Operator
Operator
Good afternoon ladies and gentlemen and welcome to the analyst call on the GSK First Quarter 2020 Results. I will now hand you over to Sarah Elton-Farr, Head of Investor Relations, who will introduce today's session.
GSK plc (GSK)
Q1 2020 Earnings Call· Wed, Apr 29, 2020
$54.66
+0.81%
Same-Day
+0.53%
1 Week
+1.29%
1 Month
+0.00%
vs S&P
-4.21%
Operator
Operator
Good afternoon ladies and gentlemen and welcome to the analyst call on the GSK First Quarter 2020 Results. I will now hand you over to Sarah Elton-Farr, Head of Investor Relations, who will introduce today's session.
Sarah Elton-Farr
Management
Thank you. Good morning and good afternoon. Thank you for joining us for our Q1 2020 results, which were issued earlier today. You should have received our press release and can view the presentation on GSK's website. For those not able to view the webcast slides that accompany today's call are located on the Investors section of the GSK website. Before we begin, please refer to slide two of our presentation for our cautionary statement. Our speakers today are Chief Executive Officer, Emma Walmsley; Luke Miels, President, Global Pharmaceuticals; and Iain Mackay, Chief Financial Officer. We have a broader team available for Q&A. We request that you ask only a maximum of two questions so that everyone has a chance to participate. And with that, I will hand the call over to Emma.
Emma Walmsley
Management
Thanks, SEF. And welcome everybody to today's call. First and most importantly, I very much hope that all of you and the people around you are safe and well, and we appreciate you joining us today. We are facing an extraordinary global health threat with enormous direct and indirect consequences. And alongside updating you on our Q1 performance today, I want to start by sharing how we're responding to this. Supporting the global response to COVID-19 is at the heart of GSK's purpose as a company, and our businesses and portfolio are highly relevant and much needed. We've mobilized across the Company to respond to the pandemic, and I'm pleased to report that our Company is performing well and has demonstrated resilience in the face of significant pressures and uncertainty. Our people have been outstanding, showing courage and deep commitment to ensure that our product continues to be made available to patients and the people that need them. Today, we've got over 20,000 essential workers going every day into our manufacturing and R&D sites. We're working hard to make sure our employees stay protected and supportive and are investing in high-frequency communications as well as providing teams with the technology, resources and adjusted policies to support them, whatever their role. We've implemented business continuity plans across all our essential operations. In our supply chains, we’re closely monitoring all parts of our manufacturing network, and our teams have shown tremendous agility to respond quickly to fluctuations in demand. The clinical trials, we've implemented proactive measures to protect study participants, staff at clinical trial sites and our employees, while ensuring regulatory compliance and the scientific integrity of our studies are maintained. While recruitment for clinical trials has slowed due to disruption of the pandemic and diversion of resources to other clinical priorities,…
Luke Miels
Management
Thanks, Emma. And hope you're all well. So, good news is that we've had a strong start in pharma in 2020 with growth in our new products across the portfolio. We did see some impact from COVID-19 towards the end of the quarter in Europe and in the last two weeks of March in the U.S. And this was most notable in HIV, which benefited from customer stockpiling and as you'd expect Ventolin, which saw some stock building, but also increased use. Excluding COVID-19 impacts, the underlying trends are good and new products continue to perform well. And to give you some examples, the Trelegy, we continue to see good growth in the class, and in our share in all key markets. And we expect to get you its approval of asthma later this year. In the case of Nucala, we remain the market leader in the EOS [ph] disease segment. And I'm pleased to say that we're benefiting from strong launches of our home admin, but especially in Europe where we've seen a significant shift. We also have a good -- we have good data in nasal polyps and plan to file in the second half of the year. Benlysta, which is in its 10th year on the market, continues to generate strong double-digit growth and the sub-cut formulation is increasingly important here. And we're pleased that the FDA designated our lupus nephritis indication as a breakthrough this quarter, and filing is planned for later this year. On Zejula, I'll talk to the first line ovarian cancer indication in a minute. But, we are picking up a greater share of new patient starts as we benefit from the operational and execution changes we've made. We've also increased HCP engagement, and actively using the quarter data that was added to…
Iain Mackay
Management
