A killer education

Undetected and untreated, HPV can lead to sometimes fatal cervical cancer. However, a groundbreaking PR education effort has helped lift the death sentence.

Undetected and untreated, HPV can lead to sometimes fatal cervical cancer. However, a groundbreaking PR education effort has helped lift the death sentence.

"Cervical cancer is the only cancer for which there is one cause: the human papilloma virus (HPV)," says Pam Rasmussen, VP of corporate communications at Digene, maker of the HPV test. "It can be prevented - through vaccination against the most common types of [HPV] for girls and young women, and ongoing screening at appropriate ages with the Pap and HPV tests. If every woman had access to and took advantage of these technologies, we could virtually eliminate cervical cancer."

The HPV test was approved in 1999 in the US as follow-up for inconclusive Pap tests. In 2003, it was approved in the US for routine screening in conjunction with the Pap for women 30 and older. Rasmussen says, "Women didn't even know about the virus" in 2003.

Making progress with PR

Eradicating cervical cancer cannot happen without education. Both Digene and Merck, maker of Gardasil, the first HPV vaccine, approved in June, are committed to education and have made tremendous headway.

HPV and its link to cervical cancer were virtually unknown a few years ago - Merck discovered HPV awareness was as low as 6% in 2004. Today, stories are widely reported. Cervical cancer prevention legislation has been introduced in 45 states. Dramatic increase in HPV awareness is testimony to PR's ability to impact public health education.

"The overall objective was to educate audiences on the link between HPV and cervical cancer," says Kelley Dougherty, director of public affairs for Merck vaccines. "Think about the original 'A-ha' moment - a cancer [is] caused by a virus. Every woman who will ever be sexually active risk[s] getting this virus that could lead to cervical cancer. It's stunning, but it took a lot for people to understand because it was a shift from what we appreciate cancer [causes]. It was exciting to watch as people started to understand."

Before widespread use of the Pap test, cervical cancer was one of the most common causes of cancer death for American women, according to the American Cancer Society (ACS). The Pap test helped decrease cervical cancer deaths in the US by 74% between 1955 and 1992. Still, the ACS estimates diagnoses of about 9,710 cases of invasive cervical cancer this year in the US. About 3,700 will die.

"The Pap [test] is highly subjective," Rasmussen says. "It [involves a] person looking through a microscope for abnormal cells. About one-third of cervical cancer cases are due to Pap failure. Cervical cancer is slow-developing. It's not possible to go from normal Pap to invasive cancer. The HPV test is a computerized molecular test that detects the genetic footprint of the virus. There's no human interpretation."

Rasmussen continues: "Our purpose isn't to get Digene front and center because we have
no competition. We considered ignorance to be our biggest competitor."

Doctors were slow to recognize the HPV test's role, mainly because the Pap was entrenched and the HPV test was originally approved as a secondary measure.
Rasmussen says doctors didn't proactively offer the test because they worried women would be alarmed; they were uncomfortable talking about a sexually transmitted disease; and because the HPV test is approved for every three years because of its accuracy, they were concerned that women wouldn't come in annually.

"Educating women helps doctors," Rasmussen says. "Our response [to fear of alarming women] is, 'Let the woman decide.'" So the "Choose to Know" message was born.
"The message is about empowering women. [The importance of annual visits] is just an educational challenge, and [we] don't assume that women can't understand."

The objective was to get women talking with each other and with their doctors, and to get them to ask for the test. "We have to motivate women to ask for it," Rasmussen says. "People know ads are paid for. A really good article or broadcast is much more credible. If women see this test talked about in their favorite magazine, it motivates them."

Lippe Taylor, a PR firm that specializes in reaching out to women, worked with Digene on the effort. Evelyn Sprigg, SVP of healthcare at the agency, attests: "PR can react on a dime. Advertising takes weeks [or even] months to ramp up a campaign. We can respond in 30 seconds."

Digene focused on print, and the team notes there were a lot of misconceptions and misinformation, even in healthcare media. Awareness initiatives, such as National Women's Health Week, Gynecological Cancer Awareness Month, and Cervical Cancer Screening Awareness Month, were leveraged. Doctors were reached via journals and medical meetings.

Rasmussen says one challenge is to keep re-inventing the story and notes that "new and non-traditional partnerships [help]." Mother-daughter communication is a new angle. Digene has partnered with organizations, including Women in Government, the WNBA, and, recently, the Spirit of Women hospital network, to host a series of "Girls' Night Out" events in 22 markets.

