Alexander Lefterov/Endpoints News

Mi­cro-in­flu­encers with a ma­jor plat­form: Are they the next big thing in phar­ma mar­ket­ing?

Dami­an Wash­ing­ton didn’t want to be “the MS guy.”

He was a life­long per­former — he booked his first com­mer­cial at 15 pro­mot­ing Cap­tain Crunch ce­re­al — and a fun­ny guy with a YouTube chan­nel full of clever videos. The on­ly prob­lem? He wasn’t get­ting a lot of views.

Un­til one day in May 2017. That’s when he filmed his ex­pe­ri­ence at an in­fu­sion cen­ter get­ting Genen­tech’s then-new mul­ti­ple scle­ro­sis treat­ment Ocre­vus. Sud­den­ly, the self-pro­claimed nerd with a de­gree from Mid­dle­bury Col­lege was get­ting hits.

To­day he’s what mar­ket­ing teams and tech-savvy teens call an in­flu­encer — the se­mi-fa­mous rulers of so­cial me­dia who are slow­ly re­plac­ing celebri­ties in phar­ma dig­i­tal ad cam­paigns.

Thou­sands of users watched Wash­ing­ton’s first in­fu­sion video, which wasn’t spon­sored. In the in­tro, he talks about his ex­pe­ri­ences tak­ing Co­pax­one and Rebif. The for­mer didn’t give him the de­sired ef­fect and the lat­ter came with side ef­fects that he de­scribed as a hang­over-like feel­ing mi­nus the night of drink­ing.

Dami­an Wash­ing­ton

“We kind of want to nip this dis­ease pro­gres­sion in the bud,” he says in the video, ex­plain­ing why he switched to Ocre­vus. Then he brings a cam­era to West Hills Hos­pi­tal & Med­ical Cen­ter in Los An­ge­les where he ex­plains each step of the in­fu­sion process as it’s hap­pen­ing, live while get­ting his IV drip.

“Done deal-y, for re­al­ly,” he says at the end. “First in­jec­tion, so far so good, quick and pain­less … Thanks Ocre­vus.”

Com­ments flood­ed in from oth­er MS pa­tients. To his sur­prise, Wash­ing­ton had in­ad­ver­tent­ly cre­at­ed a com­mu­ni­ty fo­rum for pa­tients who were ea­ger to share their own sto­ries.

“Great video! I’m mov­ing from Tysabri to Ocre­vus right now. It was good to see the process,” one com­menter post­ed.

“90 sec­onds got you a new sub­scriber bro. Great video, look­ing for­ward to check­ing out your oth­ers. I have to stop Tysabri and am con­sid­er­ing Ocre­vus,” an­oth­er said.

Af­ter that, Wash­ing­ton start­ed crank­ing out MS videos. The view­ers want­ed more — and so did Ocre­vus’ mak­er Genen­tech. Af­ter see­ing his videos, the phar­ma com­pa­ny be­gan sign­ing him on for pro­mo­tion­al work. Not all of his videos are spon­sored — and he’s nev­er di­rect­ly pro­mot­ed a drug for a phar­ma com­pa­ny — but his most re­cent gig was per­form­ing a rap rais­ing aware­ness for MS at the com­pa­ny’s #MSVis­i­bil­i­ty Vir­tu­al Con­cert em­ceed by Broad­way per­former David Os­mond.

“The aim is to shift the al­go­rithm on YouTube in my fa­vor as far as rel­e­vant con­tent and in­for­ma­tion for peo­ple with mul­ti­ple scle­ro­sis,” Wash­ing­ton said, adding that it’s al­so “an­oth­er way to put my­self in front of peo­ple and to be the an­swer to ques­tions that peo­ple have.”

In the di­rect-to-con­sumer space, this type of mar­ket­ing — al­go­rithm-dri­ven so­cial me­dia mar­ket­ing — is mov­ing to eclipse TV ad­ver­tis­ing by phar­ma mar­keters in terms of reach, Kathryn Aikin, se­nior so­cial sci­ence an­a­lyst and re­search team lead in the FDA’s Of­fice of Pre­scrip­tion Drug Pro­mo­tion, said at a re­cent Duke Uni­ver­si­ty event. On TV, phar­ma ads fea­ture fa­mil­iar faces like Queen Lat­i­fah, Ser­e­na Williams and An­nie Mur­phy, but many in­flu­encers on so­cial me­dia are just reg­u­lar peo­ple — with a lot of fol­low­ers.

