On Friday, I wrote a post, listing out the factors related to the potential level of profitability of Top Glove. You can read the post here. Over the next few weeks I will try to discuss in more detail each of the factors or groups of factors, starting from the most impactful one. Inevitably things will be missed and new information will come around after this post gets published. Thus, if you believe anything has been missed at the time of posting, or if any additional relevant information comes around, please do share it in the comments section. Most importantly - as such information might get missed, make sure that you always do your own research. The purpose of this post, and of other similar posts, is to generate discussion on the topic, which would eventually bring positives to everyone as informed decisions are always the best decisions.
Vaccines, Medication, and the End of COVID-19
Unquestionably, the most relevant event to both the business decisions of all glove manufacturers, and to the investment decisions of the general public, over the past at least 10 months, is the COVID-19 pandemic. As effective medication has not been discovered up to date, the main hope for the world to return back to normal as quickly as possible, is an effective and widely available vaccine.
On medication in particular, most of the medication used to treat COVID patients as of now, is symptomatic. In other words - it deals with the symptoms and with related illnesses, not with the COVID virus itself. The drug that has been assigned the highest degree of promise - remdesivir, has been recommended against by the World Health Organization (WHO) as of 20 November 2020 (Source). However, new information on the topic appears daily. For instance, a recent study (published just yesterday - 11 December 2020) showed positive results when remdesivir was combined with baricitinib (Source). This will continue to be the case, and it is highly likely that eventually an effective medicine, or a combination of medicines, will be found that will allow for the healthcare systems in the world to be unburdened. This is the main problem that countries are currently facing. In a significant percentage of cases, COVID positive patients need to be under constant medical supervision and in these cases at-home treatment is an unavailable option.
Factors to Consider with Vaccines
While advances in that direction continue, it is by now a widely accepted opinion that an effective vaccine, distributed to a large percentage of people across the world, will be the one to put the actual eventual end to the pandemic. The main considerations in regards with each vaccine at this time are the following:
- How efficient it is;
- How safe it is;
- How quickly it can be produced and in what quantities;
- How much it would cost;
- Who will get it.
All of these questions are important to answer, but the details may go beyond the scope of this post. For the purposes of the post, we will review the most important players in the field. For the sake of simplicity, we will ignore the legal approval process each vaccine has to go through in order to be used in each country. While not an insignificant factor, we will assume that the process will be heavily accelerated and that any delays will not cause material changes in the scheduling of events. Thus, we will not delve into the safety aspect of the vaccines as this is a topic each country's authorities would need to resolve. We will also assume that the reported test efficacy rates will be consistent with the efficacy rates in the general population. We will not discuss the cost as it is immaterial to our topic. Data compiled by Bloomberg is used in the analysis below (Source).
On 18 November 2020, the company released its test results, reporting 95% effectiveness against COVID (Source). The company said it will produce up to 50 million doses in 2020 (scaled back from 100 million doses announced earlier (Source)), and another 1.3 billion doses in 2021 - an amount sufficient for 650 million people or about 8.3% of the population of the world. Up to now known contracts with countries include the following:
EU - 200 million doses (enough for 100 million people)
Japan - 120 million (enough for 60 million people)
USA - 100 million (enough for 50 million people)
UK - 40 million (enough for 20 million people)
Malaysia - 12.8 million (enough for 6.4 million people) (Source)
The vaccines will be available at different times to different countries and population segments within countries.
