End of summer, Q2 Pharma disclosures, Infectious diseases & newly elected WHO AFRO RD

Very demure, very mindful round-up after brat summer 🍏

Sep 01, 2024

Dear Friend of Global Health Conversations,

Happy new month! As the beginning of September ushers in the expiration of out-of-office replies and a return to ‘business as usual’, I, as a South African, still think of September 1st as ‘Spring day’. And occasionally revert to calling the Christmas break the ‘Summer holidays’.

I have continued pursuing my hobbies of literature and art being encouraged to read Proust at the refreshing literary festival that I attended in Gstaad this fortnight with my clever bestie. Proust’s father is credited with wiping out Cholera in France. This fortnight, Friend, sixty cases of cholera are reported in Sudan daily. The Economist has also shone a spotlight on the plight of the country.

Over our long weekend, we dined at the Alpina with authors and fellow book nerds, lots of spa and Swiss food at some favourite spots, and a full day hiking through Saanen and Rougemont. We had the utterly frivolous time that we deserved. As summer draws to a close I am rested and back to normal life. My writing has been a bit more frivolous over the summer, with more subject area deep dives and chat. I am returning to pertinent headlines and summaries in the FiRs. Nevertheless, I have one last deep dive focussed on NHS cancer care planned for later this month in collaboration with Loredana Marta of Vulvarina. And I expect that I will return to fondue and deep dives for a fortnight or two during the December ‘Summer holidays’.

When we last spoke I was in Brazzaville. I relished in the best of Congolese cuisine with Mum and our friends. Flouting all conventions (including my own advice), I played fast and loose, throwing caution to the wind and foregoing malaria prevention. I was happy. And in no mood for Malarone-induced hallucinations. My disclosure elicited a raised eyebrow from my Mum who recounted a story from her field research days in multi-drug resistant malaria. As the story goes, she herself contracted the aforementioned resistant strain that she was treating and studying; surviving due to the careful and complex combination of therapeutics that she was administered. For my part, I have been feeling phantom itches ever since.

The recommencement of the INB Negotiations is soon upon us, following the 74th Session of the WHO AFRO Regional Committee meeting in Brazzaville, wherein the incoming Regional Director, Dr Faustine Ndugulile was elected. The day after my last Mpox update brought this Bhekisisa update about which clades are circulating where.

Finally, I have finished some books that I started earlier this year. There's nothing like carrying a Bible-width work of Russian literature in one’s hand luggage, or under the arm like a swollen baguette, to make one feel learned and intellectual:

Tolstoy’s Anna Karenina (tragic, wistful, confusing), James O’Brien’s ‘How they broke Britain’ - particularly relevant but could annoy you terribly if you don’t lean a little left. And I started Richard Osman’s ‘Thursday Murder Club’ but as much as I love a good mystery novel - it simply didn’t stick. My most recent purchase from the book festival is The Paris Trilogy. The author is clever and charming and signed my copy. Unfortunately, I simply cannot make out what she wrote. So I’ve included it in the postcard Behind the Scenes. Do write to me in response to this e-mail if you can read what follows ‘Pour Christiana’ (in French.)

Hoping you make the most of the sunshine,

Christiana

1. Q2 2024 Pharma Financials are here.

In late July, the Q2 Pharma financial disclosures and reports started rolling in. Starting with J&J & Abbott and working through August for Lilly & Gilead. I have finally read the reports. And (having tried myself and failed - ultimately working through the Q2 2024 earnings calls of the top 20 pharma and biotechs and Linksbridge summaries) I can assure you that you won’t find a brief and comprehensive summary of these elsewhere. :) Each heading has a link to the report or announcement summary and other notable reports on the details are linked within.

The companies that did best this quarter were largely those involved in the Diabetes and weight management industry. Something I discuss in the Profitability of Skinny & Semaglutides podcast episode. I ask myself: Through PPPs and co-ordinated global health financing, is there a world in which we might see drugs for infectious diseases fuelling pharma and biotech growth, and thus incentivising further, sustained R&D in these areas, a bit like we saw in 2021-2022? The only companies with significant decreases this quarter are Moderna & BioNtech - for reasons we know. Another company announcing a decrease was Korean LG Chem, not listed here.

1. Lilly - 36% UP!

No company grew more than Lilly - both in diabetes & weight loss and oncology. Lilly reported a 36% increase in quarterly revenue, totalling $11.3 billion. The growth was fueled by diabetes drug Mounjaro and weight-loss injection Zepbound, which generated $4.2 billion in sales. (See my Q1 financials edition for background on these) Other significant contributors included breast cancer drug Verzenio, which saw a 44% rise to $1.3 billion, and insulin injectable Humalog, which grew 43% to $631.6 million. With supply chain issues for tirzepatide products easing, Lilly expects 2024 revenue around $46 billion, reflecting a $3 billion increase.