Across the board, in­flu­encer mar­ket­ing was worth around $9.7 bil­lion in 2020, ac­cord­ing to In­flu­encer Mar­ket­ing Hub, which es­ti­mat­ed the mar­ket would grow to $13.8 bil­lion in 2021. At the same time, over­all dig­i­tal ad spend in the phar­ma space sky­rock­et­ed 242% year over year from Jan­u­ary to Feb­ru­ary in 2020 and 2021, Me­di­aRadar re­port­ed.

Health Union, which ac­quired WEGO Health in June, pairs phar­ma com­pa­nies with pa­tient in­flu­encers as one of its ser­vices. It al­so owns 38 — and count­ing — on­line health com­mu­ni­ties, such as mul­ti­plescle­ro­sis.net. While Wash­ing­ton is now proud to be “the MS guy,” Health Union has a com­bined net­work of more than 100,000 in­flu­encers in vir­tu­al­ly every con­di­tion.

Ear­ly fig­ures sug­gest the strat­e­gy is work­ing: In one case study, an In­sta­gram cam­paign by Health Union for a “niche on­col­o­gy brand” fea­tur­ing pa­tient and care­giv­er in­flu­encers saw 114% high­er traf­fic rates com­pared to the brand’s bench­marks on oth­er dig­i­tal me­dia.

As phar­ma ad­ver­tis­ing shifts to so­cial chan­nels like In­sta­gram and Tik­Tok, a num­ber of ques­tions arise: Who are in­flu­encers, who’s reg­u­lat­ing this kind of mar­ket­ing, and will it stick — or is it just an­oth­er fad?

For some, the word “in­flu­encer” con­jures im­ages of stilet­toed Kar­dashi­ans hawk­ing the lat­est fads — and that wouldn’t be com­plete­ly off-base. The Cana­di­an biotech Duch­es­nay did, af­ter all, re­ceive an FDA warn­ing let­ter back in 2015 af­ter Kim Kar­dashi­an en­dorsed its morn­ing sick­ness pill Di­clegis on In­sta­gram with­out de­tail­ing the drug’s risks. The re­al­i­ty TV star ul­ti­mate­ly is­sued an­oth­er post with the hash­tag #Cor­rec­tiveAd, in which she out­lined the risks.

And her sis­ter Khloe Kar­dashi­an is cur­rent­ly one of the celebri­ty mi­graine suf­fer­ers fronting Bio­haven’s Nurtec ODT dig­i­tal-first ad­ver­tis­ing cam­paign.

But to Jack Bar­rette, for­mer CEO of WEGO Health and cur­rent chief in­no­va­tion of­fi­cer of Health Union, the de­f­i­n­i­tion of an in­flu­encer in the phar­ma space is much dif­fer­ent.

“An in­flu­encer is, es­pe­cial­ly in the area of se­ri­ous ill­ness and chron­ic ill­ness as we de­fine it at Health Union, some­one who has a fol­low­ing of oth­er folks that they con­verse with and bring to­geth­er and pro­vide ad­vice to,” he said.

Jack Bar­rette (Cred­it: Chris­tine Hochkep­pel, Salty Broad Stu­dios)

When he co-found­ed WEGO more than 14 years ago, Bar­rette would have called them “health ac­tivists” or “pa­tient lead­ers.” If he had to guess, the name “in­flu­encer” be­gan to stick rough­ly three to five years ago when it be­came clear that so­cial me­dia com­mu­ni­ties were form­ing around these pa­tients.

