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Social media in EU healthcare advocacy


[The following text is a revised transcript of my presentation at Britcham’s healthcare working group breakfast briefing on 21 November 2013. Questions and comments are not included due to the fact that the meeting was under Chatham House rules. Special thanks to all those who contributed with ideas and tips for the presentation. Please check the above presentation as all references below are made on the basis of those slides.]


I’ll talk about four main topics in the context of Social Media Advocacy in the Healthcare sector in the European Union. Note that the topic is a bit more narrow than “Digital Advocacy” as that would include a deeper analysis of websites, interactive tools, mobile apps, newsletters and other tools apart from social media. I plan to discuss that issue more in-depth at another time, and if you are interested in a presentation or training on that topic, please let me know.


So let’s see these four topics:


One: outline and a bit of context, Two: a look at what your objective could be, Three: a few ideas and topics to talk about (which is quite a challenge for many people when trying to communicate to policymakers and to the broader stakeholder community), and Four: a few tips and considerations that I’d like to highlight.


So let’s look at the context in which social media and generally Digital Communication operates in EU affairs advocacy.


Short attention span


The first one is a well-known fact: the phenomenon of short attention span. This little cartoon says:


“Hello, and welcome to short attention span news!” / “Here’s a picture of the President!” / “It looks like something’s happened in another country!” / “Well, that’s all for today!”


In terms of news, this is something that we are often confronted with.Extremely condensed, extremely narrowed-down pieces of information,especially on social media, which often reinforces instead of overcoming this challenge.


Multiple layers of healthcare policy


The other element is the following: when talking about the health sector or health policy, it obviously has a lot of layers and topics, depending on your company and your industry. You may therefore deal with one segment far more than with others, including the public health aspect (which is much broader and may include macroeconomic measures, social security etc.), antibiotics, clinical trials, medical devices or anything else. Also, when it comes to the European Union’s competencies in the healthcare field, there are huge differences: the EU has strong regulatory powers in authorizing new drugs and active substances, shared competencies with the Member States on e.g. medical devices, but limited powers in the field of healthcare services and social security systems. This also has an impact on which institution, diplomat or policy maker you are planning to or should be interacting with.


How EU policy makers view various lobbying methods


You may know the Burson-Marsteller study which was released a couple of months ago on EU lobbying and communication. There is this famous (or rather infamous) chart where it says:“How helpful would you say each of the following tools are in making informed decisions in your work?”, asked from policymakers. Internal meetings are most effective in their view to make informed decisions at work, and then you’ll go all the way to the bottom and that’s where you will see social media. Social media is way down and rated at a scale where it is considered to have very limited positive effects on making informed decisions.


Is social media useless for making informed decisions?


This made me and a lot of people who are involved in communication think: does social media have a place in advocacy or it is an exception?I would like to focus on the term “make informed decisions”. Social media, in my view, is not the tool to make informed decisions. It has a very important overall but its role is not to inform people in depth,especially not policymakers.


And here’s another chart that says: “which are the digital tools that you use to make informed decisions”?If you look at the upper part this chart, these are all websites: corporate, academic, NGOs, your own sectoral website or your industry’s very own website, Wikipedia and others.


If you then go to the lower part,you see what we broadly call social media, including Facebook, YouTube, other social networks.And again: policy makers do not consider this as useful tools to make informed decisions.


So what is social media’s role in EU advocacy?


But, I will argue again, if the role of social media as a channel is not to inform in-depth the policymakers, it must have a different role.The best analogy is to compare that to classic marketing,especially branding. Branding’s goal is not to directly sell the product, but for the transaction to happen, or in this case, the policy maker to trust and listen to you, a baseline trust needs to be established. That’s where social media can be extremely useful… but the informed decision will not be the direct result of your social media efforts.


