Much like it was for so many industries in the US, September 11 was
a defining moment for healthcare PR.
In the aftermath of the terrorist attacks, New York and its overburdened
hospital system desperately needed medical supplies, burn creams,
vaccines, blood, and human skin. Then, as the city's inhabitants tried
to make sense of their experiences and emotions, authorities recognized
the need for specialized mental health services. Healthcare, and the
effort to communicate its services, was very much at the center of the
And now with the presence of anthrax, the fear of further attacks, and
post-traumatic stress looming over US citizens, healthcare
communications remains at the forefront of the nation's effort to return
Reestablishing communications won't be easy given that the war on
terrorism has devoured the attention of the mainstream press, pushing
issues like the Patients' Bill of Rights, Food and Drug Administration
(FDA) approval of drugs, and other breakthroughs to the backs of
newspapers. But that doesn't mean these issues are going away, or that
healthcare won't play a more vital role in this new climate.
A lot was going on before the September attacks. After years of partisan
wrangling, the Patients' Bill of Rights finally passed the Senate and
House of Representatives, albeit in two different forms. The
McCain/Kennedy legislation, which allows patients to sue their HMOs for
an unlimited amount, passed the Senate on June 30. The more conservative
Dingell/Norwood legislation, which caps the liability of HMOs, scraped
through the House on August 2. The bills may differ in content, but at
least they present a starting point from which Congress can work.
The Pharmaceutical Research and Manufacturers of America (PhRMA), one of
the special interest groups supporting the Dingell/Norwood bill,
continues to hold press conferences and apply pressure on the state
level to spread the message that while it supports a Patients' Bill of
Rights, it also wants to ensure that pharmaceutical companies have free
reign in research and new drug discovery.
Reexamining healthcare's place
The events of September 11 literally placed the Patients' Bill of Rights
on hiatus. According to a poll conducted by USA Today, the bill has
dropped from the number-one to the number-five concern of Americans.
This may not last too long, though. As the country heads further into
the clutches of an economic recession, and more workers become
unemployed - and the number of uninsured rises - the need for a
Patients' Bill of Rights, prescription drug cards, and medicare reform
will grow louder.
In fact, President Bush has stated that his top concerns for the country
are his education bill and the Patients' Bill of Rights. And while
various press conferences and press releases may have been put on hold,
at least temporarily, the PhRMA says that it continues to move forward
with its agenda.
"Business as usual" is the message that many of these special interest
groups hope to convey to the public. "The nation's focus has obviously
changed, but we're optimistic that Congress will address these issues in
the near future," declares Jackie Cottrell, deputy VP of public affairs
for the PhRMA. "In times of crisis, people have a greater awareness of
their health, and we are ready to provide awareness so that people know
what's happening with regard to the Patients' Bill of Rights."
Citizens for Better Medicare, a group founded by the PhRMA, recently
mailed copies of Newsweek's special edition entitled "Health for Life"
to offices of members of Congress, along with a letter from PhRMA
president Alan Holmer telling policymakers to "use it when making
healthcare decisions." The group says it believes these issues will
become more relevant in the near future, and is prepared to continue
communication activities so the public understands its position.
Staying on top of the issues
Special interest groups representing the healthcare industry have been
plodding along, trying to adjust campaigns to fit the current climate,
but also pushing forward with issues that many of them admit will be
below the radar for the next few months.
One group that has continued full-throttle in the face of the shifting
landscape is Public Citizen, a nonprofit organization founded by Ralph
Nader. Public Citizen has been actively speaking with the media, sending
out releases, and writing letters to Congress to draw attention to the
fundamental flaws that it sees in the Best Pharmaceuticals for Children
Act, which the organization seeks to have extended for another year. The
law, which provides pediatric drugs for children, also opposes generic
drugs, which leaves some families unable to afford the care they
As special interest groups try to draw attention back to the issues of
Medicare and prescription drug benefits, some organizations are finding
that they have to be prepared for new crises that have arisen after the
September 11 tragedies. Families USA, a nonprofit group dedicated to
affordable healthcare, found itself having to respond to a Bush health
proposal in his economic stimulus package, which planned to transfer
$11 million from the State Children's Health Insurance Program to
recently uninsured adults.
