Zhang Li (pseudonym) is not yet 40 years old this year, but he was approached by shingles a year ago. This is a disease that is compared to "immortal cancer" and has a high pain index, which is more commonly known in China as "snake wrapped around the waist". Zhang Li had originally intended to endure it, but missed the optimal treatment time, leaving behind a sequela of neuralgia.
Now, as long as Zhang Li is at home or alone in the office, he doesn't wear a coat and his upper body is naked. He is afraid that the friction of his clothes on the skin will cause neuralgia, which is like electric shock, needle pricking, burning, and even punching holes in his body like an awl. At the beginning, Zhang Li was afraid of embarrassment for his female colleagues, and over time, everyone became accustomed to his outfit.
In fact, there is an antidote to shingles. In 2019, the National Food and Drug Administration approved the launch of GlaxoSmithKline's herpes zoster vaccine "Xin'an Lishi". This highly protective vaccine is a "good medicine" for herpes zoster and is GlaxoSmithKline's largest single product in recent years. Last year, global sales exceeded 3.6 billion US dollars (approximately 26.3 billion yuan).
But when this vaccine arrived in China, it was "acclimatized" and its promotion was hindered. According to public data, the penetration rate of the vaccine is only 0.3%, and the batch issuance volume is also quite low. The annual sales revenue is only a fraction of the expected market size of 100 billion yuan by securities firms. Recently, GlaxoSmithKline awarded the exclusive rights to domestic vaccine leader Zhifei Biotechnology for the herpes zoster vaccine, with a three-year large order of 20 billion yuan, no less than a gamble.
Recently, a reporter from the Daily Economic News interviewed GlaxoSmithKline on issues related to the herpes zoster vaccine, but the other party politely declined the interview.
GlaxoSmithKline's previous promotion was not smooth
On the morning of October 9th, Zhifei Biotech (300122.SZ, stock price of 57.25 yuan, market value of 137.4 billion yuan) announced that the company had signed an "Exclusive Distribution and Joint Promotion Agreement" with GlaxoSmithKline Biotech and GlaxoSmithKline Hong Kong (hereinafter collectively referred to as GSK) on October 8th, with a total minimum purchase amount of over 20.6 billion yuan in the next three years.
According to the agreement, the initial period of the agreement between GSK and Zhifei Biotechnology is three years, and the minimum procurement amount for the next three years is 20.64 billion yuan. Zhifei Biotechnology stated that the agreement ensures the basic supply of the agreement products. If the performance is normal, it is expected to have a positive impact on the company's agency business revenue and operating profit. The company will fully utilize its marketing network to promote the normal performance of the agreement.
The agreed upon products and the expected minimum annual purchase amount for each year
Screenshot of Zhifei Biological Announcement
This announcement injected a strong shot into the already sluggish vaccine sector, and on the same day, Zhifei Biotechnology rose its limit. The market is so bullish due to two factors. Firstly, Zhifei Biotechnology has strong strength in the promotion of vaccine products, with successful cases of acting as an agent for the 9-price HPV vaccine of MSD. The operating revenue of the agent products increased from 3.888 billion yuan in 2018 to 34.975 billion yuan in 2022.
Secondly, Xin'an Lishi has shown strong performance in the global market. According to GlaxoSmithKline's 2022 financial report, Xinan Lishi's annual revenue was nearly £ 3 billion (equivalent to approximately RMB 24.5 billion), an increase of 72%, making it the company's highest sales unit.
In the deduction model of securities firms, China's herpes zoster vaccine market has a scale of hundreds of billions. According to third-party data, the shingles vaccine coverage rate for people aged 5 and above in the United States reached 26.8% in 2021, while in China it was less than 0.1%. Based on China's population structure and the trend of upgrading elderly consumption, the market for herpes zoster vaccines has great potential for development in the future.
Will this strong collaboration succeed? The Daily Economic News reporter learned that Xinan Lishi has been listed in China for three years, but the market progress is not optimistic. According to the 2020 annual report of Shanghai Pharmaceuticals, a former agent of Xin'an Lishi (601607.SH, stock price of 17.31 yuan, market value of 64.104 billion yuan), Xin'an Lishi's sales revenue for that year was 487 million yuan. Since then, Shanghai Pharmaceuticals has not disclosed its specific sales revenue.
According to data from the Chinese People's Procuratorate, the batch issuance volume of Xin'an Lishi in 2020 was 1.65 million. By 2021, according to Haitong Securities, the total issuance volume of Xin'an Lishi was only 590000 units. In 2021, Xin'an Lishi even reported news of being "acclimatized" and experiencing price reductions. According to Sina Pharmaceuticals, there are industry reports that Xinan Lishi has started to reduce prices and subsidies, selling products with near expiration dates, and there has been news of a "special price of 2800 yuan for two injections" in Longhua District, Shenzhen.
