Genetic EYE ON THE MARKET MICHAEL CEMBALEST J.P. …

EYE ON THE M ARKET • M I CHAEL CEMB ALEST • J .P . MORG AN Last u p dat e d 6/1 0/2 022

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1

[1] Vaccination update

Table of Contents:

1. Vaccine types and locations ...........................................................................................................................2

2. “A pandemic (mostly) of the unvaccinated”: adverse outcomes in unvaccinated vs vaccinated people .............3

3. Vaccination overview .....................................................................................................................................7

4. Variant prevalence by country ...................................................................................................................... 10

5. New vaccines and antivirals ......................................................................................................................... 11

Latest Update:

Eric Topol at Scripps Research published this table on Omicron variants that are rapidly comprising a larger share of infections. Key points:

Significant increase in transmissibility vs Omicron BA.1

Higher immunity escape (susceptibility to virus despite vaccination or prior infection)

Reduced cross immunity with BA.1 (if you had BA.1 you can still get infected with these new variants)

More resistant to monoclonal antibodies

3 shot effectiveness vs hospitalization of ~80% is still high compared to 90%+ for pre-Omicron variants but 2 shots doesn’t look good

No news yet on effectiveness vs more recent variants

Omicron specific vaccine may be released soon, but effectiveness vs variants with high immunity escape is uncertain

Omicron variant update BA.1 BA.2 BA.2.12.1 BA.4 and BA.5

Transmissibility increase Reference 30% increase 25% over BA.2 ~10% over BA.2

Immune escape Reference + +++ +++

Ability to infect cells Reference + ++ Like BA.1

Cross-Immunity w/ BA.1 Reference Mostly preserved Reduced Reduced

Resistance to monoclonal

antibodiesReference ++ +++ +++

Places where dominant Outcompeted >100 countries US regions (NJ, NY) South Africa

2-shot effectiveness vs

hospitalizations

32%

(95% CI 11, 49)

50%

(95% CI 7, 73)TBD TBD

3-shot effectiveness vs

hospitalizations

81%

(95% CI 75, 85)

83%

(95% CI 71, 91)TBD TBD

Source: Eric Topol, Scripps Research. May 4, 2022.

https://itunes.apple.com/us/podcast/eye-on-the-market/id1367963156

EYE ON THE M ARKET • M I CHAEL CEMB ALEST • J .P . MORG AN Coronavirus

2

Vaccine types and locations

The table outlines the approaches that vaccine companies are taking to provoke an antibody response. Vaccines train the immune system to recognize the disease-causing part of a virus so that when people are infected, their bodies are prepared to fight the virus with a combination of antibody and T-cell responses. Historically, most vaccines contained either weakened viruses or the signature proteins of the virus (Types 1, 2 and 3), but the first approved vaccines for COVID were genetic (Types 4 and 5).

TypeMethod of provoking antibody response

to SARS-CoV-2

Drug companies

(bold = approved)

Existing licensed

vaccines

1

Attenuated

A live but weakened coronavirus that will infect cells and cause

them to make viral proteinsCodagenix

Measles, yellow fever,

mumps, smallpox, polio

2

Attenuated

A "killed" coronavirus that will get recognized as foreign matter

by the immune system

Sinovac1, SinoPharm2,

Covaxin3Polio (dev countries)

3

Recombinant

Recombinant coronavirus proteins, produced industrially in

outside cell cultures, which are recognized as foreign matter by

the immune system

GlaxoSmithKline/Sanofi,

Novavax4

Tetanus, pertussis, flu,

shingles

4

Genetic

(vector vaccines)

A different virus (human or ape adenovirus, measles, etc) that is

engineered to include genetic components coding for the SARS-

CoV-2 spike proteins, which causes the body to produce them

CanSino5,

Oxford/AstraZeneca6,

J&J7, Gamaleya8

Ebola

5

Genetic

DNA or RNA that will be taken up by cells and will cause them to

make coronavirus proteins

Moderna, Inovio,

BioNTech/Pfizer

1: Sinovac has been approved for use in China, Hong Kong, Indonesia, Philippines, Brazil, Chile, Mexico, Turkey and several other countries

2: Sinopharm has been approved in China, UAE, Bahrain, Egypt, Hungary and Jordan and several other countries

3: Covaxin has been approved for emergency use in India, Iran, Philippines, Paraguay, Guatemala and several other countries

4: Protein vaccines are not new, but the Novavax vaccine is combined with a proprietary adjuvant which has not been approved for use before

5: CanSino has been approved for use in China, Mexico, Pakistan, Argentina, Chile, Indonesia, and several other countries

6: Oxford/AstraZeneca's vaccine has been approved for use in the UK, Europe, South Africa, Brazil, Chile, and several other countries

7: J&J's vaccine has been approved for use in the US, UK and more than 60 other countries.