Americans’ trust in your industry – the Pulse Survey


Our research that we at the Public Affairs Council do in the US each year is a survey called The Pulse Survey. It’s about perception, that is, the public’s perception about different industries and how much regulation is there is or should be in place for those industries.


Is the general [US] public happy about the amount of regulation for a given industry or they think there should be more?If you look at the chart, well, health insurance companies (who are probably not a direct concern to you but still on your radar)is the number one:according to our polls, people think there’s too little regulation there. Policymakers should pass more laws.


Then you look at number three: pharma companies. Again, the public thinks there’s too little regulation in place. Though it was done on the basis of polling US citizens, I don’t think this would be radically different in Europe either. This means that there’s an overall public pressure to regulate the industry further.


Trust in the pharmaceutical sector and health care


The other side of this is about the trust in a given sector or industry. Who do they rate as number two, that is, the least trustworthy industry? Pharmaceutical companies.This gives the impression that the public’s perception is not very positive, at least in the US, which means that this perception needs to be somehow addressed. Even more so because this will have an impact on the policies and this will have an impact on your industry at the end of the day.


Social media for marketing vs. advocacy


Here you can see a rough, admittedly unscientific slide on the main difference between using social media for marketing purposes versus advocacy or classic public affairs purposes. What’s common is that the branding of the company and the creation ofbrand awareness is a common goal both for the marketing department and the advocacy side as well.


However, the major difference is that marketing tries to influence the customer [who can of course be the wholesaler, the hospital, the healthcare provider too]. Advocacy, on the other hand, is aiming at the policymaker and those who influence the policy maker: this radically changes the number of people you’re possibly talking to when it comes to advocacy.While marketing can aim at hundreds or thousands or millions, depending on whether or not you are selling directly to consumers.


Advocacy, on the other hand, is in most cases used to address a far more limited number of people.If I look at it in the narrow sense and in the EU context, who will be your targets? European Commission officials, European Parliament staff and MEPs, a couple of Member States, maybe the European Medicines Agency (EMA) in London, maybe the European Food Safety Authority (EFSA) in Parma, depending on the issue. Overall, not more than a couple hundred people at best.


Who do you want to connect with?


If we look at the issue a bit closer, on the left side of the pie we have what I just mentioned:the officials, the policymakers from the institutions and a few EU agencies. Then, however, on the right side you have the broader, general public: that includes you as corporate representatives, but it also includes NGOs, the media, generally speaking, the influencers.


I see a trend, which is something that I’ve seen in various industries: European Commission people and Parliamentarians are listening much more to the public’s scrutiny, there seem to be an increasing pressure on policymakers from the broader public on highly specific issues such as at the approval of a food additive, recognition of a new treatment or banning e.g. animal testing. European policy makers are less and less ‘isolated’, and they are far less technocratic than they used to be even 5 or 10 tens years ago.


Technocratic policy-making: a changing trend


It is clear that European Commission officials are keen on listening to the public mood:there are many contentious issues like GMOs,or other health-related topics where the Commission is not going to act purely on the basis of bilateral, behind-the-scenes discussions with a few key players. These influences and influencers are becoming more important, and if they can trigger policymakers to action or inaction, then the size of your potential audience and targets have already increased to a great extent.


NGO activism in Europe


This chart is from a website called SigWatch: what it does is to monitor NGOs and NGO activity across a number of sectors, globally. I had a look at the pharmaceutical industry and what this chart shows are the issues that have come up in the past few months where a lot of NGO activism has happened.


If you look at the first one: access to medicines. The number of activities has gone up in the past three months as regards NGOs trying to put pressure on public authorities and other actors. The countries where such activism was most visible are Switzerland, US, Bulgaria and Canada. This seems to have a limited impact on EU-level as while Bulgaria is certainly in Europe,Switzerland has a special relationship with the EU without being a core EU country. However, if you look at, for instance, animal testing as number three, there you can see that the UK and Germany are very important targets.


What is the issue du jour?