Thanks, Luke. I hope everybody's fit and well today. All the comments I'll make today will be on a constant currency basis, except for specified otherwise, and I'll cover both total and adjusted results. On slide 16 is the summary of the Group's results for Q1, which is a very strong quarter with 19% reported turnover growth, reflecting the addition of the consumer joint venture with Pfizer, turnover growth of 10% on a pro forma basis. As you heard from Emma and Luke, we continued to see strong underlying performance of the business during Q1, even in these challenging circumstances. Additionally, this quarter, we saw turnover growth impacted by COVID-19 pandemic in various areas across our businesses. In pharma, we saw turnover growth of 6%, approximately half to two thirds of which was related to pull-forward in stocking patterns, primarily respiratory in Europe and international, and HIV in the U.S. And consumer turnover grew 11% pro forma, 14%, excluding the impact of brands that are under review or being divested, and around two thirds of which is related to increased COVID-19 demand particularly in the U.S. Finally, vaccines, while we’ve seen some adverse changes in prescription trends in the last few weeks, we did not see any material financial impact in the first quarter. I’ll go into more detail on each of these businesses and the drivers in a moment. Total operating profit was up 42% with total earnings per share up 89%, primarily reflecting the strong operating performance as well as increase in the value of shares in Hindustan Unilever. On an adjusted basis, operating profit was up 24% reported and 14% pro forma, while adjusted earnings per share was up 26%, reflecting both the operating leverage as a result of higher sales, and the one-off impact of a…
Emma Walmsley
Management
Thanks, Iain. So, in summary, the business has performed strongly in the first quarter. Although of course we have uncertainty, especially over the next few months, we're confident we can navigate this crisis by prioritizing our people, business continuity and leading the way on solutions. At the same, time, we remain very-focused on delivering our long-term priorities of innovation, performance and trust our 2020 areas of focus. We're progressing our pipeline. We continue to drive improvements in our operating performance. We're moving at pace with the consumer JV integration. And finally, we started our programs to prepare the Group's separation into two new companies. One, a biopharma company focused on the science of immunology, the other dedicated to everyday consumer health. These two companies’ purposes, priorities and capabilities have never seemed more relevant. Ultimately, we remain confident in the resilience and sustainability of GSK's business, our ability to deliver on our strategic goals and that we can be part of the solution for the COVID-19 pandemic. We're now joined for Q&A by Hal, Brian, David and Roger. And so with that, operator, this team is ready to take your questions.
Operator
Operator
Thank you. [Operator Instructions] And the first question comes from the line of James Gordon, JP Morgan. Please proceed.
James Gordon
Analyst
Great. Thanks for taking the questions. James Gordon, JP Morgan. Two questions, both on vaccine. The first one is about vaccines’ recent performance. If I heard correctly, pharma consumers did give the COVID boost in Q1, I think 4% and 8% and the vaccines’ growth rate was clean. But then, the vaccines pressure probably only really started at the end of the quarter in a way. So, could you talk about what you saw at the end of Q1, so what was the exit rate for vaccine division’s performance, or could you talk about what you’ve seen for April? How much acceleration have you seen already and is the U.S. prescription trend for Shingrix much of a guide or was it a lot more benign than that? And then, the second question also on vaccines was flu. So, we speculate that the governments might want to mandate or much more strongly encourage people to get flu vaccinations this year and for the next few years, because they don't want to deal with flu and COVID at the same time in all the people. But, if that happens, is GSK placed to capitalize on much of that? Could you really scale up your flu vaccines or is that much more challenging because I think yours is A based [ph] and Sanofi’s is cell-based. So, is your vaccine for flu sustainable or can you participate in that also? Thanks.
Emma Walmsley
Management
Thanks. I'm going to pass this to Luke because it's related to commercial and frontline demand. But, headline is, you're right, great demand and a clean performance from vaccines in Q1. But that definitely as both Iain and Luke mentioned, we’re facing a slowdown in Q2 just because of both, healthcare capacity and patients’ enthusiasm for -- or consumers’ enthusiasm for going outside. But, we are expecting rebound and it's not linked to the flu demand in fact. Although you should anticipate a reasonably -- no significant incremental supply on flu from us. But Luke, do you want to talk through the dynamics there?