The group issued a release and contacted the media to bring up the
problems with the stimulus package that might otherwise have been swept
under the rug by the national crisis.
Families USA also joined a coalition that included the Consumer
Federation of America, the National Consumers League, Public Citizen,
and the United Auto Workers. It also issued a press release and spoke to
the media about the ethical transgressions that it felt Newsweek had
overstepped by forging a special advertising relationship with the PhRMA
for its healthcare special.
"Access to responsible healthcare is more important than ever," explains
Jennifer Laudano, spokesperson for Families USA. "As the recession
deepens and more people become uninsured, and seniors stop taking their
necessary prescription drugs because they can't afford them, we feel
that our group has a commitment to go ahead with what we do."
Even for-profit healthcare organizations are staying the course.
Pharmaceutical giant GlaxoSmithKline, maker of Paxil and Zantac,
continued rolling out a campaign for its Orange Card, a prescription
drug card that provides a 30% discount to low-income seniors and the
Regaining national attention
Meanwhile, PR agencies are finding indicators that these issues, and
other important healthcare reforms, will soon return to the national
"We've received a lot of e-mail about breast cancer legislation," says
Susan Smirnoff, EVP and co-head of Ruder Finn's New York practice.
"There are all kinds of signs that the public is trying to get the
normal volume control back on these issues, and that they want Congress
to get back to business soon."
Even though Congress may have momentarily removed various healthcare
regulatory initiatives from the table, the FDA hasn't slowed down its
process of reviewing and approving new medicines. This leaves agencies
to forge ahead with their PR plans for pharmaceutical companies. In
fact, the FDA was holding a public review of 30-40 new drugs when the
first plane struck the World Trade Center. Instead of stopping, the
department continued the review, and has since approved four new drugs:
Foradil, Xeloda, NuvaRing, and Entocort.
Product launches that may have been postponed because of the attacks
have been rescheduled, and most agencies admit that the main challenge
facing them is to make sure that product pitches remain relevant in the
current climate. Most are tending to give conservative advice and
Some companies admit that individual tactical plans have been postponed
to make sure that the tone of their campaigns are sensitive to the
current feelings of fear and anxiety.
"This is a time when the mettle between the agency and the client will
be tested," says Nancy Turett, New York-based president of Edelman's
health practice. "Some individual plans have been postponed so that we
can refocus and work with the client to change the tone of the campaign,
and wrap it into a current message."
And while many agencies admit that a more conservative approach is the
stance of the moment, they believe that their PR plans haven't been
nearly as affected as those of the advertising industry.
Strange side effects
Ironically, the current climate may actually encourage the FDA to speed
up its efforts to approve new drugs. "Research is going to take on a
greater urgency," says Marina Maher, president of Marina Maher
"The challenge is being responsive to the shifting needs of the public,
and also working out long-term strategic plans in a climate where
uncertainty is the rule of the day."
Public panic and an understandable appetite for information following
the attacks of September 11 soon led to a river of rumors and
misinformation that flooded the media. Public health information groups
were thrust into the spotlight to stem the flow of hearsay.
The World Health Organization (WHO) responded to initial fears of
bioterrorism by producing a report entitled "Health Aspects of
Biological and Chemical Weapons," and inadvertently attracted the
largest amount of media attention in its history.
"Originally, we hadn't planned on talking to any media," says Jon Liden,
communications advisor to the director general. "We didn't want to drive
up the already high level of anxiety in the US."
But news that crop dusters had been grounded for two days throughout the
country led the organization to produce a press release drawing
attention to the fact that most countries are woefully unprepared for a
The WHO's 15-member communications staff found itself inundated with
calls about the report. And 40-50 advocacy members also took to the
phones to handle media calls from around the world. Liden, who usually
doesn't speak with the media, says that he had to pitch in, and gave
about 200 interviews in two days. "Our message has been simple:
Countries around the world have to build up preparedness for biological
warfare. As of now, most countries have no capacity to deal with such a
catastrophic event should it occur."