8: Gamaleya's vaccine has been approved in Russia, Argentina, Venezuela, Mexico, Hungary, Iran, UAE, and several other countries

Source: J.P. Morgan Asset Management. 2021.

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0%

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20%

30%

40%

50%

60%

70%

80%

90%

100%

Novavax

Sputnik V

Sinovac

Sinopharm

CanSino

Johnson&Johnson

Oxford/AstraZeneca

Moderna

Pfizer/BioNTech

Vaccine type usage by country% of doses administered

Source: OWID, JPMAM. June 10, 2022.



3

“A pandemic (mostly) of the unvaccinated”: adverse outcomes in unvaccinated vs vaccinated people

Age and population adjusted data on vaccinated and unvaccinated people

The first two charts show COVID hospitalization and mortality outcomes from multiple states as reported by COVID-NET (250 acute care hospitals) and by select state health departments reporting directly to the CDC. The subsequent charts show the same gaps for states that publish high-frequency downloadable information to the public. Other states like Michigan, Georgia, Pennsylvania, Texas, Alaska and Arizona also publish this data, but in PDF form that also tends to be more dated; the trends are similar. As the Omicron variant spreads, these charts will be important markers of evolving vaccine efficacy and risks to the unvaccinated.

0

20

40

60

80

100

120

140

160

180

Jan '21 Mar '21 May '21 Jul '21 Sep '21 Nov '21 Jan '22 Mar '22

Unvaccinated

Fully vaccinated

Age adjusted hospitalizations: 250 acute-care hospitalsDaily hospital admissions, # per mm

Source: CDC, JPMAM. March 19, 2022. Universe: CA, CO, CT, MD, MI, MN, NM, NY, OH, OR, TN, UT.

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5

10

15

20

25

30

35

Apr-21 Jun-21 Aug-21 Oct-21 Dec-21 Feb-22

Unvaccinated

Fully vaccinated

Age adjusted mortality: 20 US statesDaily deaths, # per mm

Source: CDC. February 19, 2022. Universe: AL, AZ, AR, CO, CT, FL, GA, ID, IN, LA, MD, MA, MI, NE, NM, NY, PA, RI, TN, UT.

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25

50

75

100

125

150

175

200

225

Nov '21 Dec '21 Jan '22 Feb '22 Mar '22

Unvaccinated

Fully vaccinated

Fully vaccinated with booster

250 acute-care hospitals: 50-64 year old hospitalizationsDaily hospital admissions, # per mm


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100

200

300

400

500

600

700

800

Oct '21 Nov '21 Dec '21 Jan '22 Feb '22

Unvaccinated

Fully vaccinated


250 acute-care hospitals: 65 and older hospitalizationsDaily hospital admissions, # per mm


0%

10%

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40%

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60%

70%

80%

90%

100%

0

5,000

10,000

15,000

20,000

25,000

May '21 Jul '21 Sep '21 Nov '21 Jan '22 Mar '22 May '22

Unvaccinated (lhs)

Fully vaccinated (lhs)

Age-adjusted vaccine efficacy (rhs)

New York: infectionsDaily infections, # per million %

Source: NY Department of Health, JPMAM. May 8, 2022.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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100

200

300

400

500

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800

May '21 Jul '21 Sep '21 Nov '21 Jan '22 Mar '22 May '22

Unvaccinated (lhs)

Fully vaccinated (lhs)

Age-adjusted vaccine efficacy (rhs)

New York: hospitalizationsDaily hospital admissions, # per million %

Source: NY Department of Health, JPMAM. May 8, 2022.



