Zach Gobst

	Believe it or not, it’s 2020, and social media health influencers are becoming the difference between meeting clinical development timelines or falling behind competition studies. This influencer story is not just about how you reach more patients with your budget (which it does and it’s awesome), it’s about the types of patients you reach via influencers, as their communities come with engagement that far exceeds the likes of traditional media. Radio, billboard, TV, and even digital ads like Facebook, banner, and cost per click are being left in the dust. Study coordinators don’t have the time. This additional engagement from influencer communities translates in a big way. When patients are more likely to be reached and engaged in the process, study coordinators are able to make more time for them, resulting in a beautiful growing snowball of successful outcomes for studies that make it happen.

	Outside of clinical development, influencer marketing is changing the way people connect or receive information globally. It’s already an enormous market (est. $15B+) growing way beyond just runner up Bachelorettes and Love Islanders. Within the influencer market are thousands of health advocates with the power to transform the way we look at clinical research data. These health influencers have the attention, trust and devotion from niche communities-in many cases, the specific communities that can catalyze research countless indications. 

	It’s all easier said than done from a researcher’s perspective. Sponsors and investigator sites have plenty of project risks and fires to put out on the daily prior to putting any thought into patient recruitment sophistication. The challenge often becomes context switching-from a clinical operations mindset to a focus on new types of outreach, and then often back as project challenges arise. It’s the job of Leapcure and other outreach service providers to be able to adapt to changing project needs while helping balance recruitment priorities. Working with advocacy or influencers is not an endeavor of checking the proverbial box-it requires attention to the holistic workflow with inputs from influencers, campaign data, the patient voice, and the study team. Even if you’re able to launch influencer campaigns, it often takes more than just one or two strong influencers with the way clinical research works. If an influencer isn’t in the regions where your sites are or if your influencer campaigns send patients to sites that aren’t engaged, your data on the viability of that individual influencer will be limited. If you’re working with an influencer with less reach, but better regional engagement where your referrals are, it might be a better source to focus on for future retargeting. You’ll often have to work through a level of variance in site engagement depending on the timing patients are reachable and when they have the capacity beyond any of their existing responsibilities.

	It’s somewhat commonly known that advocacy and influencer approaches are basically a dependency for successful rare and ultra-rare disease research. The emerging view is that this infrastructure for broad health influencer and advocacy outreach should be enabled from the moment you’re initiating sites. Leapcure actually recommends this be put in place as many as six months prior to final protocol approval-allowing influencer campaigns to generate real-world data-which is comprised of patient outcomes data, patient reachability, patient engagement, patient sentiment, among others-for protocol design and site selection. In any case, the traditional model of waiting until you need outreach, burning through expensive forms of traditional and digital media, and leaving partnership reach to just a few marquee advocacy names are becoming things of the past.

	For those less familiar, influencers by definition are individuals that have a digital voice within niche online communities. Many consumer brands have come to rely on them for access to their potential customers, and in a similar way, clinical operations teams have the ability to incorporate health influencers into their advocacy group strategies too. In the context of clinical trials, research can benefit from the influencers’ deeper understanding of the patient community. Influencers knowledge of their community is as important in the relationship as their actual campaigns. In the majority of cases, the relationship between influencers and their community is a two-way street. Influencers are keenly aware of the preferences of their community, their opinions, their interests, and have earned their trust. Collaborating with influencers can therefore facilitate access to a highly targeted community from a behavior and interest perspective. Alternatively, to common thinking, helping these influencers vet your research opportunity helps them to unlock a level of trust in promoting your initiative too, which often transfers to the trust of their communities.

	Influencer marketing is more of an incremental innovation in the clinical trial space. In some industries disruptive innovation is more sought after. However, being in clinical research, for Leapcure’s evolution we’ve faced this tradeoff honestly. At the end of the day, we’ve moved further in the direction as a company toward the incremental innovations that we know will impact lives. By focusing on enabling broad influencer marketing rather than models such as virtual/mobile, we know we’re getting patients to better outcomes each and every year. The prudent use of health influencers can speed up learning about the patient population and drive a more adaptive recruitment approach, where feedback allows for improvement in campaign strategies and retargeting along the way. We’re seeing immediate impact as study teams can quickly see influencer and advocacy marketing approaches as central to their recruitment/timeline requirements. For example, on average, influencer and advocacy marketing approaches will contribute to 50% of referral acquisition cost reduction and improvement of referral to enrollment rates of 15:1 vs. 50:1 for typical standalone digital. This is study dependent, but the key to this is generating site engagement with advocacy/influencer patients. More reachability/patient accuracy/patient retention leads to more time invested from site coordinators.