There are always issues and topics which get a lot of attention, and NGOs, along with the wider “advocacy community” is trying to influence the policy outcome. My argument is that while decision-makers may refrain from dealing with a given issue, NGO activism and within that, social media can become very important in influencing the agenda and ultimately, the policy priorities that will be dealt with.


EU as a punching bag


This punching bag is how EU institutions are often seen. I know it from my experience as a former EU official and I had it confirmed by several friends who work in the EU institutions: they are not making policy and then wait for interaction from industry, the civil society and other stakeholders. They are so often criticized for the lack of transparency, for the so-called ‘democratic deficit’, that the EU institutions themselves are getting to be more and more committed to effective communication. Whether they do it right or not is a different matter, but they realize they don’t exist in a vacuum or an ivory tower.As a result, they want to have an interaction:industry and NGOs can play an important role in that interaction.


EU institutions want to be loved


It may sound funny but the truth is: EU institutions, like anyone on this planet, want to be loved. Policymakers are craving citizens’ attention. A very concrete example: I just met a policy maker in the European Commission who contacted me as a result of a video that I did on the TTIP, the EU-US trade and investment partnership talks. It was an experiment that I did, without any external funding or sponsorship, to explain the TTIP: I sent it to a couple of people and put it on some Linkedin groups, and then I got contacted by various people in the Commission and also from other firms asking whether they can use it for their communication purposes. This is because it’s no longer a top-down effort from the ‘the government’ to tell people of its decisions: they need to ‘sell’ the idea and convince people.


This is to say that EU institutions have a very strong need and desire to spread their policies and spread the issue they are trying to put out there.It’s not a one-way channel where industry is trying to influence the policymakers. Policymakers understand that their actions and decisions need to be supported by the broader community, or else it will fail.


What is your objective in using social media for advocacy?


Let’s move on to the next part, which covers the question of what could be your objective, your goal by using social media tools or digital tool in your advocacy efforts? I believe that the #1 goal in EU Affairs advocacy should be that you become a trusted credible source as a company.


[I don’t think that today, in Europe, changing a specific piece of legislation, social media can do any miracle in Europe. There are of course some exceptions, e.g. think of the recent Tobacco Products Directive (TPD) and the question having or not e-cigarettes considered as medicines and thus being placed under a different regulatory regime: there some “grassroots” campaigns were actually quite successful (see the UK campaign on and other petitions). On the other hand, this is far more the exception than a broader trend…yet.]


If you managed to overcome the initial hurdles and you became pretty much a trusted company by key policy makers, then they will know they can ask you for input, they can speak to you off the record, consult you, invite you for a coffee or formal meetings etc.


Your secret weapon: monitoring

In practical terms, what can you actually doby using Twitter and all other social media tools? The easiest answer is: to monitor what is happening and what will likely be happening. That includes monitoring what EU institutions are thinking [to do]: for instance, a friend of mine, who is working for a public health NGO mentioned that given the current EU Council presidency in Lithuania, Twitter is his best friend to follow what is happening at a health policy conference where participants and speakers are all sharing useful insights about the event, in real time.


Monitoring is in fact the very first and obvious step to do, even if you are not yet ready to dig deeper into the social media universe.


Spreading your views as far and wide as possible


The next objective could be to spread your view [position]. Generally, I find that is what people think social media should be used for in the first place: for instance, thinking “I have a great position paper. I’ve got to put it out to as many relevant people as possible”. However, exercise this with caution.Broadcasting information is usually not viewed well in this channel.Broadcasting means that “I don’t care much about what people think and I probably won’t even try to have a dialogue about it”.


So simply putting your materials or position out there and trying to spread it (or I may use the word ‘spamming’ it), well, it’s it probably not going to have the impact you want. Again: becoming a brand,a source of value who provides useful information that isnot about you but about an issue, that’s where you start to gain traction.