The central communications team of the WHO would play a part in any
biological attack on the US. Working with The Global Outbreak Alert and
Response Network, which is composed of 72 global and regional networks
that continually monitor reports and rumors of diseases around the
world, the team's job would be to send members to the outbreak site and
provide information to the Geneva headquarters.
"We would guide and advise governments on how to contain the spread of
the disease," says Liden. "Our job is not to provide panic, but to bring
clear and concise information to the public."
But while the WHO was busy fielding calls and trying to inform the
public about the threats of bioterrorism, Bioport, a beleaguered
Michigan pharmaceutical company, was trying to cope with the stress of
suddenly being forced into the forefront of anthrax fears.
Bioport is the only US company licensed to produce the anthrax
And with anthrax cases being reported in several states, the toxic
bacteria is the new threat causing fear for the public and the media
Kim Brennen Root, Bioport's spokesperson, says that the September 11
attacks have raised awareness of the "small Midwestern plant" that
counts the anthrax vaccine as its sole product. Although Bioport has
used a local PR agency before, Root says that she is currently handling
all of the company's media relations.
Root estimates that she has fielded at least 20 media inquiries a day
from such luminaries as The Wall Street Journal, the AP, CNN, and
However, most calls have come not from the media, but from a terrified
public that wants to find out how it can acquire the anthrax
Within three days of the attack, Bioport had received 1,000 calls from
frightened people. The company set up a consumer hotline (517-327-1656)
to inform the public that "all the anthrax vaccine stockpile that exists
is owned by the Department of Defense, and is for the protection of the
men and women who are risking their lives to fight for our freedom."
Bioport was hesitant to say if or when it might have the vaccine
available to civilians. However, the hotline message states that "we are
discussing the best way of meeting the needs of all who wish to receive
protection from the deadly anthrax bacteria." Root would only say that
Bioport was "fully committed to protecting life."
The trouble is, Bioport has been plagued by manufacturing problems, and
a long list of infractions led to the forced closure of its
manufacturing plant well over a year ago. While all of Bioport's energy
is now focused on having its plant reapproved by the FDA, the anthrax
vaccine is not expected to go back into production until at least
Mental health awareness
For many people, the shock of the initial attacks, coupled with the fear
and anxiety of future biowarfare, has been difficult to digest. One
particular concern has been post-traumatic stress. Often experienced
after people have survived a life-threatening situation, it manifests
itself through sleeplessness, flashbacks, and detachment from daily
life. Accordingly, mental health professionals have launched efforts to
inform the public about services that are available to them.
The New York City chapter of the National Mental Health Association
(NMHA) has developed a campaign with the city - called Lifenet - to make
New Yorkers aware of post-traumatic stress syndrome.
Bill Southard, president of Southard Communications, has been a member
of the NMHA's board of directors for two years, and his agency will help
design and launch the campaign pro bono. "We want to communicate to New
Yorkers that there are grief and mental health counseling services
available to them," he says. No budget for the initiative has been
The NMHA will target the campaign toward families, seniors, and children
affected by the tragedy, and it will create educational materials to be
handed out at schools and senior housing developments. The NMHA will
also write editorials for New York-based newspapers, and work with the
media on placing other stories in print and on television. There will
also be a subway advertising campaign offering tips on post-traumatic
stress symptoms, and a hotline (1-800-LIFENET) on which people can speak
to mental health professionals.
The educational campaign is a prototype that the rest of the country
will be able to use in case of another horrible emergency. "It will
hopefully make people aware of the services available to them, and
provide an anchor to the public," says Giselle Stolper, executive
director for the New York City chapter of the NMHA. "During this time of
crisis, we're acting as the city's primary public education voice."
