Industry Updates Volume 13

​Living with the Endemic

• November will be the month when the Covid Pandemic officially becomes Endemic, based on the agreement of the United States and Europe to adopt an open skies without a quarantine policy for vaccinated persons.
• This decision is driven more by political and economic considerations, than by medical or epidemiological facts.
• The UK currently has extremely high infection rates (~ 50K per day, and going higher), as do several countries in central and eastern Europe.
• Singapore, which had tightly controlled the pandemic for a long time, has now been placed on the highest category 4 travel warning by the CDC, as infections have surged.
• Israel has asked the U.S. and Europe to treat any traveler who has been vaccinated for more than 6 months, as if they were unvaccinated if they have not received a booster shot, but this request has fallen on deaf ears.
• China, Europe, and North America are all now reaching vaccine plateaus, and India, several other Asian countries, and much of Latin America will also reach this point by Q1 2022.
• There are sizable remaining pockets of unvaccinated in several countries, including the U.S.
• With 6.6 Billion COVID-19 vaccine doses administered worldwide to date, there are still at least 4-5 Billion people that have not been vaccinated at all, or just partially vaccinated. 
• The World Health Organization and the Covax facility are again complaining that very few vaccines are available for Africa and a number of other poorer countries as richer countries are buying up all the available supplies for booster shots and to create strategic stockpiles.
• Living with the Endemic is likely to mean booster shots every six to twelve months for the foreseeable future.

What Does the Medicine Say?

• The original strategy of achieving 'herd immunity' has been quietly dropped as the volume of breakthrough infections show the theory to be untenable with respect to Covid.
• National health policies say that vaccination will reduce the risk of a subsequent infection by over 50%, AND, will also reduce the risk of a severe outcome if infected by a further 50%.
• In addition, care of Covid cases has improved, and new therapeutics such as the Merck pill may reduce severe illness by a separate 50%.
• The cumulative effect of all of this is to reduce the risk of death from Covid for people with up to date vaccination by over 90%, so that the disease becomes 'manageable'.
• Merck has now offered to allow free licensing of its Covid therapeutic pill in poorer countries
• It looks like we will be living with an ongoing but much lower death rate from endemic Covid for many years to come.
• The great unknown is whether new variants which are more dangerous than Delta will emerge, or conversely will the virus naturally wane over time.
• Circumstantial evidence continues to suggest that countries which used the broader spectrum WIV vaccines have suffered less in the Covid surge as illustrated in the following graphs:

Source: Our World in Data as at 23rd October 2021

• ​The FDA and CDC made an important decision to recognize the evidence from research studies that heterologous vaccination (using a different type of vaccine as a booster) is more protective than more of the same vaccine, and has approved this approach. ​
• Some of the underlying research proving this was conducted by a team including Refana's Chief Vaccine Advisor, Professor Stephane Paul.
• Given the waning efficacy of the original vaccines, we expect a significant number of new products to be introduced during 2022, including formulations by Pfizer-BioNTech and Moderna.

The Business of Vaccines

• The value of Covid vaccine sales in 2021 and 2022 is such that the category is becoming the most valuable drug category of all time. 
• Pfizer-BioNTech and Moderna are enjoying profit margins of over 70% on their sales.
• A number of recent business articles have noted that the 2 big 'vaccines winners' were 'outsiders' - the Turkish Muslim husband and wife team who founded BioNTech in Germany, and the Boston based Moderna founded by an Armenian immigrant, and with a French CEO and Israeli Chief Scientist.
• Conversely none of the three major historic vaccine companies Merck, GSK and Sanofi got a vaccine to market. While Johnson and Johnson, and AstraZeneca (licensed from Oxford) did get to market, they have had much less favorable market share and overall economics.
• Pfizer has proven itself as an excellent manufacturing and sales partner to BioNTech, but despite its dramatic revenue and profit surge expected this year and next, this is not reflected in the share price, as Pfizer failed to agree an acquisition or long term strategic deal with BioNTech, which continues to control the underlying technology.
• The situation with the Chinese manufacturers Sinovac and Sinopharm is less transparent but consulting firm Airfinity expects they will each hit $20bn of revenue this year, based on over 2 billion shots delivered in China, and more than a billion overseas. The great unknown however is the pricing deal with the Chinese government.
• For conspiracy theorists, the fact that China has proceeded with a 100% WIV domestic vaccination program that now covers 80% of its population is a Red Flag!
• China had access also to adenovirus vaccines, like AstraZeneca, J&J, and the Russian Sputnik V. Having acquired 6 Million doses and administering them to the Chinese security forces, they suddenly stopped using it without comment. What do the Chinese know that we don't?
• Refana estimates the value of the Covid vaccine market, based on the need to provide boosters, and to protect from new variants, to be worth U.S. $180 Billion from 2023-27.
• Current global volumes of doses administered to date by vaccine type are set out below.

Source Wikipedia. Correct as at 30 September 2021