According to a research report by Southwest Securities in February this year, the penetration rate of domestic herpes zoster vaccines is less than 1%, and the penetration rate of GlaxoSmithKline's herpes zoster vaccine is only about 0.3% based on the batch issuance criteria. According to the CDC unit price of $105 per unit in the United States, as of 2022, the cumulative sales volume of GSK in the United States region is approximately 85 million units, corresponding to a cumulative penetration rate of approximately 35%. In contrast, there is significant room for improvement in the penetration rate of the Chinese market.
The reason why the promotion did not meet expectations is not that GlaxoSmithKline did not take it seriously. In an interview with the media last year, Feng Bixia, Vice President of GSK China and Head of Vaccine Business, clearly stated: "China is GSK's second largest market globally... In the process of weighing vaccine supply, GSK will also prioritize the demand of the Chinese market. With the rapid expansion of vaccine business in China, GSK will ensure the demand of the Chinese market with double-digit growth in supply every year
Difficulty in promoting vaccines: high prices, significant side effects, and low awareness rate
Herpes zoster is caused by reactivation of the varicella zoster virus. Almost all adults aged 50 and above have latent varicella zoster virus in the nervous system and may reactivate with age. Neuralgia is the most common complication of herpes zoster, with some patients experiencing persistent pain for 1-2 months, some lasting pain for 3-5 months, and others lasting pain for several years.
Theoretically, the incidence rate of herpes zoster increases with age, and the elderly should be actively vaccinated. According to the science popularization manual of the China Geriatric Health Association, middle-aged and elderly people who have suffered from chickenpox, chronic diseases, and low immunity are more likely to develop shingles; The recurrence rate of herpes zoster is generally between 50% and 60%. This also means that there is still a large market space for the herpes zoster vaccine in China.
The low awareness rate is the most urgent issue that needs to be addressed for the herpes zoster vaccine. At least Zhang Li stated that he had no prior knowledge of the existence of this vaccine. However, even if he knew that the direct correlation between herpes zoster and "death" was not strong, he may not be willing to fight it.
Now Zhang Li can still see scars left by herpes zoster on his waist, as the sequelae are severe and he often feels pain uncontrollably. In order to alleviate the discomfort, he lay down when he had nothing to do and also pushed away all social activities that could be pushed away. He said that now he has deeply experienced the 'pain of the skin'.
On social media, there are also many patients like Zhang Li who share their experiences of herpes zoster, such as burning, electric shock, acupuncture, and knife cutting, which are the feelings of many herpes zoster patients. In order to cope with the pain, some patients succumb to the intense pain that occurs day and night, and even suffer from the sequela of neuralgia, which makes them feel unbearable.
Yang Guisun, Director of the Prevention and Health Department of Foshan Fosun Chancheng Hospital, told reporters through WeChat that the main reason for the low vaccination rate of herpes zoster is that many people are not aware that this disease can be prevented with vaccines. The second factor is price. Xin'an Lishi needs two vaccinations, with a total cost of over 3000 yuan, which is a significant expense for the elderly. Therefore, the overall vaccination amount is not large.
According to his observation, some elderly people who come for injections are brought over by their children, and some may find the cost too expensive and unwilling to receive the injection. In addition, although a few recipients have relatively obvious adverse reactions after receiving Xin'anlishi, more than 94% of recipients still complete the entire process of two doses of vaccination.
A person in charge of vaccination at a community hospital in Guangzhou also stated that some elderly people are vaccinated, but not many, mainly due to insufficient publicity and many people are unaware of the vaccine.
Even though elderly people are aware of the availability of vaccines and the pain of the disease after its onset, their willingness to pay for vaccines is not high due to the relatively large side effects and high prices. According to data from the Yue Miao platform, the proportion of people receiving the herpes zoster vaccine decreases with age, with 59% of people aged 50-59, 33% of people aged 60-69, and only 8% of people aged 70 and above.
This is caused by the high price of vaccines and inadequate promotion. According to He Li (pseudonym), the director of the vaccination clinic at a grassroots hospital, the people who consulted at the hospital were retired elderly people or children with good economic conditions. They often witnessed the pain of relatives suffering from herpes zoster and took the initiative to make an appointment for vaccination.
