How One Health Care Brand Took on Vaccines Online

Amelia Burke-Garcia
Key Takeaways

What? The internet allows brands to reach a range of audiences and tailor messages to differemt literacy levels, cultural orientations and channel preferences.

So what? Brand usage of social media involves risk. Twitter is one social platform where brands can experience swift fallout from losing control of their message.

Now what? Brands should engage influencers and thought leaders who can advocate for them and reists bate from trolls. ​​

​Growth in the use of digital health communication channels has dramatically changed the nature of communication. The internet provides unparalleled opportunities to reach a range of individuals with vital information about health and a variety of other topics — and to tailor messages to audiences’ literacy levels, cultural orientation and channel preference. There are currently 2.5 billion social media users globally, and 70% of Americans now use social media to connect with one another, engage with news content and share information.

Millennials are the most active generation on social media, with 88% of Americans ages 18 to 29 using Facebook and 75% of them having created at least one social media account. Fewer adults over age 30 use social media, but their adoption is still high. More than 60% of adults older than 65 use Facebook. These numbers show a significant increase from six years ago, when only 6% of people 65 and older used social media.

Projections signal continued growth, with recent data suggesting that worldwide use of social media will increase 18% by 2020. Some data report more than 5 billion people, or about two-thirds of the world’s population, will be using social media by 2020.

With such growth comes increasing risk. Communication and media researcher Pekka Aula writes in his article, “Social media, reputation risk and ambient publicity management” that “reputation risk, the possibility or danger of losing one’s reputation, presents a threat to organizations in many ways (including) competitiveness, local positioning, the trust and loyalty of stakeholders, media relations, the legitimacy of operations, and even the license to exist.”

According to research carried out by the Economist Intelligence Unit, leading European managers consider reputation risk to be the primary threat to business operations and the market value of their organizations. The growth in social media use magnifies the possibilities of these risks, expanding the spectrum of reputation risks and boosting risk dynamics. It is useful for new and experienced social media users to understand the risks of the technology and how to mitigate them.

Twitter is one social platform where brands can experience swift fallout from losing control of their message. To avoid and mitigate risk in social media, marketers must be cognizant of best practices, how to anticipate and prepare for activations in social media, how to leverage supportive voices during times of crisis and how to limit brand crises.

Background on the Activation

Research and communication firm Westat partnered with The Motherhood, a blogger network and social media marketing agency, to produce an hour-long Twitter chat on behalf of a well-known national organization working to educate the public about the importance of vaccines. The chat was intended to share reputable information and resources about vaccines and engage parents and caregivers on the topic of vaccination for their families.

Westat suspected that this topic would be particularly divisive because data suggest that the online anti-vaccination conversation is strong. For instance, Jennifer Keelan, Vera Pavri-Garcia, George Tomlinson and Kumanan Wilson analyzed videos on YouTube about immunization and published their findings in the Journal of the American Medical Association (JAMA). They found that 32% of the sampled videos opposed vaccination and that these videos had higher ratings and more views than pro-vaccine videos.

Another YouTube analysis carried out by Keelan, Pavri-Garcia, Wilson and Ravin Balakrishnan found that 25.3% of YouTube videos about HPV immunization portrayed vaccination negatively. The researchers also analyzed MySpace blogs on HPV immunization and found that 43% were negative.

Another study published in Healthcare Quarterly by Neil Seeman, Alton Ing and Carlos Rizo analyzed the sentiment on vaccines during an influenza outbreak by studying top search results for information on vaccines during the study period. They found that 60% of the results contained anti-vaccination sentiments.

Given this context, the Westat team wanted to be prepared for anything that could go wrong during the activation. As such, it prepared for a variety of outcomes. This preparation led to great success, despite participation by anti-vaccine advocates.


The Twitter chat generated a great deal of attention around the importance of vaccines. Tracking the conversation using a dedicated hashtag and comparing the level of conversation using the hashtag before and during the chat, Westat saw a 1,176% increase in the number of people participating in the conversation during the hour. The number of tweets increased nearly 4,300%, and the impressions increased nearly 1,500%.

Although anti-vaccination participants did appear during the chat, of the 1,772 tweets published during the hour, only 262 shared anti-vaccination sentiments. Their message was diluted by the 1,510 tweets that came from pro-vaccine advocates — nearly six times the number of anti-vaccination tweets.

The top 10 highest-reaching anti-vaccine participants had a total of 44,307 followers (an average of around 4,400 followers per person). In contrast, the top 10 pro-vaccine advocates had a combined following of 175,678 (or an average of around 17,500 followers per person), demonstrating that the caliber and influence of the pro-vaccine contributors was greater than those in the anti-vaccination camp.

In fact, 17.2% of tweets during the chat shared negative sentiments about vaccination, but those tweets generated fewer than 3% of the overall impressions. This demonstrates that while the anti-vaccine sentiment may have felt overwhelming to the team, when Westat reviewed the data, the anti-vaccine content represented only a small slice of the conversation.

Anticipate and Prepare

Westat anticipated that a chat devoted to the topic of vaccines could attract anti-vaccination trolls, or those who would join only to tweet inflammatory, misguided or off-topic messages. Therefore, Westat and The Motherhood took steps to prepare, counter the misinformation shared by such participants and defuse what could be an emotionally charged situation.

One of those steps was to create a detailed script in advance of the chat to act as the framework for the real-time online conversation. The script included links and citations to reputable, impartial and nonpartisan sources to support the points made on behalf of the health care brand. Ultimately, this kept the conversation on-topic as new participants joined the chat and pulled it in different directions.

The planning paid off. Post-chat analysis of the activation data revealed that despite chat impressions being slightly above average and the number of tweets being on par with other Twitter chats executed by The Motherhood during the same time frame, the number of participants was 4.5 times higher than average, indicating how many people were engaged — for better or for worse.

Bring in Supportive Expert Voices to Create a Safe Space

Ahead of the chat, Westat notified vaccination experts and scientists about the event, and The Motherhood identified and engaged supportive parenting influencers to join the conversation and share positive messages of vaccines.

Having a team that included scientists and curated parenting influencers who supported the message and were educated ahead of time helped keep pro-vaccination tweets at the forefront of the conversation and ensured that those tweets got the most visibility.

Stay Out of the Fray

During the Twitter chat, the sponsoring organization was mentioned by participants more than 553 times, 70 of which were made by anti-vaccination advocates. The sponsor only responded to one anti-vaccine mention. The account to whom the sponsor responded, in contrast, was mentioned just 95 times throughout the chat, comprising only 3% of total tweets and 1% of impressions during the chat. The sponsor organization’s decision not to engage with the majority of the anti-vaccine content limited the visibility of that messaging, ultimately achieving the aim of the chat: to communicate the benefits of family vaccination.

The message here to brands, initiatives or campaigns conducting an activation in social media on a topic that may be controversial is that you should not get involved in emotional arguments you can’t win. In short, do not “feed the trolls.” This only provides antagonists with a larger platform to amplify their message. By not engaging, you can minimize the visibility your vehicle gives to these counter messages. An alternative strategy to manage this content is to ask individual experts to engage or intervene on your behalf.

These results demonstrate that preparing and deploying a risk communication strategy in support of a potentially controversial situation or conversation can result in a successful activation. Brands, organizations and individuals that carefully consider their message before sharing can successfully enter the online space, even if some risk is involved.

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Amelia Burke-Garcia
Amelia Burke-Garcia is Westat’s senior director of digital media and director of the Center for Digital Strategy & Research and has nearly 15 years of experience in digital, social and mobile media. She currently leads the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities’ digital communication and branding work. Most recently, she was the campaign director for CDC’s national influenza vaccination campaign where she spearheaded innovative digital strategies and partner collaborations to promote flu vaccination awareness.