Global Executive Briefing - COVID-19 Update: June 2020 - Iqvia
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Global Executive Briefing COVID-19 Update: June 2020 © 2020. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States, the European Union, and various other countries.
Agenda
+ Pandemic Status: Updated Spread of COVID-19, Transitioning to Stability
An update on the spread, and a measure to assess reopening indicators
Speaker: Murray Aitken, SVP, IQVIA and Executive Director, IQVIA Institute for Human Data Science
+ Medical Outlook: Virology, Disease Sequela, and R&D Progress
New learnings, new concerns, and the progress toward treatments and vaccines
Speaker: Jeff Spaeder, Chief Medical & Scientific Officer, IQVIA
+ Resuming momentum in clinical trials
Moving from response to recovery
Speaker: Costa Panagos, President, R&D Operations, IQVIA
+ COVID-19: A catalyst of change
A look ahead to 2021 and beyond, and the long term impact and implications for life sciences
Speaker: Marla Kessler, SVP, Strategy Marketing and Communications
Speaker: Alistair Grenfell, President Europe, Middle East, Africa, and South Asia
Speaker: Murray Aitken
2
Executive Briefing: COVID-19 Update Section 1: Transition to stability Murray Aitken SVP, IQVIA Executive Director, IQVIA Institute for Human Data Science June 2020 © 2020. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States, the European Union, and various other countries.
Global look at where we are in the COVID-19 pandemic
Not yet peaked Peaked but not yet Less than Rebounded
at < 20% of peak 20% of peak
Countries: 52 Countries: 47 Countries: 65 Countries: 7
Populat: 3.5bn Populat: 1.8bn. Populat: 2.5bn Populat: 0.05bn
• South Asia • US • UK • Most of Europe • Carib/LATAM
• Africa • Russia • Others • East Asia • Med/Mid-East/Africa
• Latin America • AU/NZ • E. Europe
• Middle East
• Sweden
44% 23% 32% 1%
population population population population
Source: OWID.org; IQVIA Institute.
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 4Future COVID-19 impact is regional and heterogeneous
Significant international and regional variation: disproportionate impact on lower socio-economic + minority groups
New York
Active cases/100k population
New Jersey
California
Michigan
Florida
Massachusetts
Pennsylvania
USA Louisiana
Projected total
confirmed cases
per 100k: 855
(range: 748-1025)
Active cases/100k population
Active cases/100k population
40 Hungary
Hungary Poland
45 (44-48) Romania
30
Projected
total 20
confirmed Poland India
cases per 91 (87-100) 10
100k: Projected total
confirmed cases
0
per 100k: 39
(range: 31-53)
Romania
110 (102-119)
Source: IQVIA Active Cases Curve Simulator.
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 5Transitioning to stability
Readiness to reopen alignment with health system utilization
New York
Re-opening Readiness Index 136 Population: 19.6Mn
106 • Rt level
Total cases to date: 362,758
104 Rt 0.79
• Positive testing ratio
81 Positive Testing 1.2%
• Testing level per capita
121
• Contact tracing planning and 86 Testing Per Capita 2.3%
implementation Contact Tracing 3.25
• Granularity and quality of case reporting Granularity / Quality 86
Elective Procedures 18%
Health Services Utilization Index
41 • Elective procedures
18 of baseline
Institutional visits 31%
31 34 60
• Institutional visits Lab Diagnostics 62%
• Diagnostic lab tests 62 Office Visits 34%
• Office visits New to Brand
Prescriptions 60%
• New to brand prescriptions
Source: COVID tracking project; Rt.live; IQVIA Real World Claims; IQVIA Institute.
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 6Executive Briefing: COVID-19 Update Section 2: Medical update and outlook Dr. Jeffrey Spaeder, M.D. Chief Medical and Scientific Officer, IQVIA June 2020 © 2020. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States, the European Union, and various other countries.
Learning from history, how do pandemics spread and end?
