Every reporter: Chen Xing Jinzhe
“What I regret most now is that I haven’t been vaccinated in Hong Kong for a year.” When I heard a reporter from “Daily Business News” interviewing HPV vaccine-related topics, Liu Shuang (a pseudonym) on the other side of the phone spoke clearly. some.
Liu Shuang is born in the 90s. When he was studying in Hong Kong in 2016, the 9-valent HPV vaccine (cervical cancer vaccine) was within reach. The HPV vaccine was advertised on the streets, bus stops, and subway cars. Twins and Joey Yung were all vaccine spokespersons. . The school also organized voluntary registration for HPV vaccination, but Liu Shuang didn’t take it seriously. He returned after graduation and found that a vaccine was hard to find. In the past two years, there has been a spread of “the garage has been purchased, the flowers have been returned, and the price of 9 has been paid”. HPV vaccination has also become one of the conditions.
Recently, Ordos announced the launch of free HPV vaccination for women aged 13-18 in the city. Officials of the Guangdong Provincial Health Commission also publicly stated that they are studying HPV vaccines to be included in the free plan. It is foreseeable that the demand will increase further.
The “Daily Business News” reporter noted that China’s new cases of cervical cancer account for one-third of the world, but the vaccination rate for key populations is less than 1%. How long will the HPV vaccine be crazy under the demand for universal vaccination? If it is included in the government’s immunization plan, what changes will the HPV vaccine market usher in?
9-valent HPV vaccination is as difficult as Moutai, which is 1499 yuan
“In addition to raising cats, HPV vaccination is also one of the labels of contemporary young women.” Liu Shuang said. At that time, it was easy to get HPV vaccination in Hong Kong. Public hospitals or private clinics could be vaccinated, shortly after enrollment. , The school also organized a voluntary HPV vaccination, about 1,000 Hong Kong dollars per injection, a total of three injections, in the school hospital can be vaccinated. All the non-girl classmates around were vaccinated.
At that time, the concept and awareness of HPV vaccination had not yet been popularized in the Mainland, but there were more cases of outbound vaccination of HPV vaccination in some social platforms or developed areas. After consulting with a medical worker, Liu Shuang chose not to vaccinate the HPV vaccine in Hong Kong for the time being after being advised that “it is not necessary and there may be side effects”. But what she didn’t expect was that after the HPV vaccine became popular in the mainland, there would be a situation of “wanting to fight and not being able to fight”.
In 2017, Liu Shuang returned to work in Chengdu. She clearly feels that the HPV vaccine, which has been circulating in Hong Kong for a long time, is not very popular in the Mainland. Until around 2019, whether to receive the HPV vaccine, where to get the vaccine, and how much to pay has become a popular topic among girls. With the deepening of the awareness of cervical cancer and the popularity of HPV vaccines to reduce the risk of cervical cancer, the popularity of HPV vaccines has risen again and again.
According to the data issued by the China Inspection Institute, between 2019 and 2020, HPV vaccines will usher in a big year of growth in the Chinese market. From the time the HPV vaccine was approved to enter the domestic market to the end of 2020, the total number of domestic HPV vaccines issued was approximately 34.89 million.
24-year-old Wang Mian (pseudonym) feels that it is as difficult to grab the HPV vaccine as it is to grab Moutai at 1,499 yuan. “As soon as the community health centers and public hospitals announce the arrival of the goods, I immediately call, and every time I call, I tell me that the appointment is over. I thought of robbing it for a year and not grabbing it.”
The upper age limit of the HPV9-valent vaccine that Wang Mian wants to inject is 26 years old, and she must complete three shots of vaccination before the age of 26. The competition in the city was fierce, and Wang Mian turned his attention back to the county where his hometown was. Her mother worked in a local women’s and children’s hospital, but the frequency of delivery only once every six months and the number of dozens of vaccines each time made it difficult for her to get the vaccine.
Finally, after a “squatting” wait, in the hospital where his mother’s friend worked, Wang Mian reserved a place for vaccination. Finally, at the price of 1388 yuan per injection, three injections of HPV vaccine were completed half a month before the arrival of 26 years old.
It is difficult to find a single shot of HPV vaccine so that vaccinators have to “the eight immortals cross the sea and show their magical powers.” Some of Liu Shuang’s friends passed the entry and exit records within six months and were vaccinated at the little-known International Travel Health Care Center. Among her friends who are engaged in the insurance industry in Hong Kong, some have included HPV vaccines in their business scope, sending messages in the circle of friends that “you can make appointments for HPV vaccines in Hong Kong clinics” from time to time.
