Mexico and Argentina, have approved its use for all age groups.
So, AstraZeneca’s initial launch in the first quarter of 2021 already sowed doubt and confusion. The COVID-19 vaccine once hailed as “the vaccine to the world” with its low price and easy storage requirements was gradually described as a “second-class” vaccine when compared to the two mRNA vaccines Pfizer-BioNTech and Moderna. Media in Germany reported on front-line essential workers such as firefighters refusing to receive the AZ vaccine because it was abandoned by the old folks.
The Oxford-AstraZeneca developers said at the time that results from a trial of 2,000 adults over 55 in the UK would soon be available, and another trial in the US in older age groups was close to providing data too. It took another three weeks for those trial results to come out and subsequently pointed to enough evidence and data that it is indeed effective for people over 65 after all. However, the damage was already done and the first impression of this vaccine among boomers and senior citizens was not good.
Then came the blood-clot crisis. Ever since March 7, deaths and hospitalisations in several countries around the world as a result of blood clots linked with the AZ vaccine led to governments pausing or changing regulations to only allow the vaccine for people under 55 or even older in some countries. In spite of Health Canada’s updated guidelines saying that blood clots as a result of vaccination are very rare and the vaccine’s benefits far outweigh any risks, Canada’s National Advisory Committee on Immunization (NACI) is currently reviewing the latest two blood clot incidents in the country – one in Quebec and one in Alberta – and might consider changing the age restrictions yet again.
In the UK, which has ordered 100 million doses of AZ vaccine, the Joint Committee on Vaccination and Immunization (JCVI) advised on April 7 that people aged under 30 should be offered alternative vaccines where available, even though its regulatory agency has reviewed the evidence and emphasized that it was not recommending new age restrictions. The most recent blow came from Denmark which has suspended the use of the AZ vaccine all together because the country has several other vaccine options and the infection rates have been coming down.
How did all these incidents affect consumer behaviour? More and more people are perceiving the AZ vaccine as unsafe and they do not want to take the risk of a blood clot no matter how low the probability is. Even with most government officials jabbing their arms with the AZ vaccine on camera, the perception of AstraZeneca as an “inferior” vaccine when compared to Pfizer-BioNTech and Moderna have unfortunately become a reality. Vaccine shopping is now trending in Toronto where pharmacies in the Greater Toronto Area raised concerns over this weekend about vaccine hesitancy and reported that a lot of AZ vaccines they have in stock are about to expire.
Reactive vs Anticipatory
Amidst all these global crises, what did AstraZeneca the company do to salvage its reputation? The company reacted to each crisis situation by sending out statements explaining next steps but none of them seemed to have registered with anybody. In an interview with the BMJ, one of the world’s oldest medical journals, Ines Hassan, senior policy researcher with the Global Health Governance Programme at the University of Edinburgh, said that AstraZeneca has not fallen short on meeting regulatory requirements. It submitted the necessary data as expected, even though the outdated data submitted to the FDA last month appeared to be a sloppy mistake. However, communication about trial design early in development, and later about the number of patients with COVID-19 symptoms from its primary analysis, could perhaps have been handled better.
According to the BMJ, part of the problem may be that AstraZeneca isn’t a traditional vaccine manufacturer. A number of commentators have raised questions about the experience of the board in communicating some of the challenging messages around vaccines. But the company does have a long history of drug manufacturing and any communications consultant would have told them that prior to a drug or health product launch, a pharmaceutical company must have in place an issues-management plan that anticipates possible issues or crises that might occur; proactively outlines steps to clearly and consistently communicate product benefits and explain the company’s position; and mobilize a group of independent scientists to educate the public on how the drug or vaccine works and saves lives.
Without a proactive communications plan, the company could only react to bad situations blow by blow. In the meantime, its reputation is at stake and its vaccine has lost trust and sown doubts among key stakeholders.
Losing Control
Most companies like to hide their heads in the sand when the first signs of trouble hit. AstraZeneca made the same mistake by letting its COVID-19 vaccine setbacks become non-stop news headlines everywhere since its launch. In addition to issuing reactive press statements, the face of the company has been restricted to its company website. About a month ago, AstraZeneca’s Chief Medical Officer Ann Taylor said in a statement on its website, “Around 17 million people in the EU and UK have now received our vaccine, and the number of cases of blood clots reported in this group is lower than the hundreds of cases that would be reached among the general population.” She then went on to explain how the company went above and beyond the standard practices for safety monitoring and ongoing tests. Ms. Taylor also reaffirmed the company’s commitment that “the safety of the public will always come first.”
The latest update on its website was the company’s response on April 7 to the UK’s and EU’s regulatory bodies’ assessments of extremely rare blood clotting events with low platelets from over 34 million people vaccinated with the AZ vaccine. “Overall, both of these reviews reaffirmed the vaccine offers a high-level of protection against all severities of COVID-19 and that these benefits continue to far outweigh the risks.”
But there are no frequently-asked questions and answers debunking the myths and misinformation out there on the link of blood clots with the vaccine. Posting reactive press releases on its website is not enough to quell public fears and doubts. AstraZeneca needs to take over the megaphone and deploy its global senior science team to deliver the key message that the company’s two-dose vaccine is safe and effective in fighting the pandemic and that its benefits continue to outweigh the risks.
The company also needs to educate global key opinion leaders (KOLs), including epidemiologists, family physicians, nurse practitioners, pharmacists, and other trusted voices within a community such as athletes and pastors, on the exact same key message and put the probability of the blood clots into perspective. As Health Canada’s Chief Medical Advisor Dr. Supriya Sharma said, “The chance of developing a blood clot while taking the birth control pill is one in 1,600. The chance of developing one after taking the AstraZeneca vaccine is about one in 250,000.” This is about the same odds as an airplane hitting your house, according to Toronto’s Chief Medical Officer Dr. Eileen De Villa.
So far, in countries where the AZ vaccine has been approved, public health officials, including those in Canada, have been reiterating confidence in the AZ vaccine, “Get whatever vaccine is available to you. It’s that simple.” Politicians in Canada, France and Germany have taken a jab of this vaccine in front of TV cameras to demonstrate their confidence in its safety and effectiveness.
But this is not enough. Positive, educational messages need to be repeated like a broken record by the media and KOLs on an ongoing basis before confidence and trust in the vaccine can be rebuilt. At present, some family physicians in Canada are still recommending that their patients wait for a better vaccine alternative than AZ, and pharmacies are raising concern about stockpile of the AZ vaccine about to be wasted due to the lack of takers. Canada is not alone – both Austria and France reported large number of eligible people refusing to take the AZ vaccine. In the meantime, more blood clots might still happen around the world, and every pause or suspension of the AZ vaccine would only exacerbate vaccine hesitancy and unnecessarily prolong the global pandemic. AstraZeneca should take immediate action in improving its global communications or risk becoming a classic case study of poor crisis management.