Why would a com­pa­ny choose to work with reg­u­lar peo­ple when they could be work­ing with celebri­ties like Kar­dashi­an? In the age of so­cial me­dia, it’s all about es­tab­lish­ing a re­la­tion­ship, Bar­rette said. It may seem in­tu­itive, but some­one with 1,000 ded­i­cat­ed fol­low­ers has a more per­son­al con­nec­tion with con­sumers than some­one with hun­dreds of thou­sands. The small­er au­di­ence in­flu­encers of­ten per­son­al­ly re­spond to com­ments and an­swer ques­tions. The bonus for phar­ma com­pa­nies is out­reach to a much more tar­get­ed au­di­ence.

“What phar­ma­ceu­ti­cal com­pa­nies re­al­ly gain is a chance to be a part of that so­cial health con­ver­sa­tion, where peo­ple are ac­tu­al­ly know­ing each oth­er and pro­vid­ing in­for­ma­tion, in a trust­ed and au­then­tic way,” he said.

Then there are the in­flu­encers who lean more on the side of celebri­ty. Take Derek Thel­er, for in­stance, a hand­some TV sit­com sup­port­ing ac­tor who mar­kets for Dex­com’s glu­cose mon­i­tor­ing sys­tem on In­sta­gram. A re­cent im­age he post­ed wear­ing Dex­com’s sys­tem on his tor­so — tagged “paid part­ner­ship with Dex­com” — as he stands by a wa­ter­fall got more than 6,000 likes. The com­ments were flood­ed with fire and heart-eye emo­jis, along with some feed­back from pa­tients.

“It’s so strange see­ing the Dex­com on an adult’s body! My son is 6 years old and it takes up much more re­al es­tate! (Less than when he was 2, though). All the best, thanks for be­ing a pos­i­tive T1 am­bas­sador for peo­ple like my boy to look up to,” one com­menter wrote.

One of the rea­sons Dex­com’s cam­paign has been so suc­cess­ful, ac­cord­ing to Hyosun Kim, an as­sis­tant pro­fes­sor of com­mu­ni­ca­tion at In­di­ana State Uni­ver­si­ty, is that it brings in a lot of user-gen­er­at­ed con­tent.

Hyosun Kim

“A lot of peo­ple … post­ed on their so­cial me­dia, ‘I [am] a Type 1 di­a­betes pa­tient and I used Dex­com and it’s a mag­i­cal game-chang­er,’ or some­thing like that,” and that can be re­al­ly mean­ing­ful to fel­low pa­tients, she said. 

Bar­rette sees Health Union as a sort of li­ai­son be­tween phar­ma com­pa­nies and pa­tient in­flu­encers, al­though it’s not al­ways about sell­ing a drug. A lot of the work Health Union does is un­brand­ed, mean­ing the in­flu­encers are hired by a phar­ma com­pa­ny to do ed­u­ca­tion­al work or raise aware­ness for a dis­ease, with­out men­tion­ing any prod­uct names.

The end re­sult is some­thing like an ad, yet doesn’t look or sound like one.

“If you’re just scrolling on your phone, and you see a guy be­ing like, ‘Look, if you got MS man, lis­ten: Let me tell you about this oth­er thing, right here,’ that is a bit more en­gag­ing, and speaks more to the view­er,” Wash­ing­ton said.

What could go wrong? It de­pends on who you ask. While Kim sees the ben­e­fits of this type of mar­ket­ing, she’s al­so been close­ly study­ing the FDA’s con­cerns, and has picked up on a few key themes.

Be­ing from South Ko­rea, Kim had nev­er seen phar­ma­ceu­ti­cal ads un­til she came to the US for grad­u­ate school work and was shocked by a Vi­a­gra com­mer­cial on TV. She end­ed up writ­ing a pa­per on pre­scrip­tion drug ad­ver­tis­ing for her me­dia law class, and since then, she’s been on a mis­sion to learn every­thing she can. Re­cent­ly, she spoke at the vir­tu­al Duke Uni­ver­si­ty event along with Aikin that was called, “In­form­ing and Re­fin­ing the Pre­scrip­tion Drug Pro­mo­tion Re­search Agen­da.”