If outbound vaccination is considered a shortcut, then the new crown pneumonia epidemic since 2020 has pressed the pause button for outbound vaccination. In other words, the huge demand for HPV vaccination is blocked in China and “cannot get out”.
The huge market demand has ignited the passion of the supply side, and even e-commerce platforms such as Alibaba Health, JD.com, and Pinduoduo have to intervene to play an intermediary role in linking vaccinators and medical institutions.
In the summer of 2020, Pinduoduo added the HPV vaccine to its “Ten Billion Subsidy” program. In the past, most of the sales in this program were high-profile products such as iPhone and SK-II Fairy Water. The addition of the HPV vaccine undoubtedly symbolizes its ranks among the “top-tier” consumer products. Alibaba and JD.com, which have already entered the market before, have also stepped up the promotion of HPV vaccines, adding fire to the HPV vaccine market.
The HPV fire continues to burn. The reporter saw on the aforementioned multiple e-commerce platforms that HPV vaccine appointment services are still on sale in many places across the country. Take the HPV 9-valent vaccine and the place of inoculation in Chengdu as an example. The lowest price of each e-commerce platform is about 6000 yuan / 3 doses, and the high is more than 8000 yuan / 3 doses. After the appointment is successful, you still need to wait for 2 months to half a year. time.
In terms of vaccine selection, the 9-valent HPV vaccine has a more comprehensive coverage and a higher price. It has become the first choice for many young women, but the disadvantage is that the supply is in short supply. The reporter learned that many people have switched to a bivalent vaccine with sufficient supply and significantly lower prices while waiting for the 9-valent vaccine to be fruitless.
HPV vaccine has become a “top-stream” consumer product
Image source: screenshot of an e-commerce platform
Penetration rate of 9-valent HPV vaccine is less than 1%
The WHO has made it clear that if cervical cancer is eliminated by 2030, at least 70% of adult women aged 35 to 45 will be screened for cervical cancer, and at least 90% of 15-year-old girls will be vaccinated against HPV ; However, the coverage rate of the former in China is less than 30%, and the vaccination rate of the latter may be less than 4%.
In the past three years, under the influence of multiple forces such as policy guidance, market education, and platform promotion, HPV vaccines have shown a enthusiasm that is different from medical products, but like consumer products.
According to data from the China Inspection Institute, the number of HPV vaccines issued in my country in 2017 was 1.46 million; in 2018, it was 7.13 million; in 2019, it reached 10.8754 million. In the whole year of 2020, a total of 15.43 million HPV vaccines were issued, of which about 7.22 million and 500,000 were issued in batches of 4 and 9 prices respectively, representing year-on-year increases of 36% and 52% respectively. According to Yuanchuan Business Review, in October 2020, in a round of applications for HPV 9-valent vaccines in Shenzhen, more than 200,000 people competed for more than 8,000 vaccines, and the winning rate was only 4%.
Young people mainly born in the 90s are rushing for “injection”, which has a lot to do with the effectiveness of 9-price HPV, age limit for vaccination and market supply.
As a common malignant tumor in women second only to breast cancer, the attention of cervical cancer remains high all year round. Statistics show that there are approximately 106,000 new cases and approximately 48,000 deaths in my country each year. About half of women of childbearing age in my country have been infected with at least one type of HPV virus. Fortunately, cervical cancer is a preventable cancer. HPV, or human papilloma virus, is the main cause of cervical cancer. The World Health Organization divides the prevention and control measures of women’s cervical cancer into three levels. Primary prevention is HPV vaccination for children aged 9-14, secondary prevention is regular screening after the age of 30, and tertiary prevention is for cancer lesions. Effective treatment.
During the blank period between the birth and introduction of HPV vaccines, a large amount of domestic market demand to be detonated has been accumulated. In 2016, my country officially approved the sale of the bivalent HPV vaccine produced by GlaxoSmithKline.
The “Daily Business News” reporter learned that currently available vaccines include GlaxoSmithKline and Wantai Biological’s bivalent HPV vaccine, Merck’s quadrivalent HPV vaccine and 9-valent HPV vaccine. Among them, Zhifei is the exclusive agent of Merck & Co., Ltd. for the sales of two vaccines in the Chinese market. In April 2020, Cinkening, the first domestically produced bivalent HPV vaccine developed and produced by Wantai Biotech, was officially launched.
Since the “price” of the HPV vaccine refers to the number of virus types that it can target, the 9-valent vaccine is the largest number of HPV viruses that can be targeted among the vaccines on the market. Therefore, although the price of the 9-valent vaccine is the highest, because of the most comprehensive protection, the vaccination fever is the highest, showing a situation of “a single shot is hard to find.”
