Seasonal respiratory viruses re-emerge post-Covid

Recent reports from the UK and USA suggest a severe cold & flu season may be in store during winter 2021-22. With lockdown restrictions, increased hygiene measures and social distancing in force for over a year to reduce the risk of contracting Covid-19, the incidence of common respiratory viruses has been very low. However, with the lack of exposure to illnesses (especially among young children), many of us have not built up antibodies and as a result our immune systems may have been inadvertently weakened.

This has prompted warnings of a potential surge in influenza as measures are lifted; data released this week by the UK’s Office of National Statistics show that in the week ending 11th June, 84 death certificates issued in England & Wales mentioned Covid, while 1,163 deaths involving flu and pneumonia were registered. Additionally, a recent study by the Houston Methodist Research Institute shows the rapid re-emergence of seasonal respiratory viruses following the relaxing of Covid-19 restrictions in Texas in March 2021.

This trend was also reported in a recent article in STAT, in which Trevor Bedford, a computational biologist who monitors which viruses are circulating via the Nextstrain service, was quoted as saying: “Just in the last month [May 2021] or so we’ve started to pick up small amounts of seasonal coronavirus, RSV, metapneumovirus, etc. It’s the first time since April 2020 where we’re starting to see other things circulating.”

There is particular concern that by the time universities, colleges, schools and nurseries reopen this autumn across the northern hemisphere, there will be perfect conditions for high transmission of seasonal respiratory viruses, particularly RSV (respiratory syncytial virus). Andrew Pavia, Chief of the Division of Pediatric Infectious Diseases at the University of Utah, warned: “There will be two years’ worth of kids who are naïve to RSV, instead of one birth cohort. That could be fertile ground for a big RSV year.”

Epidemiologist Professor Neil Ferguson of Imperial College, a member of the UK Government’s Scientific Advisory Group for Emergencies, said in a BBC interview that we must be prepared for a potentially “quite significant” flu epidemic and increased hospitalisations this winter. To help save National Health Service resources, researchers are investigating whether seasonal flu jabs and a Covid vaccine can be administered at the same time.

We are pleased to announce that our Eye Health report is now published and available to order! You can review case studies of key brands, NPD activity and much more. Plus, ensure you have registered for the free webinar on 30 June here to discuss the topline findings. For more information, please contact melissa.lee@NicholasHall.com.

Rx-to-OTC switch drivers

Allergy and sexual health are two areas of the global CHC market that continue to expand in sales thanks to Rx to non-prescription switch activity in various markets. In Japan, the Ministry of Health, Labour & Welfare’s Evaluation (MHLW) Review Conference will discuss the potential Rx-to-OTC switch of emergency hormonal contraceptives at a meeting this week.

According to CHC Insight Asia-Pacific Senior Editor, Nicola Allan: “In June 2019, an MHLW steering committee permitted pharmacists to dispense EHCs during a face-to-face transaction after the consumer has had an online consultation with a doctor. Previously, the patient had to see a doctor face-to-face to obtain a prescription to give to the pharmacist. More than 9,000 pharmacists have undertaken training that allows them to participate in the new scheme, which has prompted the MHLW to consider further liberalisation of EHC sales.”

Meanwhile, in the UK, following an application from Sanofi, the Medicines & Healthcare products Regulatory Agency last week reclassified Nasacort Allergy Relief (triamcinolone acetonide 55mcg / dose) nasal spray from Pharmacy medicine to General Sales List. The suspension can be used for the relief of symptoms associated with seasonal allergic rhinitis, including sneezing, itchy and runny nose, itchy red or watery eyes, nasal congestion or sinus discomfort in adults aged 18+ years.

In terms of switch drivers, governments seeking to reduce healthcare costs remains a primary factor, but also important is the empowerment of consumers as they increasingly use digital solutions to improve and monitor their health, a trend that is being leveraged into test & treat models. Commenting on the just-published Rx-to-OTC Switch Hot Topic Report, CIMA Senior Market Analyst Victoria Blake said the report “considers the impact of Covid on struggling healthcare systems, and the increased burden on the undertreated population. While traditional mechanisms have proved too slow in recent years, the next generation of switches – such as statins, triptans, oral contraceptives and CBD – require new thinking and a different approach.”