For the most part, Kim likes the idea of di­rect-to-con­sumer ad­ver­tis­ing. It puts some of the pow­er in­to pa­tients’ hands and al­lows them to have bet­ter dis­cus­sions with their doc­tors. But look­ing at warn­ing let­ters sent by the FDA, she iden­ti­fied three of the agency’s main con­cerns with so­cial me­dia ad­ver­tis­ing: the use of first-per­son nar­ra­tives, the pro­mo­tion of non-ap­proved drugs or prod­ucts, and mis­lead­ing ad tech­niques such as hav­ing to hov­er over a post to see the risks.

“Mar­keters are fas­ci­nat­ed by in­flu­encer mar­ket­ing be­cause these in­flu­encers are re­lat­able, touch­able, ap­proach­able, kind of, you know, per­son­al­i­ties,” Kim said. “Peo­ple see them as some­one like me, like fel­low con­sumers or fel­low pa­tients.”

But in re­al­i­ty, in­flu­encers work­ing with phar­ma­ceu­ti­cal com­pa­nies are not to­tal­ly like you — be­cause they have an in­cen­tive to post. Some crit­ics ar­gue in­flu­encers are sell­ing not on­ly prod­ucts, but a cer­tain lifestyle. Thel­er has di­a­betes, but with his Dex­com sys­tem, he al­so swims with his dog and pad­dle­boards in Se­quoia Na­tion­al Park, one In­sta­gram post sug­gests.

“[Con­sumers] are more like­ly to de­vel­op a strong re­la­tion­ship with this per­son,” Kim said. “And then they see this ad as less pro­mo­tion­al and more like in­for­ma­tion,” she said, adding that while that can be good news for the mar­keters, it may be con­cern­ing for view­ers.

One caveat to con­sid­er, of course, is that pa­tients can­not ac­cess pre­scrip­tion drugs with­out con­sult­ing with a physi­cian.

“It is a to­tal­ly dif­fer­ent ball­game,” Wash­ing­ton said. For one, he was tak­ing Ocre­vus be­fore Genen­tech be­gan spon­sor­ing him. And when he’s do­ing a video, he’ll of­ten make a dis­claimer sim­i­lar to: “This is not med­ical ad­vice. Speak to your doc­tor,” he said.

Still, crit­ics have poked holes in this type of mar­ket­ing ap­proach. For ex­am­ple, how do you know if an in­flu­encer has tak­en the drug they’re pro­mot­ing? Or if and how they’re be­ing paid?

The Fed­er­al Trade Com­mis­sion can rep­ri­mand and fine in­flu­encers who are pro­mot­ing with­out dis­clos­ing the fact that they’re be­ing paid for the con­tent. The reg­u­la­to­ry agency re­quires in­flu­encers to dis­close any “ma­te­r­i­al con­nec­tions” they have with a brand they are en­dors­ing.

In Oc­to­ber, the FTC an­nounced it sent out penal­ty no­tices to more than 700 com­pa­nies putting them on no­tice that they could face civ­il fines up to $43,792 per vi­o­la­tion for im­prop­er en­dorse­ments. Among the com­pa­nies on the list were more than a dozen phar­ma com­pa­nies in­clud­ing Ab­b­Vie, Bay­er, Bris­tol My­ers Squibb, Eli Lil­ly, Mer­ck, Pfiz­er and Take­da.

Still, the rules and reg­u­la­tions can get am­bigu­ous when a pa­tient is rais­ing aware­ness about a con­di­tion, rather than pro­mot­ing a drug.

While Bar­rette said there’s “room for in­ter­pre­ta­tion,” Health Union al­ways dis­clos­es spon­sor­ships. Wash­ing­ton has nev­er di­rect­ly pro­mot­ed a drug for a phar­ma­ceu­ti­cal com­pa­ny, but when com­pa­nies hire him to make videos rais­ing aware­ness for MS, they’ll have him ver­bal­ly dis­close if a video is spon­sored or in­clude it in the cap­tion. Back in 2020, the FDA pro­posed a study with sev­er­al types of en­dorsers (in­clud­ing in­flu­encers) to find out whether dis­clos­ing pay­ment sta­tus would af­fect pa­tient re­ac­tions.

As for dis­clos­ing whether an in­flu­encer has ac­tu­al­ly tak­en the drug they’re spon­sor­ing, Bar­rette isn’t aware of any spe­cif­ic FDA re­quire­ment to do so.