In 2020, Zhifei Bio’s revenue from agency products reached 13.955 billion yuan, accounting for 91.86% of the revenue structure, an increase of 51.88% year-on-year. Zhifei Bio is the exclusive agent of Merck’s 4- and 9-valent HPV vaccines.
However, the lack of supply has restricted the further growth of sales of these two HPV vaccines. On the one hand, production capacity cannot keep up with the explosive growth of demand, and the production capacity is severely insufficient to supply Merck in more than 70 countries around the world. Public information shows that due to capacity constraints, Merck has repeatedly stopped supplying HPV vaccines in some areas. In the early days when the 9-valent vaccine was launched on the mainland, vaccinators often saw HPV vaccines deployed in Hong Kong and other regions and packaged in traditional Chinese characters. On the other hand, the vaccine market cycle is relatively long, and it takes at least one year from production to the final domestic market.
Therefore, the penetration rate of the 9-valent vaccine is still far from meeting the huge market demand. According to the latest data from the National Bureau of Statistics, there are about 120 million people (16-26 years old) of the appropriate age group for the 9-valent HPV vaccine.and Based on the 3.324 million batches of 9-valent HPV vaccine issued by Zhifei in 2019, the number of people who can receive the vaccine is less than 1% of the total. If the penetration rate of 10% of the core population is calculated at 1,298 yuan per injection and 3 injections per person, the domestic market for 9-valent HPV vaccines will exceed 46.7 billion yuan.
Vaccine concept map image source: phototu.com
How big is the imagination of the bivalent HPV vaccine?
It is difficult to obtain a 9-valent vaccine, which brings opportunities for bivalent vaccines, especially domestic bivalent vaccines.It can be seen from the data that the issuance of GlaxoSmithKline 2 seedlings plummeted by 66% year-on-year in 2020, a negative growth for two consecutive years. This was mainly due to the production contraction caused by the company’s strategic adjustment of its own business. Wantai Bio-Xinkening Bivalent HPV VaccineSince 2020Quickly increase the volume after listing. In the internal competition of the two-price seedling market, Wantai Biological has achieved obvious advantages over the long term.
The rapid increase in the volume of 2 valent vaccines became the profit support of Wantai Biotech last year. The 2020 annual report of Wantai Biotech shows that Xinkening is priced at 329 yuan each, which is much lower than similar imported vaccines. After the listing, nearly 2 million vaccines have been vaccinated. At present, the sales of Xinkening products are mainly in cities below the third tier, accounting for 75% of the shipment volume in 2020, and the coverage of first-tier and second-tier cities is 7% and 18% respectively.
Xiamen Wantai Canghai Biotechnology Co., Ltd., which mainly deals in Wantai Bio’s HPV vaccine business, is currently the most profitable subsidiary of Wantai Bio. In 2020, Xiamen Wantai’s operating income is 980 million yuan, and its net profit is 340 million yuan.
However, the “Daily Economic News” reporter also noticed that Xinkening mainly enjoys the market dividends brought about by the limited production capacity of high-priced vaccines. Although the mismatch of supply and demand has won some time and space for the bivalent vaccine, the HPV vaccine market has The logic of technological substitution has been deeply rooted in the hearts of the people. From a global perspective, the replacement of low-priced vaccines with 9-valent vaccines is a major trend.
However, He Rui (pseudonym), the head of a fund focusing on investment in the pharmaceutical industry, also mentioned that According to global data, about 70% of cervical cancer, nearly 90% of anal cancer, and a large proportion of oropharyngeal cancer, vulvar cancer, vagina cancer and penile cancer are caused by HPV 16 and 18 genotypes. Currently on the market vaccines Both contain these two genotypes , 20% of cervical cancers are caused by HPV 31, 33, 45, 52, 58 genotypes, and only the 9-valent vaccine contains these genotypes. “If the cost is not considered, the 9-valent vaccine is recommended, with more subtypes, which can prevent more cervical cancer. However, the 9-valent vaccine is limited by capacity and age. These factors should also be considered.”
Wantai Biotech stated in its annual report that the company’s 9-valent cervical cancer vaccine is undergoing phase III clinical trials, and it is one of the first domestic 9-valent cervical cancer vaccine companies to enter phase III clinical trials. The annual report shows that the company’s research and development costs for the 9-valent HPV vaccine reached 78.67 million yuan in 2020, a year-on-year increase of 263.92%. According to industry experience, if Wantai Bio’s 9-valent vaccine can be successfully approved for marketing, it will not be until 2024 at the earliest.
