In July 2024 Airfinity announced a reduction in its sales projections for vaccines against Respiratory Syncytial Virus (RSV) for older adults in the US. This is set to decrease from $4.7 billion a year to $1.7 billion by 2030. In 2023 the market revenues in the US reached around $2.4 billion, but Airfinity’s framework indicates that 2024 revenues will decline slightly to $2.2 billion. Airfinity attributes this projection to CDC Advisory Committee on Immunisation Practices (ACIP) recommendations that vaccines should be offered as a single lifetime dose for older adults. The estimated demand and revenue projections were based on proxies from previous vaccination campaigns.
Changing demand
Airfinity suggests that ACIP was “hesitant” to share a decision on potential booster doses after the rollout of RSV vaccines last year, due to “concerns about the risk versus benefit of additional doses”. Before the new recommendations, people aged 60 and above in the US were offered the RSV vaccine. Under the updated guidance, the vaccines will be offered to people over 75 years and those at high risk over the age of 60. This reduces the estimated eligible population by 44% to 46 million.
Another influencing factor is that the recommendation for high risk 50 to 59-year-olds was delayed in anticipation of further safety and “other” data. This delay is suggested to amount to around $300 million lost revenue for GSK. These losses are exacerbated by GSK’s use of a Priority Review Voucher, which is “commonly valued” between ~$20 million and $100 million, to accelerate regulatory review of the label expansion.
Dropping the boosters
Previous estimates from Airfinity in 2023 indicated that the market would generate sales of $4.7 billion a year by 2030 in the US, working under the assumption that boosters would be offered annually. However, GSK efficacy data was released to show that revaccinated after 12 months did not increase efficacy over a single dose, alongside data on the potential risk of Guillain-Barré Syndrome (GBS) associated with additional doses. If recommendations change in the future to reflect long-term efficacy and safety data, a recommendation for a booster every two or three years could increase the US market value to $6.6 billion or $5.2 billion.
Airfinity’s RSV Lead, Isabella Huettner, commented that the recommendations will “likely stunt revenue growth in the US market” unless new data offer support for the benefit of booster shots. Although global rollout will offer “additional revenue opportunities” for GSK, Pfizer, and Moderna as other countries launch vaccination programmes, the “trend appears to be for a single lifetime vaccine recommendation” for over 75s.
“US market share estimates are difficult to anticipate at this point with different scenarios being possible.”
Huettner believes that GSK is the “most likely to capture the majority of the market in the long term” thanks to “promising efficacy and durability”. Furthermore, although safety concerns “remain until more data become available”, GSK seems to have lower GBS rates than Pfizer.
“It will be interesting to see how Moderna’s vaccine will perform; while durability is lower with only ~50% efficacy after 18 months, as of now no vaccine-attributable cases of Guillain-Barré Syndrome have been observed with the shot. Should additional data confirm improved safety signals for Moderna’s shot, the vaccine could be favoured by some healthcare providers over other options, despite lower durability.”
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