Marketing antibiotics as vaccines? Analyzing the successful marketing of a pharmaceutical innovation: the case of tulathromycin in veterinary medicine

The article investigates why tulathromycin (marketed as Draxxin since 2004) achieved exceptional success in veterinary medicine—particularly in cattle and pig sectors—despite regulatory efforts in Europe and France to reduce antimicrobial use. Framed by Whyte et al.’s concept of the ‘social life’ of medicines, the study treats tulathromycin as a material therapeutic object whose meanings and uses are co-produced through pharmacological properties, marketing, and real-world practice. The research question asks what explains tulathromycin’s sustained market dominance and how its properties and presentation came to embody solutions to organizational and health challenges in intensive livestock systems. The study is motivated by the policy context of antimicrobial resistance and French programs (Ecoantibio 1 and 2) that reduced antimicrobial use and promoted alternatives such as vaccination and biosecurity. It argues that understanding tulathromycin’s success requires analyzing both pharmaceutical innovation/marketing and the organizational structure and constraints of livestock production, including how boundaries between preventive (vaccines) and curative (antibiotics) uses are blurred in practice.

The paper draws on scholarship showing how pharmaceutical firms shape drug use via branding, packaging, promotion, and ‘scientific marketing’, which leverages scientific data and market research to align products with prescriber needs (Greene; Sismondo & Greene; Gaudillière & Thoms). It balances this with literature emphasizing user context and social demand, where clinician practices and care settings can redefine therapeutic categories (e.g., chlorpromazine’s history in France). The veterinary market differs from human medicine because products are not reimbursed; animal owners bear costs, and in productive livestock, medicines are farm expenses, making working conditions, sector organization, and willingness to pay central. The theoretical lens follows Whyte et al.’s five properties of medicines—especially how medicines transform ‘modes of understanding’—to analyze how tulathromycin’s material form, marketing, and sectoral context co-produce its meanings and uses.

The study is based on qualitative research conducted from June 2022 to December 2023. Data sources include: (1) semi-structured interviews (n = 16) with employees of pharmaceutical companies (primarily veterinarians) involved in antibiotic or vaccine product lines and regional promotion; companies are anonymized but identified as Zoetis (tulathromycin’s marketer) or competitors; (2) observations of multiple training sessions organized by pharmaceutical companies for rural veterinarians, each with over a dozen attendees, focusing on topics like respiratory diseases; informal interviews during these sessions provided an additional 10 interviews; (3) a review of professional veterinary journals (Semaine/Point Vétérinaire and Dépêche Vétérinaire) from the early 2000s to the present, plus a special issue devoted to tulathromycin; all relevant articles and advertisements were cataloged in a database and advertisements were analyzed pictorially (imagery, slogans, salient text). All interviews were fully transcribed and thematically coded across eight themes (background, daily work organization, impacts of AMR-related policies/regulations, role of vaccination, diagnostics, prevention practices, sector organization, and tulathromycin). Interview excerpts were tagged by interviewee characteristics (e.g., farm vs. industry veterinarian; beef vs. pork sector) to identify cross-sector patterns. Observational data were reviewed post hoc to support the primary interview analysis. The research context and access were facilitated by institutional trust; the most challenging interviews were with sales representatives. Ethical approval and data protection procedures were followed within the ROADMAP project framework.

• Tulathromycin’s long duration of action (e.g., 9–15 days cited in professional sources) and single-dose subcutaneous administration, with small aqueous volume and good ‘syringability’, are repeatedly highlighted as core advantages over prior benchmarks like florfenicol (oily, higher mg/kg, and requiring repeat dosing). These properties support compliance and ease farm labor. • Despite pharmacological similarities with other long-acting macrolides (gamithromycin/Zactran, tildipirosin/Zuprevo), tulathromycin outcompeted them. Literature suggests only minor differences, and high substitution rates indicate perceived equivalence among veterinarians. • Market structure and firm strategy mattered: the French veterinary medicines market is highly concentrated (top five firms hold 66.2% of sales), with Zoetis occupying a dominant position and deeply investing in key segments (e.g., fattening). • Tulathromycin’s success persisted amid EU/French antibiotic stewardship policies (e.g., Ecoantibio 1 reduced antimicrobial use by ~40%). Before 2015, large back-margin discounts strongly influenced prescribing; the 2015 French ban on antibiotic discounts (LAAAF) was described as a major market shock, with firms previously ‘trapped’ in discount spirals. • Sector organization creates strong preventive demand: In cattle, a ‘prisoner’s dilemma’ between breeders (who would bear vaccine costs) and fatteners (who benefit) undermines vaccination uptake; tulathromycin offers immediate, long-lasting protection during high-risk periods (first month of fattening), aligning payer and beneficiary (the fattener). In pigs, the drug bridges the ‘immunity gap’ post-weaning until vaccine immunity is established, with use patterns varying by farm size and labor constraints. • Intensive batching/banding systems in both sectors heighten infectious risks by grouping animals with heterogeneous immunity; tulathromycin functions as a ‘quick fix’ that stabilizes productivity by compensating for stress, crowding, and limited labor. • Material and marketing innovations reinforced uptake: easy injection, single-dose regimen, robust packaging, and especially the brand name ‘Draxxin’ and the emergent term ‘draxxination’ blurred boundaries with vaccination, shaping user perceptions and legitimizing preventive antibiotic use. • Regulatory shifts (EU Regulation 2019/6, effective 2022) tightened metaphylaxis conditions (diagnosis, justification, veterinarian examination and listing of treated animals), potentially constraining routine ‘farmer’s product’ use, but the practice-level impact requires further study.

The findings show that tulathromycin’s success cannot be reduced to pharmacology alone. Its material properties—long duration, single-dose, easy subcutaneous administration—fit labor-constrained, high-throughput livestock systems where grouping animals creates predictable respiratory risks. This alignment transforms the drug into a practical ‘quick fix’ that sustains productivity under stressful conditions, addressing organizational failures (e.g., cattle sector misalignment that disincentivizes vaccination) and bridging immunity gaps (pigs). Zoetis’ market power, targeted investment in fattening segments, and historically aggressive commercial practices amplified visibility and access. Crucially, product presentation and branding (Draxxin; the vernacular ‘draxxination’) reshaped ‘modes of understanding’ by making an antibiotic resemble a vaccine in use and perception, thereby normalizing preventive antibiotic administration even as policy discourse promoted vaccination. Thus, tulathromycin’s success lies in the synergy between fitting sector-level constraints, material ease-of-use, and marketing that blurred therapeutic boundaries, helping the product thrive despite strong antimicrobial stewardship pressures.

Tulathromycin emerged as a dominant veterinary antibiotic because its long-acting, single-injection, easy-to-administer formulation aligned with the organizational realities of intensive livestock production. In cattle, it solves a coordination problem that undermines vaccination by enabling fatteners to purchase and immediately protect incoming animals; in pigs, it covers the post-weaning immunity gap. Although pharmacologically similar alternatives exist, Zoetis’ market dominance, targeted sector engagement, earlier discount practices, and strategic branding/presentation reinforced adoption and contributed to conflating preventive antibiotic use with vaccination—as reflected in the term ‘draxxination’. The study underscores how the material conditions of administration and sector organization co-produce the perceived value and meaning of a medicine. Future research should assess how EU Regulation 2019/6, which tightens conditions for metaphylaxis (diagnosis, justification, veterinarian examination and precise listing), is reshaping veterinarians’ prescribing and farmers’ use of long-acting macrolides in practice.