Big Changes in Global Health & 2024 Pharma Financials are here!
Fiction, Reality & Countries Catching Strays
Dear Friend of Global Health Conversations,
A new fortnight is upon us. We are a month and a half into 2025 and the past weeks have injected a degree of new uncertainty in this space.
Questions around global public health funding and unity lie at the forefront. This fortnight the WHO Executive Board meetings concluded and WHO is exploring new financial strategies, including establishing a $50 billion USD endowment, to address funding gaps exacerbated by the U.S. aid suspension and withdrawal. In tandem, whatever was left of USAID seems set to be dismantled - with aid stations globally closing down instantly and many civil servants left uncertain about their future employment. Beyond this - countless patients and persons in need of the crucial support that has hitherto been funded in full or in part by the organisation face an uncertain future.
But I would like to underscore that none of this is particularly a surprise. The pace - perhaps. And I’ll admit I didn’t expect to see the world’s richest man answering questions in the oval office, toddler in tow. But the Heritage Foundation’s Project 2025 Roadmap for the next U.S Republican presidency spelled all of this out. Last summer I made a deep dive podcast episode on the 902 page document full of spoilers as to what to expect next.
On a lighter note, I started the fortnight in 30 degree centigrade, sunny Johannesburg. I went painting, worked by the pool and met a friend for brunch. Being home felt surprisingly carefree - even at a time when a lot is going on politically. Leaving, the ‘real world’ hit me almost instantly. On my layover in Doha, I fell asleep over my oat milk cappuccino. I woke up of my own accord and my ego was left largely unscathed. My next moment of respite was last weekend - a lovely time in Verbier with a good friend for ski, relaxation and raclette. It has been nice taking time for hobbies more recently, so I spent this Friday night painting pottery with a girlfriend. I appreciated and needed these little breaks. Doing the little things we love makes life feel more full.
As we speak, wars are waging. In Congo, a prison break led to over 150 women being raped and burned to death. Once again, we see women’s lives and bodies being used as weapons of war in this heartbreaking event. Across the world, people are suffering. Meanwhile, we watched the multidimensional artistry of Kendrick’s Super Bowl halftime show. Unsurprisingly, Drake is still catching strays on the entertainment stage. But on the geopolitical stage, countries like India and South Africa are catching strays in their own way. I found myself in an elevator in Geneva this week next to diplomats on their way to the Security Conference in Munich. (the EU ultimately caught some strays there, too, at the hands of U.S. vice president) Upon learning I am a South African, one remarked “Oh like Elon Musk”. My little heart sunk. Chatting with strangers is always good fun and an interesting way to take the cultural temperature. (Note: ‘catching strays’ just means subtly ‘becoming collateral damage’)
Finally, this is usually the time of year that I break down the 2024 and Q4 Pharma financials. And I wish I could’ve focussed solely on this today in a deep-dive. You’ll find a summary in the FiRs alongside some high level mentions of other pressing, current issues that I could not exclude. As you might expect, the GLP-1 market is booming, with Eli Lilly making further gains particularly with Mounjaro, as expected, after Q2&Q3. But Novo Nordisk still leads the pack in the skinny wars.
As always, I’m contactable in response to this e-mail and looking for a few more experts for my 2025 Experts Podcast series, starting in May. For some calm and levity, here is a hip remix of one of my favourite Nocturnes of Chopin - So smooth, so listenable. And if you like it, you’ll like this Beethoven one even more. Until next fortnight, Friend.
Stay well.
Christiana
Global Health & Pharma Headlines
Robert F. Kennedy Jr. Confirmed as Health Secretary Amid Controversy (Health Policy Watch; Reuters)
RFK was confirmed as Health Secretary in a 52-48 Senate vote despite concerns over his vaccine skepticism. He plans to restructure the CDC's vaccine advisory committee, potentially influencing vaccine policy. While pledging to address chronic diseases, his stance raises concerns about public health and medical research funding.