The specially created Web site, thehpvtest.com, is a primary education vehicle and has evolved to encompass suggestions from consumer feedback. "We can answer all questions [on the site] once we've gotten interest," Rasmussen says. "A lot of pharma companies don't encourage consumer feedback. I don't think it should be a one-way conversation."

Digene's "patient ambassadors" are also extremely important. "Their stories are very compelling," says Lippe Taylor president Maureen Lippe. "Most didn't know about the test and were totally unaware that the Pap was missing cervical cancer. It would have been so simple had they demanded the test."

Christine Baze, a musician and cervical cancer survivor, found Digene and became a spokeswoman and a powerful conduit in reaching women. She raises awareness in many ways, including by telling her story on her Digene-sponsored 30-city Yellow Umbrella Tour.

"When you hear her story, you see the attitude changing - people realize, 'That could be me,'" Rasmussen says. "You really internalize it. You're not reaching as many people, but it's the most motivating."

Fiscal year 2006 Q4 survey results from Digene's Web site, thehpvtest.com, show that 43% of women age 30 and older planned to ask for the HPV test and 51% already asked, compared with Q3 when 68% planned to ask and 26% already had done so.

Site visits increased from 61,696 in January to 124,791 in June, and requests for Choose to Know bracelets increased 68% over May (from 4,873 to 8,211). Digene's US HPV business increased 45% in its last fiscal year (June 2005 to June 2006). Over the past year, there was four times as much coverage of the HPV test (3,200 stories and broadcasts - about 370 million media impressions) as in the previous year.

Telling the whole story

The awareness effort is not just about detection - it's also about prevention. Merck's Gardasil is indicated for women age 9 to 26, and its arrival is "a boon and a challenge" for Digene, Rasmussen says.

"The vaccine is great news, but it will not replace screening," she notes. "Some coverage will give the impression otherwise. Our challenge is to keep getting attention for the test. If we're not careful, [vaccine news] can drown everything else out and women can get so focused on the vaccine that they won't get screened."

Lippe Taylor's Sprigg notes that "preventing cancer is sexy" and hasn't been done before. "[The vaccine is] awesome news. Media need to tell the whole story and talk to all age groups. We aren't fighting over shares of a pie. All three together can eliminate a cancer for the first time ever."

Dougherty reports Merck has not yet employed all marketing plans and strategies for Gardasil and notes that there are no plans to partner with additional manufacturers. "We review any and all opportunities to work with anyone around this," she says. "If there's something specific, we're interested in hearing it."

Merck developed multiple communications means, Dougherty says, including "a grassroots public affairs initiative in key states where stats around HPV infection and cervical cancer were particularly high: Texas, California, Pennsylvania, and New York."

The campaign, "Make the Connection," was launched last September with the goal of getting people to understand the connection between HPV and cervical cancer. Free bracelet kits and educational brochures are key elements. More than 1 million have been distributed. "Media events [and] third parties, as well as a partnership with the Cancer Research and Prevention Foundation in DC, created a ground- swell," Dougherty notes.
A partnership with Step Up Women's Network launched last fall. This year, a disease awareness broadcast and print campaign called "Tell Someone" was introduced.
Aggressive communications occurred around every key milestone Gardasil achieved, and pivotal phase III data released last fall was heavily supported with media outreach.

"[We wanted to] elevate priority on a national and statewide basis," Dougherty says. "Local events and state-by-state discussions with physicians and consumer organizations drove directly into public health awareness. It was so grassroots and so high-profile when we had data. Public health organizations [had to] take stock of where they were on this disease and [if] they were prepared for questions and implementation of something new if it were to come down the pike."

Gardasil has had a bit of a halo effect at Merck; everyone is reportedly behind HPV awareness and the vaccine. "Communications success around Gardasil and HPV represents an organizational commitment," Dougherty says. "From a PR perspective, it's the perfect storm - the entire company is committed to it being as broadly communicated in the most transparent way possible. It's the driving force around how truly successful this has been."

Gardasil is now in clinical trial for women up to age 45 and is being evaluated for use in men. "Women over 26 are going be moms, so they have to know as much as anyone else," Dougherty says.