A few days after Pfizer, on 30 November 2020, Moderna released data showing 94.1% efficacy of its vaccine (Source). It promised 20 million doses in 2020, and 500 million to 1 billion doses worldwide by the end of 2021. Two doses are needed for immunity to be achieved. Official contracts include:
USA - 200 million doses
EU - 80 million
Japan - 50 million
Canada - 40 million
AstraZeneca/University of Oxford
AstraZeneca is developing a vaccine together with the University of Oxford. This is the vaccine of which likely the largest amounts will be produced - approximately 3 billion doses by the end of 2021 (Source). However, this is also the vaccine that has shown the most significant variation in terms of efficacy during the test phase. Depending on the type of dosage used, the efficacy rate was between 62.1% and 90%, with an average of 70.4% efficacy across both groups of participants in the trials (Source). In order to increase the efficacy, AstraZeneca will work with the Russian Gamaleya Institute (read below on their vaccine) to produce a potentially more efficient version of the vaccine (Source). Nevertheless, a number of large contracts have already been signed (two doses are required, no matter the dosage):
India - 1 billion doses
COVAX - 300 million
EU - 300 million
USA - 300 million
China - 200 million
Latin America - 150 million
Japan - 120 million
Brazil - 100 million
UK - 100 million
The company has the second highest number of pre-ordered vaccine doses at 1.3 billion. As of 30 November 2020, the company is in Phase 3 of its vaccine tests, and it hasn't released official efficacy results yet (Source). The company has signed an agreement with the Serum Institute of India for the manufacturing of approximately 1 billion doses in 2021, and it is increasing it's global manufacturing capacity so that it could produce up to 2 billion doses per year. Works on this increase capacity development will continue by the middle of 2021 (Source). The following agreements have been reached:
India - 1 billion doses
USA - 110 million
Canada - 76 million
UK - 60 million
Australia - 51 million
The partnership just announced a few hours ago that its vaccine will be delayed to the end of 2021, due to disappointing results during the clinical trials (Source). This information has not been reflected in any of the calculations hereon after. Sanofi/GSK have the third highest porfolio of agreements for vaccine deliveries in 2021, with a total of 730 million doses, including:
EU - 300 million doses
COVAX - 200 million
USA - 100 million
Canada - 72 million
UK - 60 million
Johnson & Johnson
An unexplained illness in a volunteer caused a halt to the trials of J&J's vaccine in October (Source). The company announced the resuming of trials a few days later (Source). The company has agreements totaling a little over 370 million doses, including with:
EU - 200 million doses
US - 100 million
In November, the Russian institute announced that its vaccine has over 95% efficacy 42 days after the first dose (Source). Some concerns were expressed over the announcement (Source, Source), but a number of coutries have signed up agreements for a total of almost 700 million doses. These include:
India - 200 million doses
Russia - 160 million
Brazil - 100 million
Uzbekistan - 70 million
A number of other companies and institutions are at different stages of producing vaccines. They will be able to produce significantly smaller amounts than the aforementioned major players. The publicly available information is provided below for each of these players.
Total - 225 million doses
EU - 225 million
Total - 223 million doses
Pakistan - 88 million
Middle East - 75 million
Indonesia - 60 million
Total - 168 million doses
Indonesia - 50 million
Turkey - 50 million
Brazil - 46 million
Total - 202 million doses
COVAX - 200 million
Total - 60 million doses
UK - 60 million
Total - 50 million doses
Mexico - 35 million
Indonesia - 15 million
University of Queensland
This vaccine failed clinical trials and development was discontinued as of 11 December 2020 (Source).
Australia - 51 million doses
In order for herd immunity to be achieved, approximately 60% to 70% of the world population would need to be vaccinated (Source). It is important to note that WHO has not officially endorsed any number up to now (Source). Additionally, note that different vaccines have been shown to provide different degree of efficacy, and we assume 100% efficacy. So if we assume that these estimates are correct, with a world population of slightly over 7.8 billion people at the moment, between 4.7 billion and 5.5 billion people will have to be vaccinated worldwide.
As mentioned above, different countries will get the vaccines with different speed and at different times. The country that has pre-booked the largest amount of doses is Canada. It has secured delivery contracts for doses sufficient for a total of 154 million people - over 400% the size of its population. The country expects to have "most" of its population vaccinated by September 2021 (Source). Other countries that have pre-booked doses that would cover populations larger than their own include the UK (294% higher), Australia (230%), EU (172% higher than that the total population of all the countries), USA (153%), Chile (139%), Israel (137%), Japan (120%), Mexico (119%), and Uzbekistan (110%). In other words, it is likely that these countries will be able to vaccinate significantly larger percentage of their populations than is needed to achieve herd immunity by the end of 2021. It is expected that they will make sure their populations get vaccinated first, before making any left-over vaccine doses available to others. Another country with a significant population size that will likely be able to get large enough amounts of the vaccines, is India. The second most populous country in the world has secured vaccines enough for a little less than 1.2 billion people, or 85% of its population. The total number of vaccines China has disclosed up to now, would only cover about 12% of its population. However, it is suspected that total numbers have not been disclosed. For our calculations, we will assume that China will be able to vaccinate 100% of its population by 2021 with an undisclosed amount of vaccines. Thus, we will discount the country and the current numbers it has declared from our calculation below.