In addition, popular science education for dermatologists also needs to be strengthened. In a telephone survey, Zhang Qiang (pseudonym), a dermatologist who has been working in a grassroots hospital for decades, told reporters that herpes zoster is a self-limited disease that often occurs in the elderly. Generally speaking, patients who have had chickenpox or have already contracted herpes zoster do not need to be vaccinated with the herpes zoster vaccine, so he has not actively provided information on the vaccination of herpes zoster to patients. In fact, he himself, who is over 50 years old this year, did not actively receive the shingles vaccine. He believes that compared to the treatment cost of several hundred yuan for shingles, the vaccine is too expensive.
The Chongming District Center for Disease Control and Prevention in Shanghai suggests increasing public health investment through various means and methods, focusing on dissemination among communities and medical personnel to enhance the awareness of vaccine preventable diseases among middle-aged and elderly people, and promoting the recommendation of general practitioners and community personnel to receive relevant vaccines for middle-aged and elderly people; On the other hand, the Miao side believes that it is also important to provide health science education to the 20-40 year old population and make their children aware of the importance of vaccination for the elderly. "Many young people have awareness and prevention awareness of herpes zoster, and can carry out science popularization work to spread health knowledge to middle-aged and elderly people.
The Center for Disease Control and Prevention of Dongcheng District, Beijing collected information on 303 recipients aged 50 and above who received two doses of herpes zoster vaccine at the Dongcheng District Preventive Clinic from August 1, 2020 to September 1, 2021, through a questionnaire survey. Among them, 65.68% of the recipients received the vaccine through recommendation from family and friends. The acceptance of vaccine prices, awareness of the possibility of recurrence of herpes zoster, and awareness of the need for medical treatment for herpes zoster are factors that affect the willingness of recipients to recommend treatment.
A survey conducted by the Chongming District Center for Disease Control and Prevention in Shanghai, targeting 845 adults aged 50 and above, showed that the reason why they were unwilling to receive the herpes zoster vaccine was because the vaccine price was too expensive; Physical health does not require vaccination; Vaccination has significant side effects; Herpes zoster is a minor illness that does not cause serious consequences.
Visits: Vaccination has improved in first tier cities, and some grassroots hospitals have stopped purchasing due to no one available
However, in the past six months, there have been new changes in the shingles vaccine in some regions.
The above research results all show that people who have heard about the knowledge related to the herpes zoster vaccine and those around them who have had herpes zoster are more willing to receive the vaccine. Zhang Li is no longer able to get vaccinated, but he said optimistically that at least the young people around him have recognized the severity of shingles and have a sense of taking their parents to get vaccinated.
Driven by this emotion, more and more elderly people are starting to "listen to advice" to get vaccinated against shingles. On October 12th, a reporter from the Daily Economic News visited a health service station in Beijing. The staff stated that since the vaccination of the herpes zoster vaccine and influenza vaccine takes at least half a month apart, the number of elderly people who come to receive the herpes zoster vaccine has decreased after entering the influenza vaccination season. However, the number of people who have received the vaccine before was not large, with "usually 17 to 18 vaccinations per day", Most elderly people choose to receive herpes zoster vaccine because of their decreased immunity after being infected with COVID-19.
The reporter noticed that in the preventive health area of the health service station, there are multiple promotional manuals for the herpes zoster vaccine prominently displayed. Scan the QR code of one of the manuals, and the certification subject of the official account that jumps out is GlaxoSmithKline China, the manufacturer of domestic imported herpes zoster vaccine; The other manual is from the China Geriatric Health Association.
Subsequently, a reporter from the Daily Economic News conducted a telephone survey of multiple hospitals and community vaccination clinics in Beijing. Most vaccination units reported good vaccination against herpes zoster, but the remaining vaccines varied. For example, a community hospital and a private hospital stated that there have been many recent consultations, and if there is a willingness to receive vaccinations, it is necessary to make an appointment in advance; Another community hospital stated that it has sufficient vaccine inventory and can go for vaccination without making an appointment.
At the same time, the herpes zoster vaccine has become popular on third-party vaccine appointment platforms. According to the "Adult Vaccination Attitudes and Behaviors Report" provided by the COVID-19 platform, from 2021 to the first half of 2023, users of the COVID-19 platform made a total of 146000 appointments for the herpes zoster virus vaccine, and the number of appointments for the platform's herpes zoster vaccine increased significantly. The number of appointments in 2022 doubled compared to 2021.
Screenshot of "Adult Vaccination Attitudes and Behaviors Report"
However, unlike the rapid progress of first tier cities, the sales of herpes zoster vaccines are not good in grassroots hospitals with weak publicity. On October 11th, He Li told the Daily Economic News over the phone that the hospital had purchased imported herpes zoster vaccines in the past few years, but ultimately stopped purchasing them due to the low number of recipients. This year, the hospital purchased domestically produced herpes zoster vaccine at a cheaper price, and the number of recipients has only begun to increase. If we increase publicity in the future, the hospital is expected to receive a monthly dose of herpes zoster vaccine for seven to eight people.