How­ev­er, Health Union and WEGO have tak­en what he calls a “proac­tive stance,” and in al­most all cas­es the pro­mo­tion­al con­tent will ref­er­ence the in­flu­encer’s per­son­al con­nec­tion with the drug. For ex­am­ple, an in­flu­encer may say, “While I have not tak­en this med­ica­tion my­self, many in my pa­tient com­mu­ni­ty are dis­cussing it.”

Is this the dawn of a new era in phar­ma mar­ket­ing? Bar­rette said the so­cial health move­ment, as he calls it, is ex­plod­ing. The pan­dem­ic has en­cour­aged peo­ple to con­nect in “a very re­al and ther­a­peu­tic way” through dig­i­tal means, and there’s no turn­ing back. In ad­di­tion, phar­ma dig­i­tal and so­cial spend­ing has on­ly con­tin­ued to grow over the last cou­ple years.

“This idea that dig­i­tal on­line con­nec­tions are valu­able — maybe it’s not in re­al life, but they have tremen­dous ben­e­fit to folks with es­pe­cial­ly chron­ic dis­ease and se­ri­ous ill­ness to be­come health­i­er be­cause they par­tic­i­pat­ed in the so­cial health move­ment,” Bar­rette said. “So I see a con­tin­u­ing growth … I think we saved five or 10 years in adop­tion of so­cial health be­cause of the pan­dem­ic.”

And the feed­back, so far, has been pos­i­tive. Health Union grew the num­ber of phar­ma com­pa­nies it worked with by about 30% from 2020 to 2021, ac­cord­ing to Bar­rette.

When Wash­ing­ton was di­ag­nosed with MS about five years ago, the dig­i­tal com­mu­ni­ty wasn’t as es­tab­lished. He turned to blogs like Ardra Shep­hard’s Trip­ping on Air. But it wasn’t the same as pick­ing up a smart­phone and watch­ing a full trip to an in­fu­sion cen­ter.

“I would say that it’s nev­er a good time to get MS. How­ev­er, this is a fab­u­lous time to get MS,” he said. “Me be­ing able to talk to some­one in Lon­don about their dis­ease, their con­di­tion, my ups and my downs and their ups and their downs …  it’s re­al­ly, re­al­ly re­mark­able what we have go­ing now.”

For Wash­ing­ton, it’s not about mar­ket­ing trends or even the spon­sor­ship pay­ments. When asked to pre­dict what’s next in so­cial me­dia, he said he’s just go­ing to keep do­ing what he’s do­ing.

He said, “I make videos every week so that peo­ple with mul­ti­ple scle­ro­sis feel less alone. Pe­ri­od.”

Bio­mark­er 'roadmap­s' and the fu­ture of can­cer R&D; Cur­tain rais­es on #AS­CO22; Pfiz­er, No­var­tis tack­le drug ac­cess; and more

Welcome back to Endpoints Weekly, your review of the week’s top biopharma headlines. Want this in your inbox every Saturday morning? Current Endpoints readers can visit their reader profile to add Endpoints Weekly. New to Endpoints? Sign up here.

While this was not a week for earth-shattering news, there were certainly a lot of interesting tidbits. If you found this recap helpful, please recommend it to your friends and colleagues. We’ll see you on the other side of the long weekend.

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Keep­ing pres­sure on Am­gen, Mi­rati draws mixed re­views on lat­est cut of KRAS da­ta

As the close runner-up to Amgen’s Lumakras in the KRAS race, any data cut from Mirati’s adagrasib continues to draw scrutiny from analysts. And the latest batch of numbers from ASCO is a decidedly mixed bag.

While a quick comparison suggests that adagrasib spurred slightly more responses and led to a longer overall survival than Lumakras among a group of non-small cell lung cancer patients, its duration of response appears shorter and the safety profile continues to spark concern.

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Ann is one of ViiV Healthcare's newest spokespeople as the retired school administrator speaks up about her HIV status.