Pushing public health

"The Merck campaign has been amazingly responsible," says Peter Pitts, cofounder and president of the nonprofit Center for Medicine in the Public Interest and SVP of global health affairs at Manning Selvage & Lee. "[It has] done a lot to raise awareness of the condition in a very classy way. It's good for Merck and a profoundly important message for the public health."

Pitts continues: "A pharma company is first and foremost in the public health business; not the drug-selling business. The industry has learned the hard way. Benefit to the public and the company aren't necessarily mutually exclusive. PR is the best way to get across a profound and important public health message."

The pharma industry has a long history of companies who have launched widescale public health initiatives, with their own therapies at the heart of the solution, if not a front-and-center marketing message.

Eli Lilly figured out how to mass-produce insulin in the 1920s, and its longstanding commitment to public education is laudable.

"We have a strong heritage and feel an obligation to patients to continue to provide tools," says Scott MacGregor, senior communications associate for insulin products at Eli Lilly. Lilly diabetes PR focuses on management via media relations around its products and its LillyforLife program. LillyforLife includes Insulin Award Metals (started in 1974) for people who have lived with diabetes for 25, 50, or 75 years, and Achievement Awards for patients, healthcare professionals, caregivers/loved ones, and kids.

"We're limited in what we can do to reach patients because of regulations," MacGregor says. "Lilly in general has had great success with DTC and PR. People with diabetes are very often seeking sources like the LillyforLife Web site, and that's where we can really play a role. We wouldn't purport that PR is driving our business, but it plays an important role in supporting our diabetes business and providing patients and caregivers inspiration."

Partnerships are another part of Lilly's heritage. Earlier this year, it collaborated with the American Association of Clinical Endocrinologists (AACE) on a disaster preparedness campaign, which focused on tips for people with diabetes and other chronic medical conditions for hurricane and tornado seasons. "The value was purely about letting people know [how] they could prepare themselves," says MacGregor. "It wasn't about our products or touting Lilly. It was about performing a public service."

MS&L handles most of Lilly's diabetes business, but it worked with Indianapolis agency Borshoff Johnson Matthews (BJM) on disaster preparedness.

"Lilly has a long history of and commitment to working with other organizations," says BJM VP Katherine Coble. "One of our employees who was displaced after Hurricane Katrina came up with the idea. We pitched Lilly, and it strengthened the idea because it had the idea of partnering with AACE."

Beyond diabetes, Lilly also has done commendable public education work around depression, erectile dysfunction, osteoporosis, and several areas of oncology, including breast cancer.

"If you educate someone, that person has internalized not just a brand name, but what they can do to enhance health," Pitts says. "That's real health literacy."

And sometimes, that's the best weapon against disease. Tests and vaccines alone cannot eliminate such things as cervical cancer; it's going to take sustained, long-term, cooperative commitment from companies like Digene and Merck to public education and access.

"It's outstanding to be involved in a broad team effort to communicate about one of the most exciting advances in women's health," Merck's Dougherty says. "We will continue to be dedicated for a very long time."

The survivor as spokeswoman

Who she is: Christine Baze, professional musician, cervical cancer survivor, spokeswoman for Digene

Her story: After quitting her day job in January 2000 to become a musician, Baze "saw blood." She called her gynecologist, who told her not to worry and that he'd see her in a couple of months for her annual visit. All previous Pap tests were normal, but the March 2000 test showed abnormal cell growth. On April 18, 2000, Baze, then 31, was diagnosed with advanced cervical cancer with extensive lymphatic invasion. Ten days later, she underwent a radical hysterectomy. This was followed by a grueling therapy regimen.

What she does for the cause: The Yellow Umbrella Tour, sponsored by Digene. Digene reps pass out Choose to Know bracelets and pocket mirrors, and HPV test brochures to concert attendees. She teams with a physician in TV and radio SMTs for Gynecological Cancer Awareness Month each September. She speaks at events sponsored by Digene's advocacy partners, such as Women in Government. She is a motivational speaker/performer at Digene sales meetings and writes letters to the editor and op-eds.

Why she's a good spokeswoman: Digene's corporate communications VP Pam Rasmussen says: "She is passionate about our cause. She was affected by the disease and used the negative experience in a positive way by seeking to educate women. We did not put her up for this at all. She found us. People get suspicious of corporate sponsorship and celebrities. We want women who are in this for the cause. Christine offers a dramatic example of the difference our product could make to women."

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