Perspectives on future scenarios
SPREAD
Persistent Spanish flu Repeated large
community spread version 2.0 outbreaks
‘Medical’ end ‘Social’ end
Virus impact minimized by development Societies adopt varying philosophies to
of medical interventions, or mutates respond to the virus
END
Prevention and
Mutation Treatments Minimization Moderation
Vaccines
Taiwan Sweden
Source: IQVIA Global Supplier & Association Relations perspectives, May 2020; https://www.nytimes.com/2020/05/10/health/coronavirus-plague-pandemic-history.html
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 8SARS CoV-2 mutations are relatively infrequent although
D614G mutation has quickly become dominant globally
Adaptive pressures could impact future transmission as well
as efficacy of vaccines based upon earlier viral characteristics
SARS CoV-2 in Wuhan
(D614 in orange)
SARS-CoV-2 spike protein Impact of viral mutations:
• SNP mutations (green) • Increased likelihood of mutations as infections increase
• D614G mutation (red)
• Efficacy of vaccines based upon earlier versions of virus
• Accuracy of diagnostic tests
• Transmission capacity
• Severity of infection
• Potential need for booster vaccines
doi.org/10.1101/2020.04.29.069054doi
doi.org/10.1101/2020.04.28.066977doi
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 9COVID-19 is more than just a respiratory disease Diffuse distribution of ACE2 and two-phase immune response complicates clinical course including neuropsychiatric effects Source: https://arxiv.org/ftp/arxiv/papers/2003/2003.12773.pdf IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 10
The components of successful vaccine development
Treatments save patients, vaccines save populations
Vaccine platform or
Scientific Successful Compound Institutions
delivery mechanism
Phase
components execution of studies AZD1222 Univ. Oxford & AZ Adenovirus vaccine 2b/3
• Correct target • Sufficiently large
Ad5-nCoV CanSino Biologics Adenovirus vaccine 2
• Successful and long-term event rate
mRNA-1273 Moderna mRNA vaccine 2
generation of protective • Sufficiently long
immunity enough duration Beijing Institute of
Unnamed Biological Products & Inactivated vaccine 1/2
Sinopharm
BNT162 BioNTech & Pfizer mRNA vaccine 1/2
Distribution Manufacturing
capability capacity NVX-
Novavax Protein subunit 1/2
CoV2373
• Prioritization and • Rapid scaling up
Inactivated virus with
coordination • Public-private PiCoVacc Sinovac
adjuvant
1/2
• “Last mile” efforts partnerships
Beth Israel
Unnamed Deaconness & Adenovirus vaccine
Janssen
Source: Lancet 2020;395:1751-1752 and IQVIA insight.
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 11Potential integration of therapies under development
High risk individuals
(Prophylactic treatment)
Healthcare providers Vaccine for
(Prophylactic treatment) population
Patient infected with
SARS-CoV-2 Severity of illness
Plasma-
Immune derived Rx
Viral modulation
Symptom inhibition
treatment
Immunity
Mild / Moderate Moderate / Severe
symptoms symptoms
Serology testing
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 12Univ. of Minnesota
Results of notable clinical studies post-exposure (-)
French case report
study (+)
China study RCT (-) Australia HCP
VA Study
prophylaxis (ongoing)
ACTT (+: 15 vs. 11 real-world study (-) Hydroxy-
days inpatient and
chloroquine WHO SOLIDARITY
mortality trend)
study (ongoing)
IL-6 inhibitor
Remdesivir Leronlimab (+)
Case reports (+)
IL=-6 inhibitor
>600 Tocilzumab (+/-)
ongoing Supportive IL-6 inhibitor
clinical therapies Sarilumab (-)
China case-reports (+)
studies
Anticoagulation (+)
NYU series (+)
Key Convalescent + in combination
plasma with ribavirin and
= demonstrates positive benefit interferon 1b
Lopinavir/
= negative effect or outcome ritonavir
= neutral or ongoing study (-) vs. standard
US safety studies (+) WHO SOLIDARITY
of care
study with and without
interferon (ongoing)
Source: https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-therapeutics-tracker
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 13Executive Briefing: COVID-19 Update Section 3: Recovery in R&D Costa Panagos President, R&D Operations, IQVIA June 2020 © 2020. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States, the European Union, and various other countries.
Pharmaceutical company decisions on clinical trial
continuity have largely remained stable since end of April
Clinical trial continuity among
Selected clinical trial continuity statements –
top 50 pharma
April/May 2020
(n=30 companies with public statements)
“While Biogen does expect there will be some impact to timelines for
some of its clinical programs, it still expects the vast majority of the
13% 10 remaining near-term readouts to occur before the end of 2021.”
Delay existing
enrollment
“Clinical trials are continuing and we are leveraging our digital tools
10% to limit the disruption caused by the pandemic. We are seeing
Delay new
trials only
53% slowdowns in new enrollments in ongoing clinical studies and start-
up with new studies. At this time we remain confident the impact on
Attempt to
maintain and our ongoing clinical trials is manageable. Looking ahead for the
leverage remainder of the year, we do not expect delays in our planned
23% continuity 2020 regulatory submissions.”
Delay new trials solutions on case
and existing by case basis
patient enrollment “While some of our clinical trial sites remain paused for new patient
recruitment, we endeavor to continue our clinical research programs
with the wellbeing of our patients as our guiding principle. We
assess the situation continuously and where it is safe for patients
and in line with local regulations, we have restarted patient
recruitment at some sites for most of our ongoing studies..”
Source: IQVIA secondary research; company websites and press releases.
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 15The site perspective: Challenges and opportunities for support
Key challenges during COVID-19 What would help
IP accountability 12% 28%
27%
Not enough
Not enough staff staffto
and/or time and/or time
devote to
26%
study to devote to study 17%
EDC data entry 17% 21%
ReviewingReviewing
my site database/chart review to
my site database/chart
17% 13% 20%
find potential
review subjects
to find potential subjects
20%
EDC query resolution 19% 19%
Time for patient education about studies 22%
17%
Investigator site file upkeep 22% 17%
Patient phone screening and scheduling 22% 14%
Pre-screeningPre-screening patients/referrals
patients/referrals from outside
from outside sources
sources 26% 8% 7%
Follow-up
Follow-up with
with current
current study
study subjects
subjects to 4%
resume their study
to resume visits
their study visits 29% 2%
Additional staff to Remote Access Additional staff to Additional staff to Additional staff to
Monitoring visit prep 36% conduct Technology contact new referral contact patients schedule
chart/database (eSource, eReg, patients currently enrolled in appointments with
reviews to look for eMR, Telemedicine) studies current patients
Engaging and retaining patients 38% potential patients
Major impact Minor impact
Source: IQVIA US and Canada Site Survey (n=138).
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 16COVID post-containment operational recovery framework
Enabling exit, limiting disruption from COVID-19 at a project portfolio level
Study level Country level Site level Patient level
Macro level planning Country level situation Site access, protocol Patient return to sites
using tools at portfolio / and regulatory situation at site and site and enrolment re-
project level expectations staff workload forecast
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 17Recovery curve forecast
Rate at which sites and patients return to pre-COVID activities
Forecast site reopen dates
• By country and region
• By US state
• By therapeutic area
Forecast patient activity
• Early: screening and randomization activities
• Late: post randomization
Managing recovery
with timely, adaptable Forecast site reopen at a study-site level
forecasting powered
by machine learning Scenario planning simulations on shifting peak
dates (5, 10, 15 days) and government regulations
scenarios (none; mild; strict)
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 18Accelerated innovation is paving the way for a new normal
Achieving agility with patient-centric design and the right technological infrastructure
Pre-COVID Post-COVID
Protocol simplification
Complex, inflexible protocols Protocols that reduce patient burden and have built-in option to incorporate remote
study approaches; leverage common protocols on basket studies
Remote site monitoring/source data verification and remote visits
Primarily on-site operations Shift towards remote Site selection and initiation visits with remote site support and
increased hybrid of onsite/remote (at home) patient visits
Novel trial design/hybridization of studies
Traditional randomized trials Master/Platform protocols, real world comparator arms, merging of real world
modalities and early phase engagement and planning
Digitization of study procedures
Site-based study procedures Further evolution of digital patient options for clinical trial data collection such as ePRO,
vitals, spirometry, ocular exam, ECGs, glucose monitoring, oximetry, etc.
Digital patient engagement
Limited patient communication Increased use of digital communications to keep patients informed and engaged while
reducing burden and increasing retention
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 19Executive Briefing: COVID-19 Update Section 4: COVID-19: A catalyst for change Marla Kessler SVP, Strategy, Marketing, and Communications, IQVIA Alistair Grenfell President, Europe, Middle East, Africa and South Asia, IQVIA Murray Aitken SVP, IQVIA Executive Director, IQVIA Institute for Human Data Science June 2020 © 2020. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States, the European Union, and various other countries.