GSK's Vi­iV de­buts next evo­lu­tion in HIV med Dova­to cam­paign with new spokes­peo­ple and new mes­sage

When Ann saw the first TV commercials for HIV medicine Dovato, she didn’t see herself represented. So the 74-year-old retired school administrator who’s been living with HIV since 1998, reached out to GSK’s ViiV Healthcare and asked why not?

Now Ann is one of three people starring in ViiV’s latest Dovato campaign called “Detect This.” The next-step evolution in the branded campaign plays on the word “detect” — often used in describing HIV status under control as undetectable — but in this case, uses the word as a directive for people to understand they can use fewer medicines.

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Pharma brands are losing their shine with US consumers who are now thinking about the economy and inflation instead of Covid. (Credit: Shutterstock)

Phar­ma brands fade in an­nu­al Har­ris con­sumer vis­i­bil­i­ty poll: Mod­er­na drops off and Pfiz­er dips

As Covid-19 concerns are fading in the US, so is biopharma visibility. The annual Axios Harris Poll survey to determine and rank the 100 most top-of-mind brands in the US finds Moderna, which was No. 3 last year, not on the list at all for 2022, and Pfizer sinking 37 spots.

However, it’s not that Moderna or Pfizer did anything wrong, it’s just that Americans have moved on to other worries beyond Covid.

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Tran­si­tion to new Eu­ro­pean clin­i­cal tri­als in­fo sys­tem starts slow­ly

At the end of January, the European Medicines Agency officially launched its new clinical trials info system (CTIS), although the migration to the new platform has only really just begun, and sponsors have until the end of January 2023 before all initial trial applications must be submitted through CTIS.

Overall, 56 clinical trial applications have been submitted in CTIS during the first 3 months since the launch of the system on Jan. 31, according to new data posted by the EMA. By comparison, about 4,000 new trials are authorized each year across Europe.

Switzer­land to de­stroy over 600,000 ex­pired dos­es of Mod­er­na Covid vac­cine

As concerns related to uptake and distribution continue to linger, Switzerland is among the first countries that plans to destroy hundreds of thousands of expired and unused Covid-19 vaccine doses.

The European country said it plans to destroy more than 600,000 doses of Moderna’s Spikevax Covid-19 vaccine as the doses have reached their expiration date.

However, Moderna CEO Stéphane Bancel told the World Economic Forum in Davos, Switzerland that he’s in the process of throwing 30 million doses in the garbage, exclaiming, “We have a big demand problem.”

Nassim Usman, Catalyst Biosciences CEO

Af­ter $60M Ver­tex deal, group of Cat­a­lyst share­hold­ers claims biotech could’ve sold as­sets three years ago

Catalyst Biosciences was down to five employees in March, and the biotech needed to do something after two rounds of layoffs, a nixed collaboration and a culling of its hemophilia program.

In came Vertex, with $60 million to buy up the South San Francisco biotech’s preclinical complement drugs, which target the system that bridges the body’s innate and adaptive immune response and a class most known for Ultomiris and Soliris. The deal includes CB 2782-PEG, the dry AMD drug that Biogen no longer wanted in March.

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Lina Khan, FTC chair (Graeme Jennings/Pool via AP Images)

Pile-on over PBMs con­tin­ues with FTC com­ments and a new bi­par­ti­san Sen­ate bill

More than 500 stakeholders sent comments to the FTC on whether the commission should look further into pharma middlemen, known as PBMs, with many of the commenters calling for more federal oversight.

Similar to the critical open comment period in a deadlocked FTC session last February, pharmacies and pharmacy groups are continuing to call out the lack of transparency among the top 3 PBMs, which control about 80% of the market.

In a still image from BMS' new Eliquis campaign, a man draws his trumpet to life and pursues his 'What's Next?' in music.

Bris­tol My­ers Squibb re­fresh­es Eliquis cam­paign, adds eye-catch­ing an­i­ma­tions in TV ads

Passions come to life, literally, in Bristol Myers Squibb and Pfizer’s latest ads for anticoagulant Eliquis.

In the new commercial debuted this month, those passions include objects such as a trumpet, a hat and a riverboat paddle that a man draws on a screen. Then each one comes to life and he’s shown playing the trumpet, putting on the hat and playing with a band on a riverboat traveling upstream.

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