According to Nicholas Hall, “we could be entering a Golden Age. Voltaren Arthritis Pain Relief Gel’s successful US launch; OTC approval for low-dose cannabis in Australia; the possibility of OTC oral contraceptives in a major Western market for the first time; plus recent statements by Sanofi on the likely switches of the antiviral Tamiflu and the erectile dysfunction treatment Cialis. These are just the tonic this industry needs as the recovery from Covid gets underway.”

Our hot topic report Rx-to-OTC Switch is now published! Written by Nicholas Hall’s CIMA team in association with switch expert Joe McGovern of Biograph Inc, you can access information on the historic and current switch environments in key global markets, including an overview of pipeline and strategic considerations. For more information, or to purchase your copy, please contact melissa.lee@NicholasHall.com

Historically slow cough, cold & flu season

Now that four (P&G, J&J, GSK and Sanofi) of the world’s Top 6 consumer healthcare marketers have reported their latest quarterly results, two of the key takeaways are that 1) industry growth has proven very resilient in the face of the challenges posed by the pandemic, and 2) we are in the middle of an historically slow cough, cold & flu season in 2020-21, and CHC marketers with portfolios that skew heavily towards CCA products will continue to feel the impact of this trend on overall growth.

Figures from the WHO’s FluNet service show the quasi-total wipeout of flu at a global level. Despite some signs of very low levels of flu circulation in certain regions tracked by WHO, including Africa and the Western Pacific, the overall picture at a global level is stark, with an almost complete drop-off in global infections since Q1 2020. The data shown in the WHO chart below are provided remotely by National Influenza Centres (NICs) of the Global Influenza Surveillance and Response System (GISRS) and other national influenza reference laboratories collaborating actively with GISRS, or are uploaded from WHO regional databases.

Source: FluNet (www.who.int/flunet), GISRS

This trend is backed up by recent reports at a country level too. According to data obtained by The Times newspaper, UK flu cases are down by 95%; in the second week of January – the peak of the season – the number of reported influenza-like illnesses was 1.1 per 100,000 people vs a 5-year average rate of 27. This reflects similar trends in many other countries, including USA. While a billion people typically get flu globally each year, “much less than a tenth” of that figure will do so, according to leading expert John McCauley. There are a number of theories for the decline; lockdown restrictions, social distancing and the wearing of masks, and an increased focus on good hygiene practices have helped to prevent Covid, but also reduce the spread of other contagious illnesses. A major fall in international travel has curbed infections, while there has also been a huge take-up of the influenza vaccine. Meanwhile, some experts believe the spread of Sars-CoV-2 may have raised immunity against other viruses.

Nicholas Hall said: “Before Covid, we thought we knew the dynamics of consumer healthcare very well. I’ve given endless presentations quoting the three practical drivers of demand: Switch, the Emerging Markets and very importantly Cold & Flu pandemics. It’s fair to say that, without Covid, we would by now be lamenting a year of poor CHC sales. The actuality is that, with the exception of Voltaren Arthritis Pain and Differin in USA, there have been no significant switches in the past 3-4 years. The Emerging Markets still deliver, of course, but not at the stellar levels of the recent past; and we would by now be reading of the low impact on sales of the cough, cold & flu season.”

Explore the impact of lockdown on cases of cold & flu, and what the implications may be for CHC medicines, in our recently published Cough, Cold & Allergy report. For more information, or to order your copy, please contact melissa.lee@NicholasHall.com.

OECD: Covid’s impact on e-Commerce

A new report published last month by the OECD, entitled e-Commerce in the time of COVID-19, explores how the pandemic has caused an expansion of e-Commerce towards “new firms, customers and types of products, likely involving a long-term shift of e-Commerce transactions from luxury goods and services to everyday necessities”. Below we pick out some of the highlights that relate to medicines.

