More and more parents have been turning their backs on giving their children the triple MMR vaccine. Controversy over MMR safety was triggered after a paper was published in 1998 in a medical journal suggesting the vaccine was linked to autism. The level of vaccinations has fallen below the World Health Organisations target of 95%. Any level below this does not provide herd immunity. This means the risk of suffering from one of these illnesses is higher for children who have not had the jabs and children who are not yet old enough. Levels have been reported as low as 80.9% in some areas. This means the risk of measles outbreaks is getting much greater.
On behalf of XYZ Pharmaceuticals who manufacture the triple MMR vaccine we have looked at how the company can respond to the decline in vaccination levels in order to protect revenues. The strategic question we thought needed addressing was as follows: In light of reduced uptake of the triple MMR vaccination, how do we increase protection levels to WHO recommended levels (95%) and protect the revenues of XYZ Pharmaceuticals
The analysis started with the drawing of an influence diagram. I also needed to draw a mind map outside the group after the first session to help me make sure I was comfortable with all the issues and where they fitted in. Mind maps I feel are easier to use and after working on the influence diagram I needed to restore my confidence in being able to understand the problem we were dealing with.
Influence Diagram The Influence Diagram we created for this problem is shown in Figure 2. From this we can see that the perceived risk of the triple MMR vaccine (triple) is very much at the centre. By looking at some of the feedback loops from this central point it helps us understand the dynamics of the problem. I have identified a couple of feedback loops by highlighting them with coloured arrows.
The first one I am going to discuss has pink arrows. This feedback loop is referred to as a growth loop. It shows the perceived risks of the triple being greater than the risk of the disease impacting our sales negatively. As our sales decline then the number of vulnerable children increases. This eventually gives rise to more cases of disease although there is a delay in this happening as symbolised by the ‘D’ on the arrow.
Even with the use of the triple being as low as 80.9% in some areas as the decline is only a relatively recent phenomena we are not seeing the full impact yet. With more children getting the disease there are more opportunities for the disease to be cured therefore growing the perception of the risk of the triple being worse than the disease itself. The view that the disease can be treated powering this. The fact that there are more occurrences of the disease could also mean that there are more deaths, which would then have a positive impact on the view that the disease is worse than the triple. This type of loop is referred to as a drain loop.
The feedback loop identified by green arrows is another example of a growth loop. That is by going round the loop the perceived risk of the triple is being amplified. Here the possible take up of the triple by public figures is reducing. However they are remaining silent and yet the Government is meant to be supporting the use of the triple. This silence is increasing the mistrust of the establishment that then goes onto increase the public perception of the triple as being a greater risk as the government recommendations are not being trusted even by themselves.
Another major part of the influence diagram are the pressure points. These are the issues that impact onto the problem but do not take part in any loops. For example in the bottom left of the diagram we have identified the media’s desire to sell news as an external force. On the bottom right we have the Governments new policy of funding pre school places impacting the level of mixing being done by children. The point being the more the children mix the greater risk of disease spreading if they have not been vaccinated.
TOWS Analysis The next stage is to perform a TOWS analysis. This involved looking externally and internally at the problem. Externally by examining the threats and opportunities and internally by looking at the strengths and weaknesses. We identified 37 items to put into this analysis which is verging towards a limit of how many we could deal with. Over half of them were new to the analysis that is they were not explicit on the influence diagram.
For example one of the strengths of the triple we saw as being reduced pressure on GP surgeries. By this we mean there are less appointments to make and reduced recording to be done if there is one jab compared to three single ones. Many parents would organise separate appointments for each jab not wanting their child to suffer three in one day. Other examples include government public health targets as an opportunity and NHS reform of more choice as a threat.
The factors, that is the column headings, for the Viable Strategy Matrix were developed from the TOWS action plan groupings seen in Figure 6. The Viable Strategy Matrix can be seen in Figure 7. The matrix is split into two column types, factors outside our control but are measurable referred to as the outcome. As well as factors we can control which are referred to as inputs. At present the XYZ pharmaceutical company situation is highlighted in orange on the Viable Strategy Matrix.
This tells us that the Government currently supports the triple vaccine, the company is involved in research but it is slow and developmental, the press mistrust them and are much more likely to cover negative stories as this sells papers and they have some knowledge about the patterns of uptake of the triple but clear enough to develop a strategy for targeting. For example they are aware there are some regional aspects to this.
A set of possible viable strategies for the pharmaceutical company to follow has been highlighted in green. It suggests that the company should strengthen its relationship with Government, the status for research should stay the same, press relations should be improved and a greater understanding of where the non uptake is occurring be developed. The development of the strategies as suggested above should then move the company from seeing a few outbreaks of measles to the triple reaching WHO recommended levels.
Congruence Analysis
To check whether the developed strategy could work we carried out a Congruence Analysis. First we made some decisions about who the interested parties were. These are the column headings in Figure 8. They include the parties already identified, Government and Press, but also include other parties. Parents are one of the interested parties and we felt we needed to split this group into sceptics and supportive.
This was to show the different attitudes of the two groups. For example Sceptic Parents would become even more sceptical if they thought we had some power over the press. Any attempts to improve this area therefore gets a negative score as far as this group is concerned. Whereas the supportive parents would not have such strong views as they think the company is doing a good job. It does not allow for a group of parents that sit in the middle. The parents who have the jabs but are still sceptical about drug companies but cannot bear the thought of not having their child immunised and understand that research actually weights in favour of the triple.
If competitors were taking out of the analysis on the whole there is very little negative reaction. So it would appear that the strategy has potential. The greatest area of negativity is the Press so we to focus on them. If we do this then the Sceptic Parents will get different information in hope they change their views. Plus with our other strategies for our Government relations we should have impact on this group of parents. With our analysis on the patterns of uptake we can then concentrate our efforts in the right place. For example if it is a regional issue we can concentrate on the local press. If it turns out to be more of a socio economic groupings then we could devise media plans around the papers the non uptake group reads.