When your company is dealing with e.g. diabetes, you talk about diabetes as such (instead of the drugs you fabricate to treat the disease). If you’re dealing with, say, antibiotics resistance, you provide some sort of useful information on that matter that can be spread and will likely reach the people who are involved in that issue.


Reputation: individual or organizational?


Reputation is quite a broad term. I think this is more individual than organizational. You as the trusted person in your organization would build up a reputation where you can be contacted by the relevant people. Though we have seen good examples where Twitter accounts are run by organizations and become trusted sources, think of WWF’s EU account, Eli Lilly’s EU account and others.


Visibility online


This topic could merit a seminar on its own, so I’m just flagging it here: what kind of resources to have on your website that will attract the right policy-maker or influencer audience? Part of this is trying to make sure that when someone is doing a Google search, they will find you and your resources.




The last one of the possible objectives of your social media efforts is something that has a long tradition in the US and seems to be gaining traction in Europe too: petitions. The goal could be to put an issue on legislative agenda [via the European Citizens’ Initiative or by ‘regular’ online petitions].Part of this could be an initiative to change an upcoming legislation or change something that the European Parliament is currently discussing,mostly by mobilizing people to sign online forms or send direct messages to policy makers.


Keep in mind, however, that there are lot of companies [yours may also be included] where they would be very careful about using this.They have a reputation to keep, a certain brand to protect, and also considering that in the pharma and health industries are highly regulated, therefore legal concerns may also prevail when thinking about how far you can go in putting pressure on policymakers.


The classic US expression, “grassroots” activism covers this activity: bottom-up initiatives, people sending emails to their MEPs and writing to their policy makers and regulators. It might work in certain issues but this is to be exercised with caution. (See the above example about the e-cigarettes.)


Discussing health topics of general interest: diabetes


Let’s say you would like to put an issue such as ‘diabetes’ on EU policy makers’ radar, arguing that the EU should consider this in more of its proposals. I was looking for some specific LinkedIn group wherespecific discussions take place on this topic. I found the Diabetes Research Institute Foundation with a solid number of members, over 2,300, where people involved in this issue have discussions.


In fact, LinkedIn is really about finding who the relevant people are in that topic,far more than a dynamic, lively discussion on a current event. LinkedIn, at least for now, is mostly about extending your network and finding experts of interest rather than classic advocacy or even shaping the opinion of specific groups of people.


On whose behalf are you Tweeting or commenting on LinkedIn?


Whether you speak on behalf of your company or not, the general perception is that you are representing your company since your LinkedIn profile has that information. Twitter profiles are much easier in that sense since you can make it crystal clear whether re-tweets are endorsements or not, or if your views are your own or that of your employer. For lack of such disclaimers on LinkedIn, you do speak on behalf of your company. This also means that politically sensitive messages are (or should be) avoided on LinkedIn, which is not to say that you cannot enter a lively and smart discussion on health policy or how the EU approaches e.g. active ageing.


This also means that if you create or join a new group centered around a healthcare issue, that’s a perfect way to find out who else is an expert on it in a wider, even global community. Even if the group has only a couple dozen or hundred members, it cannot be centered aroundyour company, a specific drug or medicine or other. It’s about the community and personal connections, something that LinkedIn works rather well for. At the same time, almost all discussions are purely professional. For private interactions and ‘light’ topics, photos and videos, Facebook is the place to be. For instance, if your message is ‘quit smoking’, that can be a broad, personal, individually relevant topic that private people can be interested in. Talking about the new Tobacco Products Directive, however, may go down better on LinkedIn as it’s a technical and legal matter that nobody would be particularly interested in on Facebook.


The right content on the right platform: Facebook vs. Twitter vs. LinkedIn


There is one major difference between the ‘three big’ social media platforms: each requires its own type of content that you share on them. It’s fine to be present on all these platforms (and possibly others, such as Pinterest) but make sure you follow certain best practices. If you have, for instance, a position paper, don’t even try to put it on all the platforms (try e.g. Slideshare) since each work in their own unique way. When people go to Facebook, it’s like going to a party:they want to be entertained. When they go on Twitter, they only want to be entertained in part but they also have professional dialogues, especially depending on the hour of the day:if it’s, say, 9am to 5pm, the discussions will more likely be professional.