Luke Miels
Management
Yes, sure. So, James, I'll answer your second question first. So, last year, we sold 46 million doses in the U.S., which was pretty much everything we had allocated. And we've been able to do that consistently because of supply is so far, touchwood, very predictable, which -- purchases like that. But as Emma said, we rely on GMP check-ins, for the source of this and that's the 12-month, at least, notice time. So, there's limited upside for us in the coming flu season. But linked to your other question, there is the benefit of having this flu volume then linking it to the Shingrix recovery. Before I go through specifically individual vaccines and the dynamics there, if you take a medium to longer term picture, I think, we'd all agree that the world is in a way seeing a very unpleasant experiment where you don't have vaccine coverage for quite an aggressive pathogen. So, I think when people reflect on this role and physicians have confidence to suggest vaccination to patients should be increased than it was before COVID-19 emerged. Now, if you look in the U.S., -- actually I’ll go to Europe first. So, Europe, we saw a big drop-off in vaccines; if you look at Spain and Italy, it dropped off. But we're already seeing signs of the early shoots of the recovery, led by pediatric vaccines and that's very clear. Governments are signaling that they want these vaccines recruit very quickly and the U.S. is along with that. If you look at retail pharmacy in the U.S. and doctor visits, so they follow the CDC guidance. When you look at in-home administrations for Shingrix, they dropped by about 90%. But again, I think the key thing here is, we haven't seen a reduction in people wanting…
Operator
Operator
Thank you. Next question is from the line of Steve Scala of Cowen.
Steve Scala
Analyst
Thank you. I have two questions. First, just to be clear, is the Shingrix 2020 guidance, which I think is about flat to slightly up with 2019, still intact? And then second, GSK has 96 recruiting trials on clinical trials.gov. That number is down by only 12 in the last five weeks. These facts don't seem to fit with your cautionary comments on trials overall. So, can you clarify these two points?
Emma Walmsley
Management
Sure. So, I'll come to Hal to comment on the overall trials. And you’re, Steve, that the vast majority of our trials are not significantly impacted today, but Hal will comment in more details. And just to be clear, on the Shingrix guidance, what we guided was maintain run rate plus a bit of the Q4 sales at the end of last year, which would still be certainly not flat year-on-year. So, now -- and that guidance at the moment is unchanged. There's no update to that. We obviously had a strong Q1. We're really pleased with the progress we're making on supply. We do expect Q2 to be tougher because of the drop in rates under containment, but we are with -- the underlying demand is very strong and our supply is on track. So, we think we would be targeting a bounce back as containment is sort of relived. So, there will be no changes there in overall outlook at this state. Obviously, we will update you as we get more information. But, Hal, would you like to comment on the to-date impact on trials, please?
Hal Barron
Analyst
Yes. Well, thanks for the question. I think, the simple answer is that data is consistent with what we said that we haven't really terminated, only a few programs. So, most programs continue to enroll, albeit some of them less robustly than had been previously anticipated. So, as Emma mentioned, one to three months delays for the vast majority. A few have been significantly impacted, more than that, and a couple have been terminated or put on pause. But, I think that data is very consistent with the impact we're seeing, which is a nontrivial. But because of the importance of the programs that we have ongoing and the ability for us to come up with somewhat novel ways of doing these trials, we're confident that the impact is modest.
Operator
Operator
Thank you. The next question is from the line of Geoffrey Porges of SVB Leerink. Please proceed.
Geoffrey Porges
Analyst
Thank you very much and congratulations, by the way on doing all of this and also delivering good results. So, Hal, just on first of all the COVID-19 vaccine efforts. You must be taking a close look at these programs now. Are you confident that you have a surrogate for protection yet? And could you just talk about the scale of safety that you think you will need for general use vaccine? And then, Luke, could you just talk about the upcoming pharmaceutical launches you have? Obviously, Zejula, belantamab. Are you intending to launch, first of all? And secondly, what kind of degree of your typical effectiveness are you expecting, given the way that you're going to have to introduce them more or less on a virtual basis? Thanks.
Emma Walmsley
Management
Okay. We'll come to Luke on the commercial launches and readiness in a new environment first. And then, I think maybe hear from Roger first on the overall vaccine candidates and how we see that space. So, we've got multiple partnerships going on. But, Luke do you want to go first?