4

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Aug '21 Oct '21 Dec '21 Feb '22 Apr '22

Not fully vaccinated

Overall

Fully vaccinated


Seattle: age adjusted infectionsDaily infections, # per mm, smoothing = 7 days

Source: Washington Department of Health. May 25, 2022.

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20

40

60

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100

120

140

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180

200

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240

260

Aug '21 Oct '21 Dec '21 Feb '22 Apr '22


Fully vaccinated

Overall


Seattle: age adjusted hospitalizationsCurrent hospitalizations, # per mm, smoothing = 7 days

Source: Washington Department of Health. May 25, 2022.

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20

40

60

80

100

120

140

160

180

Mar '21 May '21 Jul '21 Aug '21 Oct '21 Dec '21 Mar '22 May '22

Unvaccinated

Fully vaccinated


California: hospitalizationsDaily hospital admissions, # per mm

Source: California Department of Health. May 8, 2022.

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5

10

15

20

25

30

Mar '21 May '21 Jul '21 Aug '21 Oct '21 Dec '21 Mar '22 May '22

Unvaccinated

Fully vaccinated


California: mortalityDaily deaths, # per mm

Source: California Department of Health. May 8, 2022.

0

100

200

300

400

500

600

Feb '21 Apr '21 Jun '21 Aug '21 Oct '21 Dec '21 Feb '22 Apr '22

UnvaccinatedPartially vaccinatedFully vaccinated

Virginia: hospitalizationsWeekly hospital admissions, # per mm

Source: Virginia Department of Health. May 7, 2022.

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50

100

150

200

250

Feb '21 Apr '21 Jun '21 Aug '21 Oct '21 Dec '21 Feb '22 Apr '22

UnvaccinatedPartially vaccinatedFully vaccinated

Virginia: mortalityWeekly deaths, # per mm

Source: Virginia Department of Health. May 7, 2022.

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100

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700

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Mar '20 Sep '20 Mar '21 Sep '21 Mar '22

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Fully vaccinated


Utah: age adjusted hospitalizationsWeekly hospital admissions, # per mm

Source: Utah Department of Health. May 8, 2022.

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40

60

80

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120

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Mar '20 Sep '20 Mar '21 Sep '21 Mar '22

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Fully vaccinated


Utah: age adjusted mortalityWeekly deaths, # per mm

Source: Utah Department of Health. May 1, 2022.



5

Latest data from the Robert Koch Institute

0

500

1,000

1,500

2,000

2,500

Jul '21 Sep '21 Nov '21 Jan '22 Mar '22

Unvaccinated

Fully vaccinated


Germany: 60 and older infectionsCurrent infections, # per mm

Source: Robert Koch Institute. April 28, 2022.

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UnvaccinatedFully vaccinatedFully vaccinated with booster

Germany: 60 and older hospitalizationsCurrent hospitalizations, # per mm


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100%


60+ years old with booster

18-59 years old with booster

60+ years old

18-59 years old

Germany: Vaccine efficacy against symptomatic infection


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60+ years old

18-59 years old

Germany: Vaccine efficacy against hospitalization


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Germany: Vaccine efficacy against ICU admission


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60+ years old

Germany: Vaccine efficacy against mortality




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0

20

40

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100

120

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180

Jan '21 May '21 Aug '21 Nov '21 Mar '22

Unvaccinated

Fully vaccinated

Fully vaccinated + booster

Switzerland: mortality

Source: OWID, JPMAM. May 14, 2022.

Weekly deaths, # per mm

0

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Aug '21 Sep '21 Nov '21 Dec '21 Feb '22 Apr '22 May '22


Fully vaccinated

Fully vaccinated + booster

Chile: mortality

Source: OWID, JPMAM. May 14, 2022.

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OECD countries by highest share of unvaccinated peopleNot fully vaccinated people as % of population

Source: OWID, JPMAM. Jun 9, 2022. Largest 25 OECD countries by GDP

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Current hospitalizations vs boosted populationCurrent hospitalizations per mm, 7 day avg

Source: OWID, JPMAM. Jun 9, 2022. Largest 25 OECD countries by GDP



7

Vaccination overview

Our World in Data (OWID) is a project of the Global Change Data Lab and the University of Oxford focusing on aggregating data for public use. OWID’s international COVID-19 vaccination dataset aggregates vaccination reports from government agencies and health ministries across 200 countries and territories.

