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The Challenge
MedImmune Inc., a biotechnology company based in Gaithersburg, MD, approached Franco in November 1998 with a request for a public-awareness campaign in metro Detroit to create awareness of a little-known, but potentially dangerous respiratory virus called respiratory syncytial (sin-sish-ul) virus or RSV.
Highly contagious, RSV strikes half of all children by the age of one year. By age two, virtually all children have had RSV. For most otherwise healthy children, RSV usually amounts to little more than a cold. However, for at-risk infants, such as infants born prematurely and children under the age of two suffering from chronic lung conditions, the health consequences can be much more serious. Each year, as many as two percent of children who are hospitalized due to RSV may die. RSV outbreaks typically occur in Michigan from November through May.
In addition to raising public awareness about RSV, MedImmune wanted to increase awareness of a prescription medication the company manufactures called Synagis®—which prevents serious respiratory tract disease in infants and children at high risk for RSV infection. Synagis is the only humanized monoclonal antibody for the prevention of RSV and is designed to bind to a protein on RSV, effectively neutralizing the virus.
MedImmune needed the public awareness campaign specifically in Michigan for two reasons. First, unlike most health insurance plans in the United States, Blue Cross Blue Shield of Michigan (BCBSM)—the state's largest health plan—did not include Synagis in its list of reimbursable medications. The drug is extremely expensive, costing approximately $5,000 out-of-pocket for one RSV season. The high cost contributed to some at-risk infants not being treated because their parents couldn't afford to pay for the drug and physicians were not willing to absorb the expense. Second, in comparison to other states, Michigan consistently reported low figures for sales of Synagis. MedImmune equated the low sales of Synagis to the BCBSM issue and a lack of awareness of RSV among parents of infants at-risk and at times, physicians and nurses.
The Franco Strategy
1998-1999 Campaign
Franco's initial strategy was to create a community movement that would raise awareness of RSV. The objectives of the campaign were to:
- Increase awareness of RSV in metro Detroit;
- Position RSV as a vital—and often overlooked—public health concern;
- Identify RSV symptoms and preventive measures;
- Empower metro area parents of at-risk infants to gather information on RSV prevention and Synagis from their baby's physician;
- Have parents of at-risk infants ask their doctors for Synagis prevention therapy.
Franco recommended the public awareness campaign happen first as a means for setting the groundwork to approach Blue Cross Blue Shield of Michigan later to consider changing its Synagis reimbursement policy.
Target audiences for the public awareness campaign included metro-area moms of infants at-risk, pediatricians, and influencers/opinion leaders including the Mayor of Detroit, community/religious organizations and mother's groups.
To quantify the level of awareness the general public had regarding RSV, Franco commissioned a statewide survey. The survey, which included telephone interviews with 600 adults in Michigan, found an overwhelming majority of Michigan residents had never heard of RSV or its preventive medication Synagis.
The key messages of the campaign focused on the virus - its symptoms, its season, preventive means to reduce exposure, and the availability and efficacy of Synagis.
Tactics used to carry out our strategy included:
- Supplying media kits and radio PSA scripts to approximately 100 metro Detroit media outlets;
- Recruiting local physicians to serve as medical spokespersons;
- Recruiting the president of the Michigan Organization of Mothers of Twins Clubs as a parent spokesperson;
- Securing the Mayor of Detroit to issue a proclamation declaring the month of November as RSV Awareness Month;
- Partnering with The Alexis Foundation For Premature Infants and Children, a Michigan-based organization with a vested interest in RSV prevention;
- Sending health bulletins with RSV information to health departments, local Mothers of Multiples clubs, religious organizations and churches and social services organizations;
- Positioning the MedImmune metro Detroit sales representative as a speaker at Mothers of Multiples groups and civic organizations throughout Detroit and its suburbs.
In all, the media-relations outreach for the 1998-1999 campaign produced 14 print placements, including a wire story, and 33 broadcast placements, for a total audience of more than 6.5 million.
1999-2000 Campaign
After seeing the success of the 1998-1999 RSV public awareness campaign, MedImmune asked Franco to continue its efforts though the 1999-2000 RSV season.
To kick off the 1999-2000 RSV season, Franco held a news conference featuring remarks from a well-known Detroit-based neonatologist, a representative from the research company who addressed the previous year's survey results, a representative from MedImmune, and several parents from the RSV Coalition.