In the opening summary, the OECD says that, “while e-Commerce in the past for many consumer groups was centred on high tech goods, toys or books, it now increasingly involves goods for which availability is critical to a large share of the population, including groceries, medicine and other necessities.” There were two examples given by the OECD from Brazil and Germany showing how e-Commerce has disrupted the medicines market.

In Brazil, “around 54% of Internet users had bought food or food products over the Internet in 2020, substantially up from only 22% in 2018. Significant increases were also observed for cosmetics, toiletries and medicines. As convenience has always been one of the key drivers of e-Commerce participation, it is likely that many of the new users will keep ordering at least some goods online in the future.”

As for Germany, “online sales grew significantly for medicines and groceries, historically laggard sectors in terms of e-Commerce, while overall online sales contracted by around 18% in March 2020 in comparison to the previous year.” The OECD report also highlighted the impact of Covid-19 on e-Commerce’s share of total retail sales in the UK, USA and EU.

Writing in last Friday’s CHC.Newsflash, Nicholas Hall said: “Let’s take the best case point-of-view, that the incidence of Covid-19 will shrink dramatically during the middle of 2021, with a significantly lower death rate. How do we get back to normal? Will personal and professional life pick up where it left off? I doubt that very much. It seems to me that, at the very least, working from home is here to stay, which could mean the revival of suburban shopping, with lower footfall in city centres and out-of-town shopping malls. One impact on consumer health could be a marked revival in community pharmacy and online purchases growing from 9% to 19% of total CHC sales globally in the next 10 years, and from 11% to 27% in Asia. Another fascinating statistic courtesy of Eurostat is that, uniquely, the over-55 cohort is the largest purchasing group for medicines online, which runs counter to the theory that digital equals youth.

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How consumer shopping habits are changing

A recent report by Global Data in collaboration with Amazon describes changing consumer shopping habits during the Covid-19 pandemic. The report highlights a stark increase in online sales, but stresses that the online channel did not dominate during the peak of the pandemic — the majority of sales during lockdown were made at physical stores that remained open. In addition, the highest growth rates over the past few months are attributed to multichannel retailers, rather than pure-play online retailers.

The pandemic has catalysed closer integration of physical retail and online spaces, with many traditional retailers emphasising or introducing additional services such as curbside pick-up. These services have been well-received; almost 68% of US consumers say they will use curbside collection more, even after the pandemic has subsided. Also, in countries that have reopened post-Covid, there has been a “mini-rush” back to bricks & mortar retailers, highlighting how much consumers – especially in the US, UK and France – have missed the social interaction that physical stores offer.

As a result, the penetration rate for online is coming down as consumers resume physical shopping. According to the survey, penetration will remain elevated compared to 2019 but the peaks seen during lockdown were exceptional, not a new normal. If anything, the report suggests that the role of the physical store is actually being strengthened in some ways. In the USA, Global Data projects around 35.7% of non-food sales transacted online will be supported by a physical store this year – more than in 2019.

Comment from Laura Howard Werling, Market Analyst CIMA, Nicholas Hall Group of Companies: The Global Data report challenges the narrative that the pandemic, and subsequent growth of the online channel, spells the end for physical retail. Instead, retail stores have performed well over the past few months and are successfully utilising a multichannel approach to adapt to the disruption. Consumers have been satisfied with this approach and it should be no surprise: the modern consumer views online and retail stores as one market and navigates both spaces seamlessly to achieve maximum efficiency when shopping.

We are pleased to announce a special Q4 promotional event, which will run until the end of the year! For October only, we are offering a 25% discount on annual subscription rates for Insight and CHC New Products Tracker, alongside up to 50% on selected reports titles. Watch this space — more promotions will be coming in November and December! To find out more, or to make a purchase, please contact melissa.lee@NicholasHall.com

Survey shows growing support for pharmacies in Europe

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According to a YouGov survey, commissioned by Stada and focusing on four European countries (Germany, Italy, Spain and UK), hope and confidence in healthcare professionals has grown in the wake of the Covid-19 crisis, though the picture does vary from one country to the next. With measures to reduce coronavirus infection rates defining daily life, Spaniards show the greatest concern for their health (51%), while people in Germany, Italy and UK are less worried (36-39%).

Germans (18%) are least likely to believe their healthcare system has absolutely proven itself, while 47% of Spaniards gave their health system top marks, followed by the UK (35%) and Italy (29%). Spaniards (32%) and Italians (28%) are most likely to have avoided visiting pharmacies vs only 14% in Germany and 19% in UK. In total, one in five people have greater respect and more recognition of what pharmacies provide on a day-to-day basis.

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The potentially good news for community pharmacies in Europe is that the coronavirus crisis does not appear to be leading to a large number of people ordering more medicines online. In fact, only 6% of those surveyed say they are taking this action. However, it will remain to be seen how consumer attitudes to internet & mail order purchasing of OTCs change in the coming years, especially in Europe. According to DB6 VP, Celine Waller, internet & mail order is expected to account for 19.2% of the total CHC market within the next decade, more than doubling its share from 9.4% currently. 

The survey also highlighted the likely impact of Covid-19 on the VMS market in Europe. UK consumers and Germans are generally not motivated to take more vitamins or similar products (<9%). In Italy and Spain, the readiness to do so is higher, particularly for vitamin C, D and multivitamins (13-15%). Paying greater attention to nutrition and taking more exercise hold greater attraction in the southern countries than in Germany and the UK, where people are more likely to say that the coronavirus situation has not changed their habits. 

Ensure that you have registered to join Nicholas online for a special webinar presentation with Q&A, which will take place next week! On 29 April at 10:00-11:30 UK time, Nicholas will review 2019 CHC market performance, explore the impact of Covid-19 and identify growth prospects for the future. For those unable to join, there will be the option to purchase a recording and submit up to 3 questions via email. To find out more or to register to join, please contact elizabeth.bernos@NicholasHall.com without hesitation!

Update on Walgreens Boots Alliance deal

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Since the global financial crisis, mega dealmaking has gone out of fashion but could now be making a comeback with Stefano Pessina’s planned leveraged buyout of Walgreens Boots Alliance, described as potentially the “largest private equity deal on record”, according to the UK Financial Times. Days after it emerged that Walgreens Boots Alliance had held preliminary talks with private equity groups regarding a potential US$70bn deal to go private, shares in the US-based company rose again on reports that KKR had made a formal approach.

Pessina has a 16% stake in the company and already teamed up with KKR to take Alliance Boots private in 2007, though this time there is a far more challenging amount of debt to be raised in the high-yield bond market, which will be a test of market appetite for a deal of this magnitude. Nicholas Hall commented: “Last week I wrote about the possibility of WBA’s delisting from the stock market and going private: “The general view is that this deal is just too big; and yet, and yet!” Seems I was right to be cautious about writing off what might be Stefano Pessina’s magnificent swansong and the world’s largest private equity deal.”

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Walgreens Boots Alliance is the global leader in the retail pharmacy sector, operating just under 20,000 stores in 11 countries and recording revenues of US$136.9bn in the year to end-August 2019. WBA’s US retail pharmacy business accounts for 76% of this total, but operating income has declined by 20.5% owing to drug reimbursement pressures and increased competition from Walmart and Amazon. In addition, WBA’s international retail pharmacy business reported weak growth owing to a “challenging UK market”. According to a report in Forbes, the advantage of going private would be a chance to arrest the decline in WBA’s share price, down nearly 10% this year, as the deal would take the company away from the public eye and could make it easier to focus more on pharmacy point-of-care services.

Separately, under an agreement with Mitra Adiperkasa (MAP), a leading lifestyle retailer in Indonesia, WBA is to create a Boots branded pharmacy-led, health & beauty retail business in one of the world’s most populous countries. The first stores are expected to open in H2 2020. “Boots is a great addition to our diversified brand portfolio, which will help MAP further unleash the power of its 360° retailing strategy,” said Group CEO, VP Sharma. “We are confident that the combination of Boots cutting-edge products together with MAP’s solid competitive advantages will elevate the unique Boots experience to a whole new level in Indonesia.”

Announcing Nicholas Hall’s Reports End of Year SaleUp to 25% off – valid until 31 December. We are pleased to announce a special End of Year offer for our CHC Reports! Until 31 December, we are offering a 15% discount on the 2019 Reports Catalogue, plus an additional 10% discount on orders for multiple reports. If you would like additional information on any of our publications, or would like to place an order, please contact Melissa.Lee@NicholasHall.com

Homeopathy under increasing scrutiny

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France is the latest country in recent years to call into question the role and efficacy of homeopathy, as governments look for savings in the healthcare budget. Last week’s announcement by France’s Minister for Solidarity & Health Agnes Buzyn that homeopathic medicines will be dereimbursed in France from 1st January 2021 is another blow to this consumer healthcare niche. In 2017, NHS England recommended that doctors no longer prescribe “ineffective, over-priced and low value treatments”, including homeopathy, which is said to have no clear or robust evidence to support use.

The French decision was based on a final recommendation by the Haute Autorité de Santé (HAS) stating that homeopathics have little proven efficacy and should not be covered by health insurance. In its assessment, which spanned 9 months, HAS evaluated close to 1,200 homeopathic products, many of which are currently reimbursed up to 30% when prescribed. In the interim, the level of reimbursement available for certain homeopathics will be cut from 30% to 15% on 1st January 2020, allowing consumers, manufacturers and prescribers time to prepare for eventual dereimbursement.

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Voicing its shock at the decision, key homeopathic player Boiron – which markets various leading OTCs in France, such as teething product Camilia – stated that around 1,000 jobs would be directly affected by the dereimbursement, given that 60% of the company’s business is in France and almost 70% of that is linked to reimbursed medicines. A November 2018 survey by Ipsos revealed that 77% of French people have used homeopathics.

In other countries, such as Spain and the USA, there has been a clampdown on homeopathic health claims. In November 2018, as part of a new marketing authorisation process for homeopathy, the AEMPS (Spanish Agency of Medicines & Medical Devices) indicated that homeopathics with no permitted therapeutic indication must state, “Sin indicaciones terapeuticas” (Without therapeutic indication) on packaging. Likewise, in May 2018, the American Association of Homeopathic Pharmacists announced that all homeopathic manufacturers will be encouraged to use the new disclaimer: “Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.”

Keep up to date with the latest in-depth reporting on homeopathy by subscribing to OTC INSIGHT! We have 4 title covering the latest developments in Europe, Asia-Pacific, Latin America and North America. Click here to find out what key features OTC INSIGHT includes. To receive a sample issue or for details of subscription rates, please contact melissa.lee@NicholasHall.com.

Tracker hits 20,000 innovations

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Our sister product OTC New Products Tracker has hit a significant milestone – 20,000 innovations added to a database that tracks consumer healthcare launch activity all the way back to the start of 2013, across 20 key markets. In this week’s blog, we look back at some of the highest-ranked innovations added to the archive over the past year.

A recent 4-star innovation is medical device Flow from Flow Neuroscience, a first of its kind home treatment on the European market. Positioned as a non-medicated alternative treatment for depression, the medical device comprises a brain stimulation headset and a therapy app. While stimulation is in use, the app acts as a virtual therapist that the user can interact with. Available in the UK since summer 2019, Flow retails for £399.

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Adjacent OTC categories have been fuelling the fire of consumer healthcare innovation in recent years, with medical cannabis / CBD and probiotics two of the most active categories in terms of launch activity. US marketer CBDfx is arguably the most pioneering innovator among the new wave of medical cannabis companies, launching several new delivery formats over the past two years, including vaping pens (January 2018), “chill shot” drinks for anxiety (March 2019), sublingual hemp strips (April 2019) and acne face masks (June 2019).