0%

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40%

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60%

70%

80%

Jan '21 Apr '21 Jul '21 Oct '21 Jan '22 Apr '22 Jul '22

Unique people vaccinated

Fully vaccinated

Fully vaccinated w/ booster

US vaccination progress% of US population

Source: OWID, JPMAM. June 9, 2022. Dotted lines indicate estimated vaccination rate based on trailing 7-day average vaccination rate.

0.0

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1.0

1.5

2.0

2.5

3.0

3.5

Jan '21 Mar '21May '21 Jul '21 Sep '21 Nov '21 Jan '22 Mar '22May '22

US daily vaccinationsMillions of people, 7-day average

Source: OWID, CDC, JPMAM. June 10, 2022.

Partial vaccinations(1st of 2 doses)

Full vaccinations

(2nd of 2 doses)

Full vaccinations

(1 dose) Boostershots

South AfricaRussia

IndonesiaMexicoTurkey

CzechiaIndia

United StatesNetherlands

IsraelSaudi Arabia

United KingdomSweden

GermanyBrazil

ItalyJapan

FranceVietnam

IrelandDenmark

CanadaMalaysia

Hong KongAustralia

New ZealandPortugal

South KoreaChinaChile

AfricaM East

EM Asia ex-ChinaSouth/Central America

Developed RegionsContinental W. Europe

Dev Asia

South AfricaRussiaIndonesiaMexicoTurkeyCzechiaIndiaUnited StatesNetherlandsIsraelSaudi ArabiaUnited KingdomSwedenGermanyBrazilItalyJapanFranceVietnamIrelandDenmarkCanadaMalaysiaHong KongAustraliaNew ZealandPortugalSouth KoreaChinaChile

AfricaM EastEM Asia ex-ChinaSouth/Central America Developed RegionsContinental W. EuropeDev Asia

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%

% of population

Fully vaccinated w/ booster Fully vaccinatedCountry/region vaccination rates




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RI

VT

ME

CT

MA

DC HI

NY

MD

NJ

VA

WA

CA

NM

NH

CO

OR

DE

MN

PA IL FL

US

A

WI

UT

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AK IA SD

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KS

NV MI

OH

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OK

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AR

TN

LA

MS

AL

WY

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%Fully vaccinated

Fully vaccinated w/ booster

Percent of population fully vaccinated and received boosterSorted in descending order by highest vaccination rate


Fully vaccinated people as percent of population

State RI VT ME CT MA DC HI NY MD NJ VA WA CA

Total population 83% 82% 80% 80% 80% 79% 79% 78% 76% 76% 74% 73% 73%

18-64 population 91% 86% 87% 87% 86% 83% 86% 86% 83% 84% 80% 80% 80%

18+ population 92% 88% 89% 89% 88% 85% 88% 88% 86% 86% 83% 83% 82%

65+ population 95% 95% 95% 95% 95% 95% 93% 93% 95% 94% 94% 95% 91%

State NM NH CO OR DE MN PA IL FL WI UT NE AK


18-64 population 78% 75% 77% 75% 75% 75% 74% 75% 72% 70% 75% 70% 71%

18+ population 82% 80% 80% 79% 80% 79% 79% 78% 77% 76% 78% 75% 74%

65+ population 95% 95% 94% 92% 95% 95% 95% 89% 92% 95% 94% 93% 87%

State IA SD NC AZ TX KS NV MI OH WV OK KY SC


18-64 population 67% 68% 66% 67% 70% 68% 68% 64% 63% 61% 64% 63% 61%

18+ population 73% 74% 72% 71% 73% 73% 72% 70% 68% 67% 69% 68% 67%

65+ population 94% 95% 94% 87% 88% 93% 85% 89% 88% 85% 89% 87% 88%

State MT MO ND ID IN GA AR TN LA MS AL WY USA


18-64 population 60% 61% 61% 60% 60% 61% 60% 59% 59% 57% 55% 55% 72%

18+ population 66% 66% 67% 66% 66% 66% 65% 65% 65% 63% 62% 61% 75%

65+ population 87% 85% 87% 88% 87% 84% 81% 85% 86% 84% 83% 85% 88%Source: OWID, CDC, JPMAM. June 9, 2022.



