Advocacy, often referred to as “word-of-mouth marketing,” remains one of the most powerful ways to influence behavior. Research consistently shows that consumers trust recommendations from family, friends, and even close-knit professional networks more than any other source. A Nielsen study found that 92% of consumers trust recommendations from people they know, making personal advocacy the most trusted form of advertising.
This trust extends beyond consumer goods into professional fields like healthcare. Healthcare professionals (HCPs) are typically seen as relying primarily on clinical data, guidelines, and protocols when selecting therapies and treatments. However, they are also significantly influenced by Key Opinion Leaders (KOLs).
The Shifting Landscape of Advocacy in Pharma
Traditionally, pharma companies have invested heavily in engaging KOLs to drive advocacy, especially during the early stages of a brand launch. While still valuable, recent data suggests this strategy may be overemphasized. A Bain & Company study found that KOL advocacy, while important, is not the strongest differentiator between overperforming and underperforming drug launches. Surprisingly, the advocacy of practicing physicians—those treating patients daily—proved to be a more powerful factor.
This insight points to a critical shift in how pharma companies should approach advocacy. Instead of focusing solely on KOLs, companies need to leverage a broader network of influencers, including practicing HCPs, nurses, social workers, caregivers, and even patients.
Vertex Pharmaceuticals exemplifies this approach. By cultivating a strong grassroots movement among patients and caregivers in the cystic fibrosis community, Vertex significantly boosted awareness and adoption of their treatments. This bottom-up advocacy strategy helped Vertex become a dominant player in the space, driving $9.87 billion in revenue in 2023. The results illustrate the power of grassroots advocacy in driving business success.
Power in the Periphery: Nurses, Caregivers, and Other Providers
Damon Centola, Director of the Network Dynamics Group at the University of Pennsylvania, argues in his book Change – How to Make Big Things Happen that true change is driven not by top-down influencers like KOLs, but by those on the periphery—the people who interact with patients, caregivers, and communities daily.
Drawing from examples like the Black Lives Matter movement and the spread of COVID-19, Centola demonstrates how ideas, behaviors, and beliefs spread through social networks, where everyday interactions shape decisions in surprising ways. This underscores the critical role that nurses, and other healthcare providers play in shaping brand perceptions and driving treatment decisions. A study in the Journal of Clinical Nursing found that 74% of patients consider nurses to be their most trusted source of health information.
“Nurses are often the unsung heroes in patient care and can be powerful advocates for treatments they see making a real difference,” says Dr. Linda Aiken, Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. “Their voices carry tremendous weight with both patients and other healthcare professionals.”
Harnessing the Power of Grassroots Advocacy: A Systems Thinking Approach
At Shapiro+Raj, we believe that to truly leverage the power of grassroots advocacy, companies must embrace systems thinking, acknowledging the complexity of the healthcare ecosystem and utilizing it to drive change. Here are three critical shifts necessary to make grassroots advocacy work:
1. See the Whole, Not Just the Parts
Instead of focusing on KOLs as the primary influencers, embrace the importance of those directly impacted by treatment outcomes—nurses, patients, and caregivers. These individuals can be highly influential, particularly in chronic and rare disease categories, where they become experts through lived experience.
In chronic conditions like diabetes or rheumatoid arthritis, patients and caregivers often prioritize practical benefits that KOLs and HCPs may overlook, such as ease of use or lower pill burdens. In rare disease communities, advocacy from a small group of patients can drive significant impact. Research from WEGO Health found that 81% of patients in rare disease communities are likely to try a new product based on another patient’s recommendation.
Genentech’s “Expressions of Hope” initiative for multiple sclerosis (MS) patients exemplifies this holistic approach. By engaging not just neurologists, but also MS nurses, physical therapists, and patients, Genentech created a powerful advocacy network. This initiative led to increased awareness of Genentech’s MS treatments, improving patient outcomes and increasing treatment adherence by 15%.
2. Embrace Interactions, Not Isolation
The different actors within a healthcare ecosystem – KOLs, HCPs, nurses, social workers, patients, and caregivers – constantly interact and influence each other. To harness the full potential of grassroots advocacy, pharma brands must embrace a dynamic, interconnected advocacy network.
Not all stakeholders carry the same weight in different therapeutic areas. In certain primary care conditions, patient opinions may have more influence, while in others, nurses may play a critical role in educating and guiding patients. By understanding these interactions, companies can create a constellation of advocates that creates magnetism for their brand.
As Centola articulated, “The greatest changes in behavior happen when the people we trust most share their experiences with us, and that is almost always someone we know personally—whether a patient, a nurse, or a caregiver.”
Novo Nordisk’s “Cities Changing Diabetes” program showcases this. By engaging primary care physicians, diabetes educators, community health workers, and patients, Novo Nordisk created a comprehensive diabetes management ecosystem. This not only improved patient outcomes but also contributed to their 24% growth in diabetes and 154% growth in obesity care sales in 2023.
3. Adapt to Dynamic Shifts, Not Static Campaigns
Grassroots advocacy isn’t a one-time effort. It is an evolving process, especially in today’s digital age, where conversations can go viral and shift perceptions overnight. A robust advocacy network must be adaptable, allowing brands to respond to shifting dynamics and engage advocates in real-time.
Brands must stay agile, fostering ongoing relationships with advocates and responding to feedback—whether positive or negative. Advocacy thus becomes a continuous engagement strategy rather than a one-off initiative.
Pfizer’s rapid adaptation to feedback from healthcare workers and caregivers during the rollout of their COVID-19 vaccine exemplifies this approach. By responding in real-time to concerns about side effects and access, Pfizer was able to build trust within healthcare networks and among patients, driving adoption of the vaccine.
Building an Advocacy Constellation for Lasting Success
When fully harnessed, grassroots advocacy can drive lasting change and accelerate business success. By seeing the whole system, embracing interactions between stakeholders, and adapting to dynamic shifts, pharma brands can create an advocacy network that not only drives awareness but shapes beliefs and behaviors.
As Dr. Jerome Groopman, Professor of Medicine at Harvard Medical School, states, “In healthcare, the most powerful advocates are often those closest to the patient—the nurses, caregivers, community health workers. Their voices, when amplified and coordinated, can drive transformative change.”
By taking a human-centered approach and leveraging the power of grassroots networks, including the often-overlooked voices of nurses, patients, caregivers, and other healthcare providers, pharma brands can thrive in a complex and ever-changing marketplace.
So, whether you’re navigating a new brand launch or seeking to improve advocacy efforts for established brands, Shapiro + Raj’s expertise in grassroots advocacy and insights can help you stay ahead of the rapidly changing healthcare landscape. Reach out to us at [email protected] to learn how we can help you.