The news conference generated a front page story (with a photograph) in The Detroit Free Press , and The Detroit News ran a three-page cover story in its Health & Fitness section profiling two RSV Coalition members and their children's battle with RSV. Print placements also were secured in several metro Detroit suburban papers.
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Television coverage included a five minute story on the "Healthy Living" program on WXYZ-TV 7, the ABC affiliate in Detroit.
The 1999-2000 campaign, however, incorporated a noteworthy additional goal, beyond awareness. MedImmune wanted to approach BCBSM to request a change in its Synagis reimbursement policy. The rationale was that if the reimbursement policy was changed to cover Synagis, physicians would be more likely to prescribe the drug and Synagis sales would increase. This request was a real challenge, since it's is no easy task to go up against the bureaucracy of a large organization.
Blue Cross Blue Shield of Michigan
Franco recommended a grassroots lobbying effort from a parents' perspective as the best way to influence BCBSM. Through alliances formed during the 98-99 campaign with The Alexis Foundation for Premature Infants and Children and parental contacts provided from MedImmune's metro Detroit sales representative, Franco recruited a group of six parents (all of whose children had experienced the trauma of RSV) to serve on a board.
Franco formally organized these parents and named the group The RSV Coalition (Coalition). Franco organized monthly meetings of the Coalition to strategize on the best approach to BCBSM to request a Synagis reimbursement policy change.
Franco recommended an aggressive letter-writing campaign be initiated by each of the Coalition members outlining their compelling, and often heartbreaking, experiences with RSV. Their letters (written in long hand) were sent directly to Richard Whitmer, president of BCBSM and to each of the physicians who composed the medical advisory board responsible for reimbursement policy changes at the insurance company.
The Coalition then embarked on a second round of letter writing to BCBSM, which was followed up by telephone calls by each Coalition member to each of the doctors on the medical advisory board.
Included in the second round of letters, was a comprehensive listing of facts about how RSV cannot only be debilitating, but also fatal in some instances in high-risk infants. The second round of letters included in graphic detail, the pain and suffering the Coalition members' children endured when they contracted the virus.
The Results
This second round of letters generated a response from both Richard Whitmer and members of the medical advisory board. Each Coalition member received a personalized letter from Mr. Whitmer indicating their requests were received and that he requested the medical advisory board meet to review BCBSM's policy against reimbursing Synagis. Members of the medical advisory board sent letters to the Coalition members indicating they were reviewing the current BCBSM Synagis reimbursement policy.
After a six-month effort, each member of the Coalition received word in a letter from BCBSM President Richard Whitmer, that the medical advisory board —based on the compelling arguments made by the Coalition—decided to overturn the company's current Synagis reimbursement policy. As of September 1, 2000, BCBSM completely covers Synagis as a reimbursable drug in all its payer groups.
The Epilogue
2000-2001 Campaign
MedImmune realized that still more work was required to continue the RSV public awareness outreach and wanted to continue work with Franco for the 2000-2001 RSV season.
The 2000-2001 campaign was broadened in scope with the media relations outreach focused on the entire state as opposed to only metro Detroit. Major dailies and weeklies throughout the state were sent media kits. The news releases focused on the work of the RSV Coalition, and included their personal stories.
The statewide mailing was well-received and print placements were secured in major dailies and weeklies across the state. The confirmed circulation of all print placements totaled 760,000.
Franco recruited two additional Coalition members, each of whom had seen a newspaper article about RSV.
The Coalition subsequently focused its efforts on an outreach to Michigan pediatricians, neonatolgists, pediatric nurses, and Mother's of Multiples clubs.
Franco also drafted a position paper on behalf of the Coalition which outlined its opinion on the low levels of awareness of RSV and its prevention among Michigan residents. The position paper is a key element in the materials being sent to the media, physicians, nurses and mother's groups.
As part of the Coalition's outreach to Mother's of Multiples Groups, a Coalition member addressed the Michigan Organization of Mothers of Multiples annual meeting in Lansing, MI. Her presentation focused on explaining RSV, its symptoms and the availability of Synagis.
For the first time, the Coalition was scheduled to have a presence at the Michigan Chapter of the American Academy of Pediatricians annual meeting in Grand Rapids, MI, in August 2001, where each Coalition member could talk directly to physicians about RSV and express their personal stories., as well as distribute RSV literature.
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