9

The table shows the number of people with at least 1 vaccination (referred to as unique people vaccinated), fully vaccinated individuals (which includes people who received a vaccine from a manufacturer with a 1-shot regimen such as J&J), and boostered individuals (people who completed the initial vaccine regimen and then received another shot). Partial vaccine completion tends to result in lower efficacy, with outcomes closer to unvaccinated people than fully vaccinated people. Vaccine efficacy varies substantially by manufacturer; as a result, the vaccinated share of the population is only a partial marker for protection and disease severity.

Unique ppl

vax (mm)

% of

pop.

Full vax

(mm)

% of

pop.

Boosters

(mm)

% of

pop.

Algeria 8.21 19% 6.85 16% 0.51 1%

Argentina 41.12 91% 37.49 83% 25.51 56%

Aruba 0.09 81% 0.08 75% - -

Australia 22.33 88% 21.63 85% 13.79 54%

Austria 6.83 76% 6.62 73% 5.27 59%

Bahamas 0.17 43% 0.16 41% 0.03 7%

Bahrain 1.24 73% 1.22 72% 0.99 58%

Bangladesh 129.11 78% 118.18 72% 24.04 15%

Belgium 9.25 80% 9.15 79% 7.51 65%

Belize 0.24 59% 0.21 53% 0.05 12%

Bermuda 0.05 81% 0.05 79% 0.04 59%

Bhutan 0.69 90% 0.67 87% 0.54 71%

Bolivia 7.21 62% 5.98 51% 1.58 14%

Botswana 2.17 92% 1.99 85% 0.37 16%

Brazil 184.25 87% 167.91 79% 99.87 47%

Brunei 0.44 100% 0.43 97% 0.30 69%

Bulgaria 2.09 30% 2.06 30% 0.76 11%

Cambodia 15.05 90% 14.33 86% 9.26 55%

Canada 32.75 87% 31.41 83% 21.64 57%

Chile 17.98 94% 17.54 92% 22.85 ####

China 1,290.84 90% 1,257.20 87% 779.98 54%

Colombia 42.29 83% 35.96 71% 12.46 24%

Costa Rica 4.44 87% 4.14 81% 2.30 45%

Croatia 2.31 56% 2.24 55% 0.59 14%

Cuba 10.67 94% 9.97 88% 7.30 64%

Czechia 6.96 65% 6.88 64% 4.22 39%

Denmark 4.83 83% 4.80 83% 3.64 63%

Dominican Rep. 7.23 67% 5.99 55% 2.36 22%

Ecuador 15.17 86% 13.99 79% 6.79 38%

Egypt 47.85 47% 35.33 35% 3.59 4%

El Salvador 4.61 71% 4.31 66% 1.92 30%

Estonia 0.86 65% 0.85 64% 0.47 36%

Ethiopia 24.77 22% 21.29 19% 0.35 0%

Finland 4.51 81% 4.33 78% 3.24 58%

France 54.42 83% 52.84 81% 38.64 59%

Georgia 1.63 41% 1.27 32% 0.08 2%

Germany 64.55 77% 64.52 77% 54.87 65%

Greece 7.92 76% 7.63 73% 6.07 58%

Guatemala 8.26 46% 6.27 35% 3.09 17%

Honduras 6.21 63% 5.44 55% 2.55 26%

Hong Kong 6.71 89% 6.36 85% 4.18 56%

Hungary 6.41 66% 6.20 64% 4.18 43%

Iceland 0.31 91% 0.29 85% 0.25 74%

India 1,012.87 73% 895.98 65% 36.38 3%

Indonesia 200.65 73% 167.82 61% 46.91 17%

Iran 64.55 77% 57.86 69% 27.55 33%

Ireland 4.09 83% 4.04 82% 3.06 62%

Israel 6.71 77% 6.14 71% 5.31 61%

Italy 50.79 84% 47.94 79% 40.71 67%

Jamaica 0.81 27% 0.70 24% 0.04 1%

Japan 103.64 82% 102.17 81% 76.26 60%

Kazakhstan 9.51 51% 9.29 49% 2.51 13%

Kenya 16.00 30% 12.64 24% 0.33 1%

Kuwait 3.43 80% 3.31 78% 1.31 31%

Laos 5.82 80% 5.08 70% - -


Unique ppl

vax (mