David Loew - Sanofi
Analyst · JPMorgan. Please go ahead.
Yes. Hi, Richard. On the flu high dose, we are indeed already on a very high level of penetration. We have 60% of the elderly above 65 being vaccinated with Fluzone high dose. As you know, Seqirus with FLUAD is trying to get into that space. We feel we have much stronger clinical documentation of the drug with several trials showing not just an immunological effect, but also morbidity and mortality, which has been recently documented in several publications. So we are not thinking that we are completely done on repricing. We think there is still some repricing that we can do based on these recent new trials which have been published. In terms of pricing pressure, it's clear that on the retailers there is a bit of pricing pressure ongoing. So far we think we can hold up pretty well to that in the U.S. Outside of the U.S., in Europe, as you know, Mylan is getting into that space. And on the older form of the TIV vaccines, they have been pretty aggressive on pricing. Now, the good news is that some markets have realized that in fact it's not all in the price of a vaccine. So, for example, Germany got rid of tenders. They just decided that in May in the parliament, as having tendering in flu vaccine has led in the recent years actually to a decrease in vaccination rates. So there is some good news on that. Also with the launch of the QIV vaccine, so the four-in-one, there is of course a repricing opportunity. Regarding now also our recent acquisition, Protein Sciences, that's an important addition to our portfolio because it is a differentiated vaccine, as is Fluzone high dose, and we have shown with Fluzone high dose how we were able to change the market dynamics towards people getting more differentiated flu vaccines. And we believe that Flublok is such a vaccine as it has demonstrated in about 50 years a true differentiation towards standard QIV vaccine. Coming to your second question on Pediatric, we don't believe that there is that much pricing upside. Obviously, if a six-in-one is being launched in the United States and, as you know, we are having a joint venture with MSD on Vaxelis and we are looking at the launch also in the U.S., then there is a repricing opportunity, but that's going to be for a bit later. On Pentacel, we don't think that there is that much repricing opportunity, and it was more a supply situation where we, as you remember, came back into normal supply again last December, which led to a very strong quarter four last year. So in terms of the U.S., I don't think, besides launching a new vaccine, that there is that much repricing opportunity. Outside of the U.S., there is, as you know. with Hexaxim, we are launching that in many markets around the world. And obviously there is a repricing opportunity when you launch a six-in-one vaccine.