US Federal Judge Halts USAID Work Stoppage; CDC Reports Silent Avian Flu Spread
A federal judge issued a temporary restraining order blocking the Trump administration’s freeze on USAID activities, following a lawsuit from humanitarian and business groups. The ruling prevents disruptions to billions in foreign aid, but experts warn of lasting damage, with halted health programs, layoffs, and stalled food aid shipments. USAID, responsible for $8.5 billion in global health funding, plays a key role in fighting diseases like HIV, tuberculosis, and malaria. The freeze disrupted pharmaceutical donations and frontline healthcare in vulnerable regions. Meanwhile, the CDC reported that veterinarians working with dairy cattle were unknowingly infected with H5N1 avian flu, signalling silent spread. Incomplete federal tracking has left gaps in monitoring, as some states opt out of testing dairy herds. The outbreak, affecting 157 million poultry since 2022, has driven egg prices to a 50-year high. Public health experts stress the need for stronger disease surveillance and intervention to protect farm workers and prevent wider transmission, warning of potential long-term consequences for food security and public health. But given reduced powers, what can the CDC do now? (Note: The CDC has stopped sharing data with healthcare workers and agencies since the new U.S. administration took office - not good for surveillance and H5N1.)
GAVI: Africa Advances Towards Greater Vaccine Independence - Landmark Deals
Two major agreements mark a turning point in Africa’s vaccine manufacturing capabilities. A new mRNA production facility in Egypt aims to produce 100 million doses annually, while a cross-continental partnership will expand mRNA technology. Backed by Gavi’s $1.2 billion investment, these initiatives boost Africa’s health security and vaccine self-sufficiency.
Global Initiatives Intensify Fight Against Antimicrobial Resistance
AMR is a critical global health threat, now recognized as the third-leading cause of death worldwide. In response, several major initiatives have been launched to combat this escalating crisis. The Novo Nordisk Foundation, in partnership with the Bill & Melinda Gates Foundation and Wellcome, has introduced the Gram-Negative Antibiotic Discovery Innovator (Gr-ADI). This $50 million consortium aims to accelerate the discovery of new antibiotics targeting gram-negative bacteria, which are significant contributors to AMR-related fatalities. By fostering collaboration among funders, research institutions, and industry partners, Gr-ADI seeks to drive innovation in antibiotic development.
Independently and in parallel, CARB-X has awarded $3 million to AstraDx. This funding supports the development of a rapid diagnostic tool designed to detect neonatal sepsis—a severe bloodstream infection in newborns. Utilizing advanced digital imaging and signal processing, AstraDx's technology aims to identify pathogens and determine antimicrobial susceptibility directly from whole blood samples within four hours, enabling timely and targeted treatment. (Sources: Novo Nordisk foundation; CARB-X Alliance)
CEPI Funds Spray-Dried RNA Vaccine for Easier Global Access
CEPI awarded $5 million to Ethris to develop spray-dried RNA vaccines, eliminating cold-chain storage needs and enabling nasal delivery. This innovation enhances vaccine access in lower resourced regions and could reduce virus transmission by inducing mucosal immunity. The technology aims to revolutionize global vaccine distribution with cost-effective, thermostable solutions.
RSV Vaccine Sales Slump & Mixed Pharma Earnings in 2024
Q4 2024 saw mixed financial performances across major pharmaceutical players. Notably, and not mentioned in my Q4 Pharma Finacials below - RSV vaccine sales declined sharply. Pfizer’s RSV vaccine, Abrysvo, dropped 62% in Q4 to $198 million, contributing to weaker vaccine earnings despite a 21% revenue increase to $17.8 billion, driven by Eliquis and Vyndaqel. Similarly, GSK’s Arexvy suffered a 69% quarterly decline to $198 million, reflecting overall weaker vaccine sales.
Merck’s Gardasil HPV vaccine saw a 2% annual drop, impacted by a suspension of shipments to China, despite full-year revenues rising 10% to $64.2 billion. Meanwhile, Roche, Sanofi, and Novartis posted stable growth, with Roche’s Ocrevus and Hemlibra driving 9% quarterly revenue growth to $17.2 billion. Sanofi’s Beyfortus reached blockbuster status in its first year with $1.8 billion in sales.