2. AbbVie - 59.2% Growth (Rinvoq)

AbbVie reported overall revenue growth of 4.3%, reaching $14.462 billion. However, its immunology portfolio showed significant performance, with Rinvoq sales increasing by 59.2% to $1.430 billion and Skyrizi by 45.6% to $2.727 billion. Oncology also performed well, with a 12.2% increase to $1.634 billion. Neuroscience products, including Botox Therapeutic, saw a 15.2% rise to $2.162 billion, while the aesthetics portfolio grew 2.8%, driven by Botox Cosmetic. Despite these gains, Humira revenues dropped by 28.9% due to biosimilar competition. (Further details: here)

3. Novo Nordisk - 25% Growth

Novo Nordisk posted a 25% increase in sales, reaching $10 billion for the quarter. This growth was driven by their top-selling GLP-1 products, diabetes drug Ozempic and weight-loss drug Wegovy. Despite manufacturing constraints and increased competition (discussed in a previous edition), their 2024 outlook raised to about 25%.

4. AstraZeneca - 17% Growth

AstraZeneca's revenue surged 17% to $12.9 billion, largely due to its cancer franchise, which saw a 19% increase, bringing in $5.3 billion. The cardiovascular, renal, and metabolism segment also grew, generating $3.2 billion, a 22% improvement. AstraZeneca adjusted its 2024 revenue forecast, now expecting mid-teens growth.

5. Sanofi - 10.2% Growth

Sanofi reported a 10.2% rise in quarterly sales to $11.6 billion. The Dupixent franchise, partnered with Regeneron, saw a 29% increase to $3.3 billion. Sanofi's positive performance led to an upgraded full-year profit outlook, now projecting stable earnings per share.

6. Abbott - 9.3% Growth

Abbott’s sales grew 9.3% totalling $10.4 billion. Medical devices were the key growth driver, with FreeStyle Libre continuous glucose monitor sales rising 18.4% to $1.6 billion. The company raised its 2024 sales growth guidance to almost 10%.

7. Novartis - 9% Growth (very readable report!)

Novartis reported a 9% increase in revenue, reaching $12.5 billion. Significant contributors included chronic heart failure treatment Entresto, with a 28% increase to $1.9 billion, autoimmune drug Cosentyx up 22% to $1.5 billion, and MS treatment Kesimpta, up 65% to $799 million.

8. Roche - 9% Growth

Roche’s group sales rose 9% to $17.4 billion, with pharma sales climbing to $13.2 billion and diagnostics sales up 8% to $4.2 billion. Key performers were their MS treatment and hemophilia drug Hemlibra, while eye disease treatment Vabysmo saw an impressive 81% year-on-year growth, earning $1.1 billion.

9. GlaxoSmithKline - 13% Growth

London’s GSK's revenues grew 13% to $9.9 billion, largely due to a 22% rise in HIV products, oncology, immuno-inflammatory and respiratory drugs. 2024 outlook revised to 7-9% full-year sales growth. (Read more here - and even listen if you dare)

10. Merck - 11% Growth

Merck saw an 11% increase in sales, totaling $16 billion. This was driven by the blockbuster cancer drug Keytruda, with a 21% growth to $7.3 billion, and the Gardasil HPV vaccine franchise, which brought in $2.5 billion (up 4%). Despite challenges in China, Merck raised its 2024 sales outlook to around $64 billion.

11. Bristol Myers Squibb - 11% Growth

BMS enjoyed an 11% increase in sales, reaching $12.2 billion. The growth was fueled by new products like anemia treatment Reblozyl, heart drug Camzyos, and the blood thinner Eliquis, which brought in $3.4 billion. BMS slightly increased its 2024 revenue guidance, projecting low single-digit growth.

12. Johnson & Johnson (J&J) - 6.5% Growth

J&J's quarterly sales rose 6.5% to $22.4 billion, driven by a 19% increase in oncology sales, totaling $5.1 billion. Infectious disease sales dropped 13% due to COVID vaccine proceeds. J&J raised its 2024 operational sales guidance to $89-odd billion. (Very good PDF version here with pretty graphs & charts)

13. Gilead - 5% Growth

Gilead posted a 5% increase in revenue to $7 billion, with HIV regimen Biktarvy up 8% to $3.2 billion, liver disease portfolio improving 17% to $832 million, and oncology rising 15% to $841 million. The company confirmed its 2024 sales guidance of $27 odd billion.

14. Bayer - 4.5% Growth

Bayer's quarterly revenue climbed 3.1% to $11.9 billion, with its pharmaceuticals unit delivering a 4.5% increase to $4.9 billion. Growth was driven by cancer drug Nubeqa (up 90%) and diabetes treatment Kerendia (up 72.9%). Bayer maintained its full-year 2024 outlook of a net sales change between -1% and +3%.

15. Viatris - 2% Growth

Viatris saw a 2% rise in sales to $3.8 billion on a divestiture-adjusted basis. The growth was driven by asthma drug Breyna and ADHD generic lisdexamfetamine. Viatris projects 2024 revenue growth of about 2%, expecting $500 million-$600 million in new product revenue.