According to data from the drug clinical trial registration and information disclosure platform, as of March this year, more than 40 HPV vaccines under development have entered the clinical stage, and 16 have advanced to clinical phase 3.
From an investment point of view, the market favors Wantai Biotech and Zhifei Biotech. Securities companies have issued research reports on many occasions and are optimistic about the market prospects and growth space of HPV. In April 2020, Wantai Biologics will be listed on the main board of the Shanghai Stock Exchange. After rising 44% on the first day of listing, 26 consecutive daily limits were recorded.
In the early days of listing, Wantai Biotech’s share price rose from 8.75 yuan to around 150 yuan in one breath
Zhongtai Securities released a research report that the cumulative penetration rate of HPV vaccines in the country is only 2%. It is expected that the Chinese market is promising, with a market space of more than 43.9 billion yuan, high infection rate (75%), high carcinogenic related rate, and high public attention. (Full market education), these “three highs” determine the high rigid demand for HPV vaccines, and HPV vaccines were approved in China much later than overseas, with a difference of nearly 10 years. China has a vast stock market.
“According to the calculation of the highest vaccination price of each age group (9-14 years old 2 price domestic Wantai 2 injections, 16-26 years old imported 9 price Merck 3 injections, 26-45 years old imported 4 price Merck and 3 injections), we expect domestic The HPV vaccine market space can reach 43.9 billion yuan or more.” Zhongtai Securities pointed out in the research report.
If included in the immunization program, is HPV vaccine still a good business?
Under the WHO’s plan to “conquer cervical cancer”, in recent years, the voice of including the HPV vaccine in the national immunization program has been heard from time to time.
The “Daily Economic News” reporter learned that according to whether it is included in the national immunization program, China’s vaccines are divided into the first type of vaccines provided to citizens free of charge and the second type of vaccines that are voluntarily vaccinated by citizens at their own expense. Currently, HPV vaccines belong to the second category, which are procured by disease control agencies and are usually priced according to market rules. After being included in the national immunization plan, the HPV vaccine will become a first-class vaccine, and the government will cover its funds, bid for procurement, and uniformly distribute it to all vaccination sites.
In February this year, the National Health Commission mentioned in the “Response to Recommendation No. 8996 of the Third Session of the Thirteenth National People’s Congress”, Conduct overall research on the inclusion of HPV vaccination into the national immunization plan. The Health Commission stated that the next step will be to strengthen monitoring of the suspected abnormal response to HPV vaccine vaccination, and at the same time promote pilot projects, encourage regions with conditions to explore more flexible vaccine financing methods and vaccination policies, and gradually promote HPV vaccine free of charge for people of the right age. Vaccination provides experience for the country to formulate relevant policies.
On the 8th of this month, the Guangdong Provincial Health Commission issued a notice stating that it is actively studying the free vaccination of HPV vaccines for women of appropriate age.
Once included in the immunization plan, what changes will the HPV vaccine market usher in? According to market analysis, from the perspective of vaccine prices and age-appropriate populations, the bivalent HPV vaccine is most likely to be included in the immunization program.
The first is the price advantage. Yin Zundong, deputy director of the Immunization Planning Center of the Chinese Center for Disease Control and Prevention, introduced at a recent meeting that, although cost-effectiveness is not the only factor to consider when considering the priority of the second type of vaccine into the immunization plan, it is indeed very important.
Calculated on the basis of the total domestic vaccination costs, the total cost of vaccinating people aged 9 to 14 years of Wantai Bio-Xinkening 2V vaccine is 658 yuan, and the total cost of vaccinating people aged 15 to 45 years is 987 yuan. The total cost of GSK 2 valence vaccination is 1,740 yuan, and the total cost of Merck’s 4 valence and 9 valence vaccination are 2394 yuan and 3894 yuan, respectively. The price advantage of Cinkening is very obvious.
Comparison of 4 HPV vaccines on the market
Image source: Zhongtai Securities
The “Daily Economic News” reporter learned that the Xiamen Municipal Health Commission had previously notified that from 2020 to 2022, domestic school-age girls in the city will be provided with domestically produced bivalent HPV vaccines and voluntary free vaccination will be implemented.
On the other hand, from the perspective of people who are suitable for vaccination, the applicable age of the 9-valent vaccine in my country is 16 to 26 years old, while the 2-valent vaccine is suitable for the 9 to 45 years old age group. From the perspective of expanding the coverage of young people, the bivalent vaccine is also more in line with the purpose of including the HPV vaccine in the immunization program.
