国药中生 CNBG. Influenza Vaccine Market in China 感谢疾控系统的各位领导和专家! 中国生物技术集团公司市场部 2011 年月日. China National Biotec Group Company Limited(CNBG) Jan.

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1 Influenza Vaccine Market in China 感谢疾控系统的各位领导和专家! 中国生物技术集团公司市场部 2011 年月日 China National Biotec Group Company Limited() Jan.15, 2013 呵护健

2 Dual pattern of seasonal influenza The regional differences in climate means that China has two influenza seasons Winter seasonal peak in North China: Temperate Pattern Year-round circulation in South China: Tropical or Subtropical Pattern Shu YL et al. Emerg Infect Dis 2010

3 ILI% ILI% Influenza activities- ILI surveillance in 554 sentinel hospitals Southern provinces 南方省份 周次 Northern provinces 北方省份 周次

4 Background The influenza vaccine was introduced to china in1998, and the domestic production started since 2000 Ministry of Health issued the influenza vaccination guidance in 2003 and 2005 China CDC issued technical vaccination recommendation annually since 2007, adapted from ACIP, but more influenza surveillance information are coming from National Influenza Surveillance Network of China Not covered by national vaccination program, it is a voluntary vaccination at own expense with a few exceptions There are 12 domestic and 5 foreign manufactories selling influenza vaccine in china currently About 40 millions doses were released in China annually The largest production capability in 2009 reached million doses Split and subunit trivalent influenza vaccine But only about 75% doses were vaccinated, the rest was destructed Feng L et al. Vaccine 28(2010)

5 Major Manufacturers/suppliers and price of influenza vaccine in China Name of manufacturer Generic Name Specification/dose -Changchun Institute Split influenza virus vaccine 0.5ml/dose/ vial -Shang hai Institute Split influenza virus vaccine 0.25ml/0.5ml/dose/syringe 0.25ml/0.5ml/dose/ vial -Beijing Tiantan Bio Split influenza virus vaccine 0.5ml/dose/syringe 0.5ml/dose/ vial Zhejiang Tianyuan Bio-Pharm Split influenza virus vaccine 0.5ml/dose/syringe 0.5ml/dose/ vial Changchun Changsheng Life Sciences Ltd. Split influenza virus vaccine 0.25ml/0.5ml/dose/syringe 0.5ml/dose/ vial Sinovac Split influenza virus vaccine 0.25ml/0.5ml/dose/syringe Hualan Biological Engineering Inc. Split influenza virus vaccine 0.25ml/0.5ml/dose/syringe 0.5ml/dose/vial Aleph Biomedical Co., Ltd. Split influenza virus vaccine 0.5ml/dose/syringe 0.5ml/dose/ vial Sanofi Pasteur Split influenza virus vaccine child /adult / syringe GSK Split influenza virus vaccine child /adult/syringe Norvartis Subunit vaccine Adult/syringe Abbott(Solvay) Subunit vaccine Adult/syringe Berna Subunit vaccine Adult/syringe Sale Price(retailer) In-house product: RMB77~86, Import product:rmb90~118

6 state of influenza vaccine lot release Unit: dose Child type 10,000,000 14,000,000 13,000,000 21,000,000 Adult type 26,000,000 26,000,000 41,000,000 31,000,000 Total(about) 36,000,000 40,000,000 54,000,000 52,000, lot release share of

7 Significant increase in influenza vaccine market since 2002, more likely due to environmental elements 25,000,000 20,000, Avian flu threat -7% 15,000, SARS 10,000,000 BJ outbreak 5,000, Source: Net sales after deduction of returns With no external drivers, the average growth is estimated at ~10% per year

8 Sales and revenue of influenza vaccine at provincial level during and <5 doses/1000 persons in southwest provinces while 108 doses/1000 persons in Beijing There was significant increase of sales rate during , in Beijing, Sichuan, Sinkiang, Guizhou, Ningxia TIV annual sales is positively correlated to per capita GDP of individual province Except Shanghai and Shaanxi 8

9 Immunization strategy of seasonal influenza in China Non-NIP : voluntary & out-of-pocket payment Providing financial aid or medical insurance policy in individual regions Beijing: free injection for elders ( 60ys) and students since 2007 Karamay: free injection for elders ( 60ys) and 3-7 year old children since 2008 Shanghai: free injection for high risk population (elders, students, medics, servicers etc.) during for EXPO Xi an, Zhuhai, Suzhou, Jichang etc.: included in medical insurance system

10 Key issues Low Coverage Rate about 2% coverage totally in china, with the highest rate in children and the lowest rate in elderly Because: 47.5% people don t want to get flu vaccine because of no data showed the usefulness of flu vaccination There is a general perception that influenza is not an important contributor to mortality in China Lacking of basic data study to establish financial aid system Huge cost million target population, USD9~15/per dose Disease burden : Death, hospitalization etc. Vaccine efficacy & cost-effectiveness Cost and efficacy analysis in different immunization policy Awareness of influenza and vaccine in public, government and HCW section Most of the vaccination were implemented in school for children and teenagers

11 Challenge : Huge Target Population Target population for seasonal influenza vaccination Population (in millions) Younger children aged 6-59 months 61.3 Elderly aged 60 yrs Persons aged 5 59 years who have medical conditions that put them at higher risk for influenza-related complications 84.0 Pregnant women 23.1 HCWs 6.2 Household contacts and caregivers of children <5 yrs and elderly 60 yrs Household contacts and caregivers of adults aged 5-59 yrs with chronic medical conditions Staff of kindergartens and nursery 1.4 Total Feng L et al. Vaccine 28(2010) 0.58 billion, 44% of China population

12 Opportunities of influenza vaccination in China Health system reform acceleration and rapid economic development Government will increase investment in healthcare industry during the 12th-five-year plan A(H1N1) pandemic response & pandemic influenza vaccination Successful experiences of promotional campaigns Free vaccination or financial reimbursement policy for high-risk groups, like Beijing, Karamay, Shanghai, Xi an, Zhuhai etc. 12

13 Improvements focus on Strengthening the research for vaccination policy Health and Economic Burden of Influenza Vaccine Effectiveness on sub-populations and Health Economic Analysis R&D of innovative vaccine Encouraging local governments to develop policies of financial reimbursement and medical insurance for high-risk population Strengthening the cooperation with community health centers, enhancing the cognition to influenza and influenza vaccine Strengthening the public education and promotion Improving the vaccination service (adult immunization) 13

14 Influenza vaccine of is the largest vaccine, blood products manufacturer and supplier in China The Main Force in China's Mass Vaccination Campaign since Supply full range of NIP vaccines in the past 30 years and covered nearly 85% public market and 40% private market. Producing more than 30 kind vaccines against 28 diseases has 10 production sites including 3 major influenza vaccine manufacturing facilities Annual output over 700miliion doses vaccine -SIBP is the first influenza vaccine producer in China since Now total capacity can be reached 25million doses for TIV. Collaboration with China CDC to establish an effective system for emergency response

15 谢谢! 呵护健