16. Pfizer - 2% Growth

Pfizer reported a 2% increase in revenue, bringing in $13.3 billion. Key drivers included Covid antiviral Paxlovid and strong oncology product sales attributed to Pfizer’s Seagen acquisition. Pfizer raised its 2024 revenue guidance to $59.5 billion-$62.5 billion.

17. Merck KGaA - 1.7% Growth

Merck KGaA (Merck groups largest company and the one used in the United States and Canada) returned to organic sales growth with a 1.7% increase, totaling $5.9 billion. Growth was driven by its healthcare unit, which saw a 5.3% rise to $2.3 billion. The company raised its 2024 guidance to 2-5% growth. (Read more about their recent acquisition here)

18. SK Bioscience - 1.1% Growth

SK Bioscience reported a 1.1% rise to $19.5 million. They highlight their partnership with Sanofi and plans for global sales expansion for its typhoid conjugate.

19. BioNTech - 23.3% Decrease

BioNTech experienced a 23.3% decline in revenue to $140.4 million, driven by decreased COVID-19 vaccine demand. BioNTech focused on shifting to cancer treatments, maintaining its 2024 revenue outlook of $2.7 - $3.3 billion.

20. Moderna - 30% Decrease

Moderna reported a 30% drop in revenue to $241 million. The decline was attributed to lower COVID-19 vaccine sales, increased competition in the respiratory vaccine market, and the potential for deferred international revenue. Moderna lowered its 2024 product sales outlook to $3 - $3.5 billion.

All this is upon the backdrop of the US Republican party’s new plan - Project 2025. Which, among other things, promises to roll back the ability for Medicare to negotiate drug prices. I break down the health implications of the 900 page document in the Project 2025 summary podcast episode. Some of the companies that released their data slightly later, in August, did so as Medicare pricing negotiations with the U.S. government drew to a close (this link worth reading indeed). These included BMS, Merck and Pfizer whose full-year 2024 revenue outlooks were consequently raised.

2. Update on Mpox - 01/09/2024

If you have been watching this space carefully where drug development is concerned, you will have seen that the International Pandemic Preparedness Secretariat, as part of their 100 Days Mission, have been providing fortnightly updates on the progress in R&D for Diagnostics, Therapeutics and Vaccines. (DTVs). Here is their Day 15 summary of progress and update.

There is some further background to my update this evening in my last two Mpox updates: 18/08/2024 (audio version of this here) and 21/07/2024.

In response to the outbreak, the WHO and Africa CDC have developed a Strategic Preparedness and Response Plan (SPRP) that includes tailored country coordination based on risk profile, enhanced surveillance, and vaccination strategies aimed at interrupting transmission chains. The plan emphasizes a phased approach to vaccination, prioritizing healthcare workers and high-risk populations in affected areas.

WHO has also established a global Access and Allocation Mechanism (AAM) to ensure equitable distribution of medical countermeasures. It aims to align global demand with supply, utilizing a transparent, needs-based allocation framework. However, the implementation of these strategies is contingent on the timely arrival and deployment of vaccines and other resources.

African countries have faced significant delays in receiving vaccines from international donors. WHO AFRO, along with the Africa CDC, have been coordinating efforts to manage the outbreak. Several countries and organizations have pledged vaccine doses. However, as of this fortnight, none have been delivered. Last fortnight we discussed Bavarian Nordic’s FDA-approved JYNNEOS vaccine. Additionally, Japan has pledged 3.5 million doses of its LC16m8 vaccine, notably approved for children; and the European Union has ordered 175,000 doses of the MVA-BN (JYNNEOS) vaccine from Bavarian Nordic.

Clade 1b was first identified in late 2023 and has since spread through human-to-human transmission. This clade, genetically distinct from clade II, has now been detected in Burundi, Uganda, Rwanda, Kenya, Sweden, and Thailand. The DRC has reported the highest number of confirmed Mpox cases on record - almost 18 000 suspected cases. See the Bhekisisa article mentioned above for more detail on the clade distribution. Below I have included a graph from WHO, Friday 30th August 2024 for an idea of what the distribution of clades is currently believed to be.

(Source: WHO)

(Read more here, here, here & here)

Pharma & Global Health Headlines

Behind the scenes:

Deciphering challenge: top right! (I think I know now, but I don’t want to influence any potentially better guesses) ☺️

Recent Episodes: In case you missed them! 💃🏾

Episode 23: Mpox Update 18/08/2024

On August 14, 2024, WHO DG Dr Tedros Adhanom Ghebreyesus declared the Mpox outbreak a PHEIC, the second such declaration in two years. The Africa CDC declared Mpox a Public Health Emergency of Continental Security a day earlier. The current outbreak, driven by the more severe Mpox clade Ib, first identified in South Kivu, DRC, has rapidly spread across Central, East Africa and even as far as South Africa, with the first European case detected in Sweden.

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.