Looking to 2021
Driving forces that could shape the healthcare landscape
Virus
evolution and Economic and Private sector
therapeutic policy impact activation
response
Progress in availability of safe and Depth of impact, speed of Extent to which private sector
effective vaccine and treatment return and level of policy stakeholders seize the
options to prevent hospitalization responses opportunity to restructure, and
and manage severe cases embrace and activate change
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 21Behavior shifts
Driving forces shift behaviors
Enhanced value and
New patient journey Emerging GTM model
evidence requirements
Magnitude of disruption
Potential behavior shifts
No major shift expected Potentially to be highly disruptive
Patients Personal health engagement; Technology adoption
Providers Restricted rep access; Increased tele-health adoption
Public payers Reallocation of budget from drugs to health services
Consideration of integration, consolidation. Investment in
Private payers innovation.
Hospitals Shifted role of hospitals; Opening of new treatment centers
Pharmacy More e-Pharmacy; Increase in home-delivery
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 22Business model under pressure
Pre-COVID costs growing faster than net revenue, eroding returns
P&L squeeze: Revenue and cost growth (indexed to 2010) 5-yr CAGR
140 R&D
Expense
~5%
130 COGS ~4%
Index to 2010 = 100
Net
Revenue ~3%
120
SG&A
Expense ~3%
110
100
90
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Aggregated industry P&L, top 25 Pharma companies,
Source: Company Financial Report ; IQVIA Thought Leadership analy sis 2020
C
IQVIA Q
Global Executive Briefing: COVID-19QJune |2020; Copyright
| S 2020
| COIQVIA. CO 23Implications for life sciences
New capabilities to adapt across the value chain
TODAY FUTURE
Refocus portfolio strategy on high-unmet need areas
R&D / Portfolio • Focus on oncology and specialty
Innovative use of RW evidence
Strategy • On-site complex protocol studies
Tech-enabled execution
Long-term follow-up COVID-19 patients
Safety • Traditional PV requirements
Evidence on COVID-19 impact
Supply and • Dependent on foreign API Consider domestic / collaborative manufacturing to prevent
• Consistent and frequent distribution / wholesale any supply issues or policy changes
Manufacturing
Pricing and • Price benchmarks Plan for new evidence requirements
Market Access • External technology review Accelerated focus on value demonstration
Enhance support for patients within new care sites
• Disease state and treatment education focus
Patient Support • On-site specialist referrals
Strengthen pathways and guidelines to empower patients in
and Engagement care seeking behaviors
• Hospital driven treatment and care
Remote monitoring and tele-health continuation
• Share of voice based customer engagement Local precision and coordination
GTM Model • Coverage and frequency models (F2F focus) Call-center based remote engagement
• Key account management Scientific / clinically focused field-team
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 24Profitability impacts
Operating margin at some risk (2021-2022)
Large pharma
baseline* Impacts Rationale
2019 actual
Disruption in demand from April to June, offset by forwarding
Net sales 100% buying in March, and return in July-Dec at 95% of 2019 level
Slight increase due to shifting some production to
COGS 28% more expensive locations
Initial investment in virtual technology off-set by
SG&A 27% more significant rebalance of field force investment
R&D 19% Maintain program at same absolute level
Operating margin 25% Management priorities and actions to maintain operating margin
Source: Company financial statements for 15 largest companies by global pharmaceutical sales; IQVIA Institute.
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 25Building a more resilient ecosystem
Transitioning to the future with a stronger healthcare system
Re-establishing a stronger system:
Embrace the role of technology
COVID-19 pandemic as an accelerator of change that
Digital Global promotes efficiency in customer engagement and ways of
innovation connectivity working
Learn from global community
Global healthcare and life science community learns from
historic response
Increase value to healthcare system
Re-setting assessment of ICU capacity, testing
Value capabilities, vaccine infrastructure and innovative
calibration therapeutics to optimize health system and life science
value
IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 26Thank you For more information, please visit IQVIA.com/COVID19 Or contact us at insights@iqvia.com
Disclaimer
The analyses, their interpretation, and related information contained herein are made and provided subject to the
assumptions, methodologies, caveats, and variables described in this report and are based on third party sources and data
reasonably believed to be reliable. No warranty is made as to the completeness or accuracy of such third party sources or
data.
As with any attempt to estimate future events, the forecasts, projections, conclusions, and other information included herein
are subject to certain risks and uncertainties, and are not to be considered guarantees of any particular outcome.
All reproduction rights, quotations, broadcasting, publications reserved. No part of this presentation may be reproduced or
transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information
storage and retrieval system, without express written consent of IQVIA.
Copyright © 2020 IQVIA. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States and various
other countries.
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