REPORTS: Worth reading: Linksbridge published their Global Vaccine Market Model and Impact Global Health release their report on why Global health R&D makes a strong investment case for Team Europe
(Image Source: Time)
(Image Source: ABC News)
2024 and Q4 Pharma Financial Disclosures: Growth Driven by GLP-1 Products
We witnessed interesting, significant financial movements in 2024 across pharma, really building upon what we saw in late 2023, too. Notable revenue growth from GLP-1 products, oncology, and obesity treatments. I have written extensively on this and some links to past relevant newsletters and podcasts will be at the bottom of this segment. :)
Companies like Eli Lilly and Novo Nordisk led the sector with substantial increases in diabetes and obesity drug sales. Meanwhile, AstraZeneca capitalized on strong oncology performance and Gilead & BMS faced policy-related headwinds.
Company Performance Overview
AstraZeneca
AstraZeneca posted $54.1 billion in full-year sales, marking a 21% increase in 2024. Oncology lead revenue at $22.4 billion (up 24%). RSV monoclonal antibody Beyfortus saw its sales more than double to $722 million. Q4 revenue rose 25% to $14.9 billion. The company emphasized growth in emerging markets and projected high single-digit percentage revenue growth for 2025. Many years ago, on my former blog probably back in 2018, I wrote about how focussing more on ‘emerging markets’ could create incredible opportunity for big biotech and pharma. AZ is a good example of that this past year and I imagine that those that follow their lead will see positive financial increases, too. Read their report here
Bristol-Myers Squibb (BMS)
BMS reported $48.3 billion in full-year sales, a 9% rise. Legacy products such as Eliquis and Revlimid contributed significantly, while the company’s growth portfolio, including Reblozyl (up 77%) and Opdivo (up 9%), showed strong momentum. Q4 sales improved by 9% to $12.3 billion. However, BMS projected a revenue dip to $45.5 billion in 2025, attributing this to various portfolio shifts. (Their report) Notably, I didn’t find significant updates on ASPIRE - their 2024 program to improve access to innovative treatments in LMICs.
Eli Lilly
Lilly’s full-year revenue surged by 32% to $45 billion, fueled by its blockbuster GLP-1 products. This is huge. But not a shocker. Their diabetes drug Mounjaro more than doubled sales to $11.5 billion, while weight-loss treatment Zepbound generated $4.9 billion in its first full year. Oncology drug Verzenio contributed significantly, with a 37% increase to $5.3 billion. Q4 sales soared 45% to $13.5 billion. Lilly expects 2025 revenue in the $58 billion–$61 billion range. Here’s their report.
My prediction based on the past year and a half of monitoring is that Lilly will overtake Novo Nordisk in the next 24 months - I predict that theirs could turn out to be the ‘best-in-class’ but who knows - I haven’t been watching as closely as I usually would. And my prediction might be wrong. But I doubt it. What we know about Zepbound and Mounjaro is that their mode of action may make them very successful in the long-run. Nevertheless, there are many factors at play - and regardless of who ‘wins’ - the GLP-1 space has been a blue ocean in the early 2020s despite the fact that Novo’s first has been on the market since 2017. These two got in early. And are reaping the benefits.
Gilead
Gilead posted a 6% revenue increase, reaching $28.8 billion. HIV treatments, led by Biktarvy ($13.4 billion, up 13%), were a key growth driver. However, the company forecasted lower 2025 revenue ($28.2 billion–$28.6 billion) due to changes in U.S. Medicare policy, impacting pricing and reimbursement.
Novo Nordisk
A little more detail here as this has been the big player of the past 18 months. Even when their growth was surpassed by Eli Lilly, their numbers were not. At least until now, the 2024 financial reports. (Read their annual report here.)
Novo Nordisk demonstrated exceptional growth. Full-year revenue surged 26% in constant exchange rates (CER) to DKK 290.4 billion ($41.9 billion). This was driven by continued demand for their GLP-1-based diabetes and obesity treatments, which now make up the majority of sales. The company solidified its global leadership in the GLP-1 market with a 55.1% value market share, up from 54.8% in 2023.