Another mental health agency has rushed to produce public service
announcements to educate the public about depression and anxiety. The
National Mental Health Awareness Campaign (NMHAC) and the Ad Council
have created two PSAs that will be broadcast on national TV and radio
during the next six months.
The spokespeople and stars of the PSAs are Tipper Gore and Alma
Washington, DC agency Susan Davis International wrote the PSAs, and
coordinated the launch of the campaign. The group is also handling media
relations for the NMHAC.
"People are talking about the mental health issues related to the crisis
everywhere," says Jennifer Devlin, VP of media relations at Susan
"We want to communicate that it's okay to talk with mental health
experts if you feel you need to."
The PSAs offer a toll-free number (877-495-0009) and a website
(www.nostigma.org), linking people to mental health services in their
As the spokespeople, Gore and Powell have appeared on a number of
national and local morning TV programs, including Good Morning America
and the CBS' Early Show, and have cowritten an editorial featured in USA
Another aspect of the campaign will focus on creating forums to educate
journalists on how to write about and cover mental health. The group
will also release a poll that provides statistics on how the national
psyche is holding up since the attacks.
"The next step is a town hall meeting in New York with survivors of the
attack and firefighters," says Devlin. Tipper Gore will host the town
hall meeting, which will then be held in Washington, DC and at other
locations around the country.
Changing with public sentiment
Of course, the guiding force behind the kinds of campaigns that agencies
decide to run will be the public mood and how it has changed since the
attacks. Some agencies say that, at least temporarily, consumers may shy
away from so-called lifestyle drugs, such as Viagra or other medications
not considered to be life-saving. But as consumers adjust to new life in
the US, most agencies believe that the public will come back to
"I don't like the term 'lifestyle' drugs," says Edelman's Turett. "To
many people, those medications that combat obesity, balding, erectile
dysfunction, and other life-quality issues are the difference between
feeling confident about yourself and being unhappy."
Many agencies believe that healthcare will grow out of the tragedy,
because taking care of health is something that people can exert control
over. "We are starting to see a return to nesting and to family, things
that we can control," confirms Tom Beall, managing director of Ogilvy's
global health and medical practice.
The public mood, however, may prove decisive in shifting toward issues
that may not have enjoyed popular support previously, but will now be
accepted, such as the privacy arena. Consumers typically have grave
reservations about sharing their private information with a number of
hospitals and healthcare agencies. An issue that has come to prominence
since September 11 is the idea of a national data network, which would
provide an electrical medical record of every person in the US. In times
of a crisis, the ability to move information quickly is of paramount
importance. An agency specializing in healthcare technology PR would now
find a much easier and less decisive environment in which to pitch such
a network, and to draw a positive response.
"National defense has taken over as number-one right now," says John
Smith, SVP of the health practice at Brodeur. "Where people would have
previously put up more of a fight about privacy, there is an
understanding that such a system now makes sense."
However, as the healthcare PR industry and the rest of the world change
in the wake of the horrible attacks, it may come to the realization that
both public mood and the word "normal" have been permanently
BIOPORT: THE LONELY PLIGHT OF THE ONLY VACCINE MAKER
Anthrax cases have provoked hysteria in an already-anxious public. And
Lansing, MI-based Bioport has been thrust into the spotlight as the only
company in the US licensed to produce the anthrax vaccine. In fact,
that's all it produces.
"There has been an evolution in how the news has been reporting the
terrorism," says sole spokesperson Kim Brennen Root. "At first, it
centered on what happened and what we do as a nation. Invariably, it
shifted to how it could have been worse. The first threat to come to
mind was bioterrorism. That's when we entered the story." In response to
numerous inquiries, Bioport set up a consumer hotline (517-327-1656) to
answer questions about vaccine availability.
Bioport is currently focusing on getting its plant reapproved by the FDA
after multiple infractions forced its closure over a year ago.
"Our commitment is to protect human life and meet the current demands of
the Department of Defense," says Root. "What happened has changed the
profile and focus of our company."
Root expects the company to start manufacturing again in mid-October,
which means that the anthrax vaccine won't go back into production until
at least 2002.