Like CBD, probiotics have also enjoyed high levels of innovation in terms of delivery formats and positioning. Two examples of probiotics targeting a new consumer healthcare niche include Elebiotic, a recent Recordati launch in Spain positioned to manage recurrent acute otitis media in infants, and Khan’s Morning, a probiotic launched in South Korea in early 2019 that is claimed to help break down the alcohol and acetaldehyde that causes hangovers.

Review 20,000+ launches and innovations with OTC New Products Tracker, the ultimate competitive intelligence tool! Products are graded with a star rating, from 1* (essentially “me too” and generics) up to 4* (1st Rx-to-OTC switches in a category, creation of a new OTC class or other major leaps in innovation). With a recently-released major update including eye-catching new graphics and powerful search filters that help you visualise and explore the vast archive according to your exact specifications, now is the perfect time to set up your free trial. For a demo or more information, please contact waisan.lee-gabell@NicholasHall.com.

PPoC initiatives key to future CHC growth

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For the final instalment in our series of blogs on Nicholas Hall’s Infinity Zones for future CHC growth, we turn to the topic of Pharmacy Point-of-Care (PPoC). As our recent blog on e-commerce indicated, internet & mail order sales of OTCs are growing fast but store-based sales still account for 78% of the global OTC market. In an increasing number of markets, PPoC initiatives are providing new, speedy and effective alternatives for consumers unable or unwilling to wait for a GP appointment. Below is a summary of some PPoC initiatives in recent years from all four corners of the globe.

In February 2019, PTS Diagnostics and Kroger Health, which operates 2,100+ pharmacies and clinics in the USA, announced the full rollout of CardioChek Plus analysers for point-of-care blood testing to help identify individuals at risk of heart attack, stroke and diabetes. The CardioChek Plus system accurately tests lipid profile and glucose simultaneously with one fingerstick, enabling a more seamless process for the customer. It measures total and HDL cholesterol, triglycerides and glucose, providing on-site results in as little as 90 seconds.

In Vietnam, Chris Blank and his team at Pharmacity have the ambition to reach 1,000 stores in just 1,000 days. But, as Nicholas Hall said, it’s more than just store openings that is propelling Pharmacity to national dominance – it has carefully figured out the offline and online needs of its customers and is working hard to build traffic in each store, so the proposition is for vertical as well as horizontal growth. Ultimately, Pharmacity will succeed by delivering holistic PPoC solutions to the unmet health needs of its customers.

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Turning to Europe, LloydsPharmacy (Celesio / McKesson) started offering sore throat tests for people aged 18+ years in 600 stores across England, Scotland and Wales in November 2018. Pharmacists ask questions and examine the throat to determine the possible cause of pain. If necessary, they will take a swab test to check for infection. If the results are negative for Streptococcus A, the pharmacist is able to offer advice, as well as a range of OTC treatments.

As for Latin America, Brazil’s ANVISA approved a resolution in late 2017 that allows any health establishment nationally, including pharmacies and drugstores, to administer vaccinations, providing that they meet certain requirements. This follows a number of local legislation changes permitting pharmacies to offer a greater number of services – among them, the application of vaccines, health monitoring with point-of-care testing and self-test equipment – in the states of Sao Paulo, Amazonas, Para, the Federal District and the city of Sao Paulo in November-December 2017.

Don’t miss out on your final chance to benefit from our pre-publication discount when you pre-order Nicholas Hall’s New Paradigms for CHC 2019: Over the Horizon, written by Nicholas himself! Analyse each aspect of the CHC industry, with a focus on crucial issues including Healthcare trends, Innovation, M&A, Switch and much more. Nicholas will also unveil all the “infinity zones” he has identified as being paramount to the future growth of the industry. In addition to this, you can upgrade your purchase to include a customised in-house presentation or webinar with Nicholas. To find out more or to place your order, please contact melissa.lee@NicholasHall.com.