LinkedIn, as mentioned before, is a very slow platform, very clumsy and slow when it comes to anything but networking. On Facebook, on the other hand, simply pulling a link to your corporate blog will not work, but maybe an interesting popular science article can do the trick, or if you have a very visual content, with videos, that will work in terms of interaction (shares, likes, comments). See also a bit later a few ideas and examples of what kind of content you can share when it comes to healthcare and pharmaceutical topics.


To sum up: being present is indeed important, but be mindful which type of content and in which packaging do you present that.


Infographics in healthcare advocacy?


Here is an example from Eli Lilly: a position paper in the form of an infographic on the EU-US trade talks. The reason I like this piece of content is because it’s not directly about their company but something that’s useful for a broader audience.


Vine (video on Twitter)


This photo, which is a video in its original form, shows the lung of a smoker and a non-smoker. My point here is that it was re-tweeted by the @EU_Health account, specifically by DG SANCO (health and consumer affairs directorate general). The video only “talks” about how smoking damages the lung. Essentially, that’s the only message there, but it gained visibility since it was not talking about a company, a policy but about an “issue”.


Talking about an issue, therefore is what an EU policymaker can possibly endorse because they agree with this sort of message (e.g. showcasing the negative effects of smoking).


SEO in advocacy


When I mention“being visible” or “being findable”, there are some technical terms to understand. SEO stands for search engine optimization: this means that when you search for any kind of keyword or term on Google or other search engines, which websitesget listed first, second etc.Let’s say you are searching for “Clinical TrialsRegulation”: when a Member of the European Parliament or their assistant searches for information, what are they going to find online?


A small but interesting idea: it may be worth putting an ad on Google so that when someone searches for a topic where you have an EU-related interest, your ad will be displayed for those specific keywords (like “Clinical Trials Regulation”). Alternatively, you can also try to “optimize” your message or your website to show up among the “natural” hits, but that is a rather technical and complex process. In any case, running an ad related to a legislative file or a specific issue of interest for your EU lobbying efforts could be something to experiment with. Also, your aim is not to have hundreds of clicks on this ad that leads the visitor to your position paper or other online resource. If three assistants of various Members of the European Parliament click on it, that may be your goal: a targeted, relevant audience gets your message.


How much is a signature on an online petition worth?


My friend, Jon Worth, whom you may know as one of the most experienced EU bloggers and online gurus, a couple of weeks ago wrote a blog post asking a similar question: what does signing an online petition actually mean?


There is no clear answer for that because it depends: you may know about the latest European Citizens’ Initiative that reached over 1.1 million signatures to stop vivisection (experiments and dissection of live animals). The Citizen’s Initiative, if all are checked and are actually fine, is going to be put on the European Commission’s agenda, even if there is no obligation to pass laws on this topic. These are therefore signaturesthat are worth a lot because the initiative (or petition) achieved what they wanted.


Jon, in the above presentation, mentions Dutch MEP Marietje Schaake: she got several hundred or even thousands of emails campaigning to ban shark finning. Since she has nothing to do with this topic in the European Parliament, this is a completely lost effort. This meant that somebody just put an email“machine gun” and aimed at the wrong target. So having a huge number of signatures and demonstrating lots of effort is not, by definition, going to do the trick.It needs to be very well thought of and properly targeted at the right audience.


Neonicotinoids and social media


There were few other examples recently from other industries, e.g. from the pesticides field that you may have heard of, namely the so-called Bee Colony Collapse Disorder. Neonicotinoidsare a kind of pesticides, whose market authorization has recently been suspended by the European Commission. I wrote about the communication and social media angle of this issue on my blog.