	Fortunately, resourcing for health influencer campaigns is essentially the same burden as doubling down on broad advocacy efforts. Health influencers can be introduced to the traditional patient advocacy group strategy and certainly can dovetail any advocacy outreach material approvals and will mesh well because influencers and advocacy can often be connectors to each other for the study team. Health influencers are being incorporated into the primary focuses of recruitment strategies because they are a growing marketing segment. Particularly in noisy or competitive landscapes, health influencers provide a differentiator that sets your patient advocacy apart from the many competing voices.

	Note, however, that advocacy and influencer partnerships are not just another variation on digital marketing. Patients from influencer partnered advocacy are self-selecting your study and are more motivated to participate in research. 

	Successful utilization of health influencers in your outreach strategy typically requires the following three steps.

		First, it is important to vet the influencer before establishing any partnership. You need to vet the influencer and the influencer needs to vet you. Research potential influencers and the positions they have taken to ensure that their reach and influence are substantial enough to have a positive effect on your patient advocacy. Ask pressing questions about the dynamics of their communities, their experience, and what outcomes are likely. Answer their question, too, about your experience bringing awareness to similar communities. Assure them of the patient journey and process to unlock their ability to trust your collaboration. Note, their social media metrics/reach/impression metrics can sometimes be “vanity metrics.” An influencer’s raw page views and follower numbers can be inflated easily and do not necessarily correlate to patient engagement and influence. If you struggle to get responses you’re comfortable with, initiate a pilot scope to begin. When that fails, you get the signals you need to prioritize outreach with their community. If they aren’t confident with their actions, that might indicate how previous campaigns went. Try to get the conversation down to the data.
		
		Once you have settled on a prioritized list of potential influencer partners, review your engagement strategy and message points with each of them to check for alignment. Also gauge the influencer’s eagerness to share these views with the patient group. It’s best to be proactive with the types of materials they will need to use. Anticipate variations of materials to get the wheels churning at the very least. Also get an understanding of timing requirements for launching and relaunching.
		 

		When you partner with an influencer, the next step is to engage that person in the creative strategies that will forward useful patient information. Clearly define the key points and information that will be important to this patient population, making sure to include open-ended questions of the influencer to help measure what the patient actually finds important. Reference the clinicians and advocacy groups that are respected by the patient population, offering their perspectives and opinions to help inform the patient, but, most importantly, to empower the patient. It’s also important to note that some health influencers will require a fee to work together, depending on their platform and reach.
		
		Close collaboration with the health influencer is key to making the partnership beneficial. The goal should be to develop mutually-agreed-to strategies, plans, and messages that benefit the patient population and then have the influencer deliver them effectively in a way that the study organizer cannot do on its own. A health influencer partnership can go wrong if you are overdependent on that individual partner being successful. If their campaigns can’t get out of the gate properly or the traffic isn’t what they told you it was going to be, you don’t want to have your full study strategy leveraged. You need to continue building additional partnerships and anticipating efficiencies from adapting to campaign data.
		
		Be clear about what you want the influencer to reach. Rather than simply having the health influencer endorse or publicize your trial, be specific about what engagement results you are seeking and exactly how the influencer can help you reach that goal. The cost of testing traffic also must be factored into the partnership. It’s best to be conservative about expectations and give a multi-month timeline for the influencer to make sure that the campaigns launched are as effective as possible.
		 

		The third step is to forge partnerships that improve the long-term connections for both parties. In most cases these influencers are not on an island, they know other influencers and advocacy leaders for future collaboration. Similarly, your broad outreach efforts can lead to new or strengthened connections for influencers. Leverage the connections with all patient advocacy groups to help the influencer have the most impact with your strategy and messaging. Leave them better off than they were before your engagement.

	In almost every case, incorporating health influencers and advocacy in recruitment strategies will improve enrollment value, often by improving the referral acquisition cost and always by reducing the referred-to-enrolled rate. The ROI on health influencer partnerships can often be good. For example, Leapcure’s use of health influencers and patient advocacy yields an average cost savings of $1 million per project. In 2020, there is an incredible amount of opportunity still left for study teams to explore broader influencer and advocacy outreach. Health influencer communities are growing in quantity and size year after year as patient communities find better ways to organize around their needs. 

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