Yesterday, PFE disclosed that they expected a 24% uptake in the latest COVID booster. That is below street estimates which sent the stock on a little tumble.
It may not be enough.
PFE properly wrapped the 24% number in caveats which is appropriate given the shot was just approved last week and anecdotes suggest insurance systems have not yet caught up. The problems with hitting that 24% number, however, are legion.
The experience of the bivalent booster makes the most optimistic case. It was released in September of 2022. By May of 2023 - the most recent data available from the CDC - about 17% of the population had taken a dose. Total doses administered through May were 56k. Of that amount about half occurred by the end of October in 2022.
While the bivalent booster attracted negative attention for its limited human data and the CDC's recommendation that it be made available to even young children, it was not as pointed as what has emerged in the wake of the most recent approval. FDA advisory committee member, Dr. Paul Offit has criticized the booster for its limited clinical evidence. Dr. Joseph Ladapo, the Florida Surgeon General has warned residents of possible harms. Dr. Marty Makary, a leading proponent of evidence-based medicine has called the booster approval "insane." The most consistent area of agreement appears to be that the booster may be appropriate for people 75 and over.
These criticisms have not made their way to legacy media outlets where former White House advisor Dr. Ashish Jha has been counterdetailing with claims of safe and effective on Good Morning America. As with many things these days, how you view a topic will depend on your media diet. It is probably worth noting that PFE is a regular advertiser on legacy cable shows.
Nevertheless, public perception of the safety and efficacy of COVID vaccines continues to deteriorate as demonstrated by the slow uptake of the bivalent booster in 2023. It should continue to erode as awareness of the aforementioned doctors' concerns are raised.
While PFE has suggested they estimate the uptake based on flu shots - around 50% - that association seems like a stretch given the significant difference in the technology and the broad population-wide recommendation. Another worry is the steep decline in cases already evident in the positivity data at the CDC.
My best guess is that the COVID uptake gets halved again to around 8%, with at least half of that amount administered in 2023. Of course, the price is better. If we are conservative and assume insurers will pay $130 and about half of doses are administered in the next few months, that means around $1.1B in revenue in very late 3Q and 4Q 2023 for PFE in the US.
The 24% that appears to have some people worried looks like a pipe dream barring an change in public attitudes.
Emily Evans
Managing Director – Health Policy
Twitter