Luke Miels
Management
Sure. So, short answer is, premium will go ahead virtually. I think, we can do that quite effectively and being very thoughtful about that. And we've actually started that process with the NCCN and guidelines as well. With BCMA, ideally we'll wait, because it's a novel agent. It's new. So, we would hold back until the restrictions are lifted. I hope that answers your question, Geoff?
Geoffrey Porges
Analyst
Great. Thanks, Luke.
Luke Miels
Management
Hang on. And you also asked about effectiveness. So, yes, I mean, there's lots of consultants running around right now with reports. I think, the data that we've seen just through our own good sell outcomes. So, this measures where the call related and the change in behavior. It's about 20% to 30% on average as effective as a face-to-face call. That being said, there are some very, very interesting outliers where you can see some physicians really, really go with this medium, and we're seeing calls in people we normally might have only seen someone for 10 or 15 minutes drawing their calls out to 35 minutes. Now, that might be because they don't have much to do because they're not seeing many patients. But interestingly, even in some of the more busy physicians like pulmonologists right now, we're seeing longer calls. So, I think it's going to be very stratified by the individual physicians. What they prefer, the bulk of value though is still going to be derived from face-to-face rep calls and HCP events.
Emma Walmsley
Management
Roger?
Roger Connor
Analyst
I think from a vaccines point of view, Emma’s mentioned, collaborations, we believe are going to be key to we think finding a vaccine solution. We've got seven partnerships in place. And I think it's a busy few months ahead as we start to see the data readout in those various candidates. I'd say on your specific questions, I think it's too early to say if there is a surrogate. Obviously, we'll be in discussions with the regulator about that. In terms of the level of safety testing as well, that’s another regulatory discussion that we'll have as we looked ahead and what are quite aggressive accelerated timelines of vaccine development compared to what would normally be considered. What I would say is, with our adjuvant technology, this is a proven adjuvant that has been used before in previous pandemics and has very strong patient safety data and history as well, which means we've got a proven track record here of a platform that can be used for a number of partnerships to develop vaccines going forward.
Operator
Operator
Next question is from the line Andrew Baum of Citi. Please proceed.
Andrew Baum
Analyst
I was listening carefully to how Emma you described GSK taking very seriously the -- I can remember if you said ophthalmic, but you referenced the adverse events associated with belantamab. Perhaps you could share with us now that the FDA has advanced discussions with you, the types of monitoring restrictions as you might expect in the label. I'm more focused on the earlier lines of therapy than the third line, given the commercial opportunity that how restrictive they may be. That would be helpful. And then second, on your HIV franchise, I would imagine switching patients is going to be increasingly problematic if they don’t present in person. So, perhaps you all could talk to maybe Juluca in the current environment -- Dovato, rather, in the current environment?
Emma Walmsley
Management
Yes. So, thanks Andrew. And you're absolutely right. So, we’ll come to David on that. But, the switch market is going to be the bit toughest near term. Hal, why don’t you give a bit more commentary on BCMA and views on that? And then, we'll come back to David.
Hal Barron
Analyst
Yes. Thanks Andrew. I want to be careful our discussions with regulatory agencies are confidential and therefore, I’m not ongoing to comment on the ongoing discussions. But, I think a couple of things are important to remember. The data in this heavily pre-treated refractory/relapsed patient population from DREAMM-2 was very robust and we see the benefit outweighing the adverse events experienced, particularly the ocular ones in the program. What we have noticed, and I've discussed with you and all of you on the call several times before, is that these ocular adverse events are unique. And although they were well managed in the clinical programs, it's important to us to make sure that myeloma experts and eye care professionals in the real world are able to work together to ensure that the drug’s used safely in patients. And of course, we're open to any approach that ensures patient safety is well-handled. In addition to managing it well, we also have, as we move into earlier lines, the opportunity to do more dose exploration when belantamab is added on standard of care therapies or other effective medicines. It's possible that the dose needed will be lowered and therefore managing the unique adverse events through dose reduction is possible. In addition, we're evaluating various schedules that might enable that. And lastly, the one combination that I've mentioned, and this is part of an ongoing proof-of-concept study is, and you're aware of this study, but the really interesting data with the gamma secretase inhibitor is small number of patients and much support from preclinical data looking at inhibiting gamma secretase to prevent the clipping of the BCMA off the plasma cell. And, in CAR-T therapy, this has resulted in a very high response rate, and again, a small number of patients. And we're cautiously optimistic that that combination may even be a third avenue by which we can lower the dose, and in addition manage the ocular adverse events. So, again, we continue to believe the benefits seen in the 2.5 mgs per kg [indiscernible] outweighs the adverse events. But, we take it seriously and are looking at ways to optimize how the drug used in the real world.
Emma Walmsley
Management
David, do you want to talk about the 2DR and switch dynamics, please?
David Redfern
Analyst
Yes, sure. Thanks, Andrew. So, I think, the first point is, of course HIV is a lifetime disease. And patients with HIV of course need to take daily oral medication. Otherwise their viral load will rebound. They can potentially ultimately resist them. And that oral medication is pretty straightforward to renew prescriptions on an outpatient online basis. So overall, we expect the HIV business to be pretty robust and resilient through COVID-19 period. And as we’ve seen pretty strong sales in the first quarter, of course there was some stocking in that [Technical Difficulty] probably about a week of early refills and extra stock coming forward. But, the underlying performance I think was still strong, particularly with 2DRs of £186 million. We're pleased with the progress on the Dovato and Juluca. Dovato now recommended and preferred in the guidelines in the U.S. and in Europe. So, you're obviously right, Andrew. I mean, there is definitely less switching. It was down about 60% in the U.S. I think it is probably down about 40% right now as physicians adjust for new patients, prescriptions online and they're not coming in and being revisited. So, that will kind of lock in the market share for the moment. It probably means, we'll sell a bit more Triumeq and Tivicay, and Dovato will stay stable. But hopefully, once patients get revisited, that will start to rebound. But there is definitely an impact with the switching in the short-term on the 2DRs.
Operator
Operator
Thank you. Next question is from the line of Jo Walton of Credit Suisse. Please proceed.
Jo Walton
Analyst
Thank you. If I can return to a vaccines, in particular your COVID vaccine work. Are you largely related to helping to other people with adjuvants and then doing manufacturing of the resulting vaccine? Just wondering where you have this sort of spare capacity. We know how difficult it is to add capacity for something like Shingrix. And yet between you and Sanofi, you seem to be able to promise hundreds of millions of doses. So, just some sort of help on how that comes about. And if you could give us some sense of, if you're planning on this being an annual or every few years vaccine or whether you think it's likely to be effectively a one and done, even if it's a couple of shorts within that? And secondly, if I can just push you on Shingrix, the level of the RAR that came in there versus the incremental supply. And clearly if we were just to take 4-time the first quarter, we'd be way higher than consensus for the year. I'm just wondering how big the RAR was? Thank you.
Emma Walmsley
Management
Yes. I think, the RAR -- and correct if I wrong, was 50 for the quarter. Is that right, Ian?
Iain Mackay
Management
In the quarter, yes.
Emma Walmsley
Management
In the quarter, it was 50. And obviously -- and there's no change, as we said earlier. So, our overall outlook for the year on Shingrix, we had a great Q1, Q2. It is expected to look a bit different. But again, we're working on the balance. Supply is very much on track with what we've been aiming for. And I completely understand the question in terms of how come we can -- a vaccine -- this normally takes 10 years, it’s 18 months in this kind of capacity provision. I'll ask Roger to explain the very significant differences. And by the way, one of the reasons why -- when the question we were trying to answer is how do you get to a vaccine that works at scale, the best probability of success as fast as possible with COVID is a very different scenario in a pandemic crisis than with a new technology of Shingrix. But perhaps Roger, you can give a little bit more kind of color on that in terms of the difference between that and the Shingrix capacity expansion.
Roger Connor
Analyst
Exactly. Listen -- thanks very much for the question. I think, to be clear, the partnerships that we have in place area adjuvant partnerships. So, we're obviously providing our adjuvant, which for those who don't know, is a separate vial of product that we deliver and is in preclinical and then moving into clinical testing. I think, it's important to know that that adjuvant technology already exists as a proven adjuvant that we have supply before. It’s our adjuvant system number three. So, the supply chain actually already exists for it and is a discrete supply chain, is quite different technically from Shingrix, completely different technology. So, the two aren't interchangeable. And we keep some redundant capacity in it for these very reasons for pandemic preparedness on flu. So, the supply chain is there now. We still have expansion to do. So, to reach the levels that we believe that will be required for the partnerships that we have and for the populations involved, we believe that we will have to expand and that will take time. But, we're not starting from zero, like some other vaccines will have to. I think that's important. Shingrix is also a very much more complex bulk process and also supply chain as well. So, I think that’s the difference. On the seasonality questions as well, I think it's too soon to tell, who knows. But, with the fact that we'll be part of a number of different vaccines hopefully means that if that does become seasonal, we’ll be part of that solution as well.
Operator
Operator
The next question is from the line of Emmanuel Papadakis of Barclays. Please proceed.
Emmanuel Papadakis
Analyst
Maybe wanted to kind of just your perspectives on the data you reported earlier this month in terms the nasal products opportunity. It seemed somewhat at face value inferior to the incumbent competitor in the past. So, perhaps you could just give us some early thoughts in terms of the commercial potential and degree to which that’s synergistic on your current business in severe asthma and timing for that ramp, if any. And then, perhaps the second question just coming back to HIV capital because you said you’re going to refile in the summer. Any color you can give us now in terms of class response, timing could be on the market and then assuming we're back in the semi normalized world, the speed of launch we might anticipate? Thank you.
Emma Walmsley
Management
So, David, do you want to talk about Cab? And then we’ll come Luke for the lifecycle management, commercial potential on Nucala.
David Redfern
Analyst
We’ve had discussions with the FDA on Cab. And as we said today, we expect to resubmit in the middle of the year. We do expect it to be type 2. So, that can take perhaps six months for the FDA to review. So, on that basis, if all goes well, we would expect [Technical Difficulty] back end of this year or the early part of next year. And just remember, this is entirely related to the CMC and particularly data on the specific quality control. It's not related to clinical safety data.
Emma Walmsley
Management
David?
Luke Miels
Management
Yes, sure. So, Emmanuel, great question. I think, the key thing to zone in here, if you can compare our SYNAPSE versus SINUS-24 and 52 with dupilumab, the key area to look here is the number of previous surgeries. So, for a mepolizumab Nucala, a 100% of these patients had had at least one previous surgery, whereas with dupi in SINUS-24 was around 69%, and in SINUS-52, it was 58%, and similar rights for the placebo in both those arms. If you look at three or more previous surgeries, they're very, very resistant disease, complex disease. One in four mepo patients had previous surgeries, three or more previous surgeries where that was 23% and 15% respectively in SINUS-24 and 52. So, our thinking is that the numeric differences there are really driven by a difference in patient populations with 34% of patients in GP studies had no previous nasal polyps surgery and therefore had less persistent polyps, which may theoretically be more easy to treat. In terms of the opportunity, I would say, if you look about five years out, it's probably £80 million to £100 million of the opportunity. So, it's a nice add-on, it reinforces the product, but it's not transformational in itself.
Emma Walmsley
Management
Thanks, Luke. Next question, please?
Operator
Operator
Next question is from the line of Kerry Holford of Berenberg. Please proceed.
Kerry Holford
Analyst
Hi. A couple of questions for me please. Firstly on SG&A. Some of your global peers’ reported SG&A figures were lower than the previous run rate. As what happened with you in this year quarter, is it something we should anticipate being more apparent in to Q2, are you seeing a significant decrease in your spend, travel projects, and then likely that's simply being reinvested into digital and telemarketing? And then secondly, thinking about utilization, particularly in the U.S., how do you think about the rest of your business, rising U.S. unemployment, and could the effective negative payer mix shift is significant to you this year, if not next? And I wonder if you would comment on which of your products may be at risk.
Emma Walmsley
Management
I'm going to ask Luke to comment for both. It’s very much in the bucket of sort of unknown, although clearly unemployment figure is significant. But in terms of direct impact, and I'm not sure we’re going to give a lot of detail to which product. But, Luke, talk a bit about the shifting mix. And just in terms of SG&A, I think part of that growth came from either one-off legals or TESARO. Is that right, Ian?
Iain Mackay
Management
Yes. That's right.
Emma Walmsley
Management
So, clearly, our goal is to invest behind our new launches and oncology preparedness and make sure that non-customer facing costs just keep coming down. And obviously, we're going to make savings in travel, like everybody is. And as Q2 experiences what it does, we’d expect that to stay a lot in control. But, exactly, I said, we're very vested in making sure we have faster as opening -- markets do open up, and the investment in digital is ongoing. And obviously, we’re not making COVID-related redundancies. But Luke, do you want to talk a little bit about...
Luke Miels
Management
I mean, you can imagine we're looking at this very, very closely. As Emma said, it’s very hard to predict. But if I could just lay out our thinking, and I'll just take you through the products after that. So, as you know, if you get laid off in the U.S., you have the option of COBRA to bridge your commercial insurance. Some people are going to go into the Obamacare health exchanges and people can enroll in those. And then unfortunately, some people may fall into the Medicaid category or that may be expanded. What's interesting is Congress did provide subsidies for COBRA in 2008, but they don't seem to be signaling that they're going to do this in 2020. And also, let's not forget that employees who are furloughed, they lose their salary, but so far not their health insurance and there's good examples with Disney and other companies like that that are doing that. So, we're trying to calculate where everyone will land and it's really hard at this stage. I mean, the baseline, if you look at right now, we think it's about a reduction of 9 million so far. So, that's roughly where we think it is. But yes, I think it depends, with bankruptcies -- I mean, companies can still provide insurance on the bankruptcies, unless they choose to walk away from their plan, and then people aren't eligible for COBRA at that point. So, Chapter 11 doesn't necessarily mean that you lose your benefits. Now, in terms of the products, the ones which have the higher commercial component Breo, Advair, Flovent and Ventolin. So, they're the ones which obviously we’ll watch closely. Nucala it a bit lower. I mean, there may be some impact on biologics because they're a bit more expensive. But…
Operator
Operator
Thank you. Our last question comes from the line of Graham Parry, Bank of America. Please proceed.
Graham Parry
Analyst
So, just then firstly on Shingrix, just wanted to square a couple of comments. So, you said the full-year guide is unchanged with Q1 was running quite a long way, well above the fourth quarter, plus a bit rate. So, is that a little conservative in the Q1 -- sorry in the full year guidance in Q1 capacity, though indicative of what you think you can actually produce through the year? And you also said, you expect an impact in 2Q, but also fact that the April orders are being filled. So again, is that just sort of anticipating some sort of drop-off down in April? And then secondly, in your comments around COVID impact, you specifically mentioned supply chain manufacturing as a COVID risk. And I'd say that's an area that most of the companies have been perhaps more robust in their statements on. Is this because of their particular difference in GSK supply chain vulnerability or just a different communication style in terms of communicating with the market? Thank you.
Emma Walmsley
Management
I suspect. Thanks, Graham. So first of all, on Shingrix, there's no change to our outlook because as we said, we've had a very -- we're actually on track with our supply plans. We have had a strong quarter, but there is no question, Q2 will be tougher when -- as Luke said, the vaccination rates drop by 80% to 90% in the U.S. market. The signals from wholesalers in the first two ordering dates of April are positive signals on the underlying demand, but that is going to flow through, but it's a signal of the confidence of a bounce back. So, we do think the curve will be differently shaped and we'll obviously update you as we go through the year and results come through. And in terms of supply chain, I certainly won’t be signaling any specific concern. You may be right in terms of different company talks and communications. We think we've got a very robust supply chain and we're really pleased with the way of 70-plus factories are mobilized to fluctuating demand. We just want to make sure that we are responsibly signaling the potential risks with a lot of uncertainty in the world. And this may be related to third-party suppliers or indeed government actions that one can imagine in the external environment, perhaps more fundamentally than internally. But no, no specific concerns that we're looking to flow.
Iain Mackay
Management
I think I’d only add there, our commentary in the earnings release, Graham, is directly responsive to guidance from both the SEC and the FRC in terms of laying out the risk that may be forward-looking. But I'd echo completely Emma's comments with respect to the resilience and the performance of our supply chain.
Emma Walmsley
Management
Okay. So, with that everybody, again, thank you very much for taking the time to join us. Please do stay well. And we'll look forward to catching up with you soon.
Operator
Operator
Thank you. Everyone, that concludes the call. You may now disconnect. Thank you joining us.