The imported vaccine in He Li's mouth is GlaxoSmithKline's recombinant herpes zoster vaccine "Xin'an Lishi", while the domestic vaccine is "Ganwei" of Baike Bio (688276. SH, stock price of 61.91 yuan, market value of 25.56 billion yuan). In January of this year, "Ganwei", as the first domestically produced herpes zoster vaccine, was approved and launched, which is the technical route for attenuated live vaccines. Unlike Xin'an Lishi, which is suitable for people aged 50 and above and has two doses of vaccination throughout the entire process, "Ganwei" is suitable for people aged 40 and above, requiring only one dose of vaccination procedure, and priced at 1369 yuan/dose, lower than Xin'an Lishi's 1598 yuan/dose.
Screenshot of Dongwu Securities Research Report
The "filial piety bombing" is also one of GSK's marketing ideas, but the timing is difficult to grasp. Last year, Dr. Dingxiang released the science popularization of herpes zoster vaccine at multiple marketing nodes such as Mother's Day and 618, and promoted the full process vaccine service of GSK herpes zoster vaccine. "It is recommended to take parents to receive herpes zoster vaccine as soon as possible" was put on the hot search, but due to exaggerated disease descriptions and cited data, he was accused of "selling anxiety".
Multiple domestically produced seedlings under research are benchmarking against "Xin'an Lishi", GSK needs to hurry up
According to Yang Guisun's clinical experience, although domestic vaccines have lower prices and fewer side effects, their effectiveness still lags behind imported vaccines.
According to official data released by GSK, the protective efficacy of the recombinant herpes zoster vaccine Xin'an Lishi for people aged 50-59 is 96.6%, 97.4% for people aged 60-69, and 91.3% for people aged 70 and above. The latest clinical data shows that Xinan Lishi can provide at least 10 years of protection for adults aged 50 and above. When the reporter visited the community health station, the staff also stated that the protective effect of Xin'an Lishi "can be maintained for at least 10 years, and at most 20 years", and "generally, if it has been used, it is not necessary to use it".
According to the investor relations activity record released by Baike Biotechnology in September, it is recommended to strengthen the vaccination against herpes zoster around 5 years due to the high possibility of recurrence when the human immune system is weakened. At present, the company has not fully released the protective efficacy data of "Ganwei", only stating that the protective efficacy of the vaccine is equivalent to that of products with the same technical route.
Due to the fact that only three herpes zoster vaccines are currently available globally, the "same technology route product" mentioned by Baike Biotechnology refers to the Zostavax herpes zoster vaccine from MSD, which was approved for release in the United States in May 2006. The effectiveness of reference Zostavax in the elderly population aged 50-59 is 69.8%, and the protection rate of "sensory dimension" may also be around 70%, which is about 20 percentage points lower than the protective effect of GSK's recombinant protein vaccine.
In the international market, due to the significant increase in protection rate of Xinan Lishi, it has gradually replaced Zostavax, which has also created a best-selling myth of Xinan Lishi's global sales exceeding 3.6 billion US dollars in 2022. At the grassroots hospital where He Li works, although many vaccinators did not choose Xin'an Lishi due to its high price, some consultants believe that the protection rate of "Ganwei" is not ideal and have given up receiving the herpes zoster vaccine. They said that if spending a thousand yuan on the herpes zoster vaccine cannot guarantee that you won't get it, then the vaccine is not worth it.
Perhaps due to the vast "intermediate market", the number of domestic herpes zoster vaccine entrants is still increasing. At present, several domestic vaccine companies, including Wantai Biotechnology (603392. SH, stock price of 45.43 yuan, market value of 57.615 billion yuan), Watson Biotechnology (300142. SZ, stock price of 22.88 yuan, market value of 36.776 billion yuan), and Green Bamboo Biotechnology (02480. HK, stock price of 35.15 Hong Kong dollars, market value of 7.116 billion Hong Kong dollars), are developing herpes zoster vaccines with different technological routes. Most of these vaccines under research are recombinant herpes zoster vaccines (CHO cells), In theory, it can achieve higher protection efficiency, aiming to benchmark or surpass Xinan Lishi, and attract elderly people who value cost-effectiveness more.
This means that there is not much time left for "Xin'an Lishi" to rewrite the sales myth in the Chinese market. On October 16th, GSK declined a request from the Daily Economic News for an interview on the herpes zoster vaccine.
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