For Wantai Biotech, if HPV vaccine is included in the immunization plan, heavy purchases can provide a guarantee for performance growth. But at the same time, how the government’s centralized procurement of HPV vaccines will be priced is still unknown. According to the record of investor research activities announced by Wantai, the relatively low-priced Xinkening gross profit margin is still as high as about 90%.
“Inclusion in the national immunization plan definitely means that Wantai Bio’s HPV vaccine has lost the advantage of free pricing. Judging from the 2020 annual report disclosed by Wantai Bio, the actual purchase of Xinkening last year was 2.07 million, and the winning price range was 329 yuan-344 yuan per bottle. However, because Wantai uses E. coli production technology and the cost is relatively low, Xinkening’s profit level based on the current pricing is also considerable than that of Zhifei Bio without pricing power”, He Rui Said.
He Rui pointed out that in the field of HPV vaccines, under the age of 15 is still a dormant market. Based on the current domestic HPV vaccine application population and census data, it can be estimated that the current domestic HPV vaccine demand population is about 330 million people. Excluding about 10 million people who have been vaccinated, the country’s memory demand gap will still reach 320 million. people. Combining with the price level of domestically produced bivalent HPV vaccines, even if the stock vaccination rate is 50% and the per capita vaccination cost is roughly estimated at 500 yuan, once it is included in the immunization plan, the stock space of my country’s HPV vaccine market is still huge.
He RuiIt is also emphasized that it needs to be clarified that being included in the immunization plan is not equal to purchasing in quantity, and purchasing in quantity is mainly based on the pressure of medical insurance funds, so it is necessary to control the price of the varieties included in medical insurance. However, the funding of the immunization program mainly comes from national and local financial funds, and my country attaches great importance to vaccine safety, and it is unlikely that a substantial price reduction will occur. At present, only Fujian Province has included Wantai’s bivalent HPV vaccine Xinkening into the provincial medical insurance, but the winning bid is still between 329 yuan and 344 yuan per tube, and there is no obvious price reduction.
If the HPV vaccine is included in the immunization program, will Zhifei Bio, which acts as the agent of the 9-valent vaccine, be affected? In 2020, Zhifei’s net profit increased by 39.51% year-on-year to 3.301 billion yuan, and more than 90% of the company’s revenue comes from Merck’s vaccine agency revenue.
Many people in the pharmaceutical industry said that the inclusion of HPV vaccines in the immunization plan in the short term is still in the design and imagination stage. Vaccine expert Tao Lina pointed out to reporters that whether the second-class vaccine will be included in the national immunization program is not a temporary matter. Consideration should be given to multiple factors such as whether the health damage caused by the disease and the burden of medical expenses are serious, the safety and effectiveness of the vaccine itself, and whether the market can provide sufficient production capacity guarantee.
“In the next 10 or even 20 years, the HPV vaccine is unlikely to be included in medical insurance or the national immunization plan.” Taolina said that in terms of importance, the HPV vaccine is not yet ranked. At least two more urgent vaccines (Haemophilus influenzae type b vaccine and 13-valent pneumonia vaccine) are still waiting in line.
It can be foreseen that in the near future, with the gradual approval of a large number of HPV vaccines under development, the current competition pattern of only four products will be broken, and a new round of competition will inevitably come. He Rui believes that whether Wantai Biotech’s 9-valent vaccine can challenge the dominance of Merck’s 9-valent vaccine industry depends on production capacity. In the future, Wantai Biotech’s capital expenditure for HPV vaccines will be very important.
Reporter’s notes丨The incidence of cervical cancer is getting younger, and vaccination needs to be increased
In China, about 106,000 women are diagnosed with cervical cancer each year, and 48,000 women die from the disease. A survey published by the Chinese Journal of Cancer in 2017 showed that after 2001, the incidence and mortality of cervical cancer among Chinese urban and rural residents increased significantly, and the incidence tended to be younger. Therefore, the prevention and treatment of cervical cancer for women of middle and low age in China must be paid enough attention.
Increasing vaccination is one of the effective ways to prevent and treat cervical cancer.However, the penetration rate of HPV vaccine in my country has been low for a long time, so it is includedNational Immunization Program, Allowing more women of the right age to vaccinate for free will help solve the inequality caused by high-priced vaccines.
Reporter: Chen Xing Jinzhe
Editor: Tang Hui
Video Editor: Zhu Xingyun
Vision: Zou Li
typesetting:Tang Hui Ma Yuan
Daily economic news
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