You may know, which is similar to and a couple of other petition websites. They campaign and collect signatures to trigger a change in some specific policy or political issues. To ban the above mentioned pesticide, they collected 2.9 million signatures which they presented to EU officials and underlined the impressive number of people who have signed it. I’m not familiar with how thorough they actually checkedthe signatures, but even if you assume that, say, 20% were fake or spam or duplicate entries, it’s still a pretty impressive number. When we talk about how policymakers are influenced by the wider society, it’s a very strong argument.So this is to say that in certain issues, signatures or huge number of signatures can make an impact or reinforce certain policy directions.


Manage your (own and your boss’) expectations


I think it’s very important to understand that social media tools will not resolve all the public affairs challenges and issues you face. It’s not necessarily the best tool to trigger an amendment or lobby for a legislative change, though as we have seen, there are exceptions.


Another question that is so often asked is: how do you quantify to your management your social media efforts? How doesit translate into a business goal if you are planning to conduct some research and studies, share it on various platforms, gain some traction – but how does it translate into business and advocacy goals?


There is no free lunch


Also, keep in mind that despite the fact that almost all social media channels are free, it’s not free: your time is not free, resources you search for and share are not free, creating new ones like infographics are not free, and all this require appropriate allocation of resources.


What to share on social networks? (in the pharmaceutical & healthcare field)


It is always essential to find high quality content and valuable pieces of information that you can share with others. This does not necessarily have to be your own stuff, but something that you handpicked or “curated” and others in your field would find useful. A good example is the infographicthat EFPIA has shared and was re-tweeted by the European Medicines Agency because it is a handpicked, curated, quality piece of content.


On the other hand, you can also be a content creator, which is obviously going to take more time, effort, brainstorming and resources… but having your own proprietary content maybe better for your visibility overall.


Create your tribe…and lead it


Here is a book from Seth Godin, one of my favorite authors, entitled ‘Tribes – we want you to lead us’. The idea is to find and “assemble” likeminded people, people who are interested in a topic (such as healthcare, active ageing, e-health or any other niche topic of interest) and you can lead: not in a managerial way, but you can “unite” them around that topic.


Mastering the tricks of the trade


A general issue to bear in mind is that mastering the tricks and methods of social media takes a bit of time. For the sake of example, you see on this slide one aspect:when do certain tweets actually get re-tweeted? This is just to highlight the fact that there are many elements of mastering the tools, and in this specific example you see that tweetssent at 4AM European time are not very likely to be re-tweeted.


Why do it?


Consider your objective when engaging in social media: do you only want to “Keep Calm and Jump on the Bandwagon” because many others do it also? Consider the aspects I outlined earlier in the presentation before getting started.


Management of social media efforts


Make sure the management side is discussed in due course: are you tweeting for the company or as an individual?How much time can you dedicate to the management side of doing these activities? Once the basics are clear, identify the key players, especially on Twitter and LinkedIn, and think about which channel could work best for you and your issues.


Alternative channels


You might now Quora, a great social Q&A website. You can put a question that anyone can answer, and people can up-vote or down-vote the answers on the basis of their quality and relevance. It’sin fact a forum but you can find extremely interesting questions. As an example in the healthcare field, here’s one on antibiotics: “Why are people not developing new antibiotics?” Anyone can answer it, add to the discussion and bring in new perspectives that will be seen by a large audience (in most cases).




It may sound a bit of a cliché, but don’t expect to do it right the first time, feel free to experiment. What works fine, what doesn’t, and see what you can get out of it: social media, especially the advocacy side and within the EU, is still relatively new and it’s a safe environment to test ideas on.


Thanks for your attention and feel free to share your comments with me.


I’m very glad to see this article retweeted by DG SANCO’s social media team – thank you!


Social Media in EU


Posted in EU Affairs, Marketing, Public speaking

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