GLP-1 Diabetes Portfolio
Ozempic: Sales surged 26% to DKK 120.3 billion ($17.4 billion), maintaining its position as the top-selling diabetes drug globally. However, supply constraints persisted.
Rybelsus® (oral GLP-1): Revenue rose 24% to DKK 23.3 billion ($3.4 billion).
Victoza® (older GLP-1 product): Sales declined by 37%, as the market shifted to newer, more effective treatments.
Obesity Treatments
Wegovy: Sales climbed 56% to DKK 65.1 billion ($9.4 billion), securing a 70.4% global volume market share. Novo Nordisk emphasized continued strong cardiovascular outcomes, further reinforcing the drug's medical necessity.
The company expanded Wegovy® to 15 markets worldwide and invested significantly in supply chain enhancements to address high demand.
Financial Outlook for 2025
Novo Nordisk expects 16%–24% sales growth at CER, driven by further GLP-1 expansion.
Operating profit growth is projected at 19%–27%, with heavy investments in manufacturing and research to sustain supply chain stability.
$11.7 billion was allocated for manufacturing expansion, including the acquisition of three Catalent sites to increase production capacity.
Novo Nordisk’s stronghold in GLP-1 and obesity treatments, coupled with increasing healthcare acceptance of these drugs, positions the company for continued market dominance in 2025 and beyond.
When we get to April/May and start to see the Q1 2025 disclosures - I have no doubt that it’ll still be Eli Lilly and Novo at the top of the pack - but there are emerging players, and potential currency fluctuations to consider. (Worth mentioning here that Denmark has indeed caught some U.S strays over Greenland, but again, let’s see how this transpires) Let’s watch and see!
Some of my past Global Health Conversations resources on this topic:
Newsletters:
2024 Q1 Pharma Financials Published Across the sector - Guess who's in the lead? - May 2024
End of summer, Q2 Pharma disclosures, Infectious diseases & newly elected WHO AFRO RD - September 2024
The real toll of weight-loss injections: Semaglutides, the economy & you - October 2024
2024 is here! Roundup of the past year's wins! - January 2024
And the relevant podcast episodes below:
Behind the scenes:
Little bit of this and that, here & there.
Recent Episodes you might have missed!
Episode 19: Drug Licensing and the Pandemic Accord
In this episode, we look at Colombia's recent move in issuing its first compulsory license. The country challenged ViiV Healthcare's monopoly on their patented drug, dolutegravir, an HIV therapeutic, in an attempt to open doors for affordable generic versions and thus improve accessibility & affordability.
Special: Personal Notes on Intersectional Feminism from The Mountains ft. Vulvarina
In January of 2024, Loredana Marta of Vulvarina asked me to collaborate with her on a piece on Intersectional Feminism entitled: xxxiii: up in the mountains. And we happened to record it too. Loredana and I did a previous podcast episode together on Women's Health that was particularly interesting and enlightening. More recently, we also wrote a joint piece on Global Health Conversations about Alzheimer's treatment in the uk. As Loredana and I narrate the piece, you will learn more about me, Christiana. And something that is important to me: Women's rights. Particularly in healthcare.
Episode 22: Project 2025’s Impact on Healthcare, Women's Health and Regulation
In this fortnight's episode we explore and discuss Project 2025's proposed policies, which could dramatically impact health, women’s health and safety. The plan includes lifetime caps on Medicaid, reducing coverage for millions, and increased out-of-pocket costs for Medicare recipients. It threatens reproductive rights and seeks to curtail the CDC's public health role, potentially weakening responses to health crises. Basically, an anti-epidemic preparedness vision and plan.
Episode 24: What is the Pandemic Accord, really?
This episode takes a high level overview of the Pandemic Accord, its purpose and a walkthrough of some of its most pertinent Articles. A walkthrough. The Pandemic Accord is a proposed global agreement aimed at strengthening pandemic prevention, preparedness, and response. Emerging in the aftermath of COVID-19, the accord aims to address gaps in international coordination, surveillance, and equitable access to medical countermeasures, globally.