The total quantity of disclosed doses that would be available in the entire world by the end of 2021, would be 7.95 billion - enough for a little over 4 billion people, or about 51% of the world population, assuming that there are no unforeseen delays or test failures (see Sanofi/GSK and University of Queensland above). If we discount the figures for China (1.4 billion population, 350 million disclosed doses), we will actually get to an a little more optimistic figure of over 59% of the rest of the world being covered. Unfortunately, as mentioned above these vaccines will not be available equitably. Let's assume that the big players - EU, USA, and Japan, vaccinate 100% of their populations (a total of 900 billion people, requiring about 1.8 billion doses) before providing the rest of the vaccines to others. Let's assume that India vaccinates 80% of its population (1.1 billion people, requiring 2.2 billion doses) before doing the same. These four countries (let's view the EU as one country in this case) alone will account for a little over half of the total available doses for the entire year 2021. We can add to that calculation the other countries that have secured more than 100% coverage and we can assume they will do the same - Canada, the UK, Australia, Chile, Israel, Mexico, and Uzbekistan (300 million people, requiring 600 million doses). In other words, these countries will absorb 4.6 billion doses out of 7.6 billion available for the year (remember we discounted China). The rest of the world, accounting for 4.1 billion people (again, China is discounted) will receive 3 billion doses, enough for 1.5 billion people, or a little over 36% of the population. Most of these doses will likely come through COVAX, which has the goal of getting at least 2 billion doses by the end of 2021 (Source). It must be noted that the delay with the Sanofi/GSK vaccine has not been included in the calculations above. That vaccine will likely become available in batches only at the end of 2021, which means decreased availability for the year of a total of 730 million doses.
Will People Vaccinate?
The acceptance of getting innoculated with a COVID vaccine, especially as quickly as they are getting rolled out, is not universal. A study conducted by Ipsos in late July and early August showed that while on average throughout the world, a significant percentage of people would be willing to get a vaccine (74% on average), this widely varied from country to country. In Russia, which is the producer of one of the major vaccines, only 54% would rather agree. The figures are generally lower in Europe as compared to Asia - France (59%), Poland (56%), Germany (67%), versus China (97%), Malaysia (85%), South Korea (84%). The figure for the United States was 67% (Source).
Another international study, published in Nature Magazine in October and conducted in June, showed similar numbers - Russia at the bottom with 54% ready to get a vaccine, followed by Poland (56%) and France (59%). On top were China (88%) Brazil (85%), South Africa (81%), and South Korea (79%). The figure for the United States was 75% (Source).
A Pew Research study published in September showed that the number of people who would willingly get a vaccine fell to 51%, from 72% in May (Source). In other words, the trend - specifically for the United States, appears to be towards fewer people interested in getting a vaccine willingly. This trend may or may not reverse as new information gets published.
The battle with COVID-19 will be hard. A number of obstacles will have to be overcome before a large enough percentage of the world population could get an effective vaccine. Based on the currently available data, this does not appear to be achievable by the end of 2021. Insufficient amount of vaccine doses will be available, based on current projections, to achieve herd immunity assumed to be 60-70%. The available doses will not be distributed equally, and most importantly - the world may end up in a situation in which countries where people may be most unwilling to get a vaccine would have the highest per capita number of vaccines available, and vice versa. However, new information emerges daily and the situation is highly fluid.
Important disclaimer: Any views expressed are for informational and discussion purposes only. None of this information is intended as, and must not be understood as, a source of advice. It is imperative that you always do your own research and that you make any decisions based on your personal situation and your own personal understanding.