Don Tracy, Associate Editor

Data shows that from 2014-2019, pneumococcal vaccinations in seniors increased by 10%, growing sales for Prevnar 13 due to government recommendation in addition to a high-profile advertising campaign.A 2014 recommendation by the Advisory Committee on Immunization Practices (ACIP) for adults aged 65 years and over to receive Prevnar 13 was followed by Pfizer initiating a high-profile advertisement campaign for the vaccinations. During this time, Medicare and private insurance companies began covering the vaccine as well. According to a new study published in the Journal of Policy Analysis and Management, over the next five years, this resulted in a 10% increase in vaccination among seniors and a corresponding $1 billion annual increase in Prevnar 13 sales. According to the authors of the study, government vaccine recommendations may offer substantial value to pharmaceutical manufacturers, further implying that direct-to-consumer (DTC) advertising can lead to successfully achieving public health goals when motivations align.1
“Our results suggest there is real value to vaccine manufacturers in winning a recommendation from ACIP, and that direct-to-consumer advertising of pharmaceuticals is not the unequivocal boogeyman that some people think it is,” said Brandyn Churchill, assistant professor of resource economics, UMass Amherst, study co-author, according to the University of Massachusetts Amherst. “It can be an effective tool to achieve public health objectives—as long as the incentives are aligned.”
On the other hand, the study also found that the efforts of the campaign did not translate to a significant decrease in mortality and infection rates from pneumococcal disease, suggesting that Pfizer was the main beneficiary of the recommendation, according to the investigators. By 2019, ACIP reversed course on its previous recommendation, stating that there was a significant population protection achieved through increased vaccination rates among children, showing benefits associated with herd immunity.1
“We didn’t find any evidence of a public health improvement, but someone benefited—in this case it was Pfizer,” Churchill told the university. “The marketing of Prevnar 13 was a success in that it helped achieve a stated policy goal—even if that goal changed as ACIP followed the science.”
“While our results show that the ACIP recommendation and Pfizer’s advertising response led to increased vaccination rates among the elderly, ACIP concluded in 2019 that their 2014 recommendation for routine vaccination of the elderly had done little to reduce PCV13-type disease at the population level of this age group,” the authors explained. “ACIP acknowledged historically low incidence of PCV13-type disease among the elderly, instead attributing these declines to pediatric take-up of Prevnar. Yet we identify at least one major beneficiary of the recommendation—Pfizer.”
The investigators estimated that ACIP’s recommendation for vaccination with Prevnar 13 caused a spike in annual Medicare Part B Fee-for-Service on Prevnar 13 by $14.41 per beneficiary, which translates to $478 million per year.
“Given that the Medicare Part B FFS population we study represented approximately 57.6% of the total Medicare population in 2015, this estimate extrapolates to a total increase in Medicare expenditure for the pneumococcal vaccine of $839 million per year,” the study authors wrote. “Similarly, we also find that the recommendation increased annual Prevnar 13 sales by approximately $1.03 billion compared to the associated changes experienced by comparison pharmaceuticals. Overall, these estimates highlight the value pharmaceutical firms can gain from health care recommendations.”
According to the authors, this study is the first to provide quasi-experimental evidence of the impact of adult vaccine recommendations on firm marketing decisions and consumer behaviors. In 2015, the American Medical Association called for a ban on DTC advertising. However, the study suggests that DTC advertising has the potential to help government agencies successfully achieve public health goals over time. They also acknowledged that a key difference with Prevnar 13 was that Pfizer was the sole manufacturer, resulting in goals aligning perfectly between the pharma company and the government. Additionally, they found that these efforts resulted in a spillover to the shingles vaccine, further suggesting that these initiatives could benefit multiple areas of public health in the long run.
Despite its findings, the authors also mentioned a number of limitations associated with their methods. First off, vaccine data were taken from self-reported information from NHIS. Findings were also reported to be similar with data from Pfizer itself and the authors were unable to analyze changes in direct-to-physician advertising. Overall, the authors stated that future ACIP recommendations will have different effects as a result of the political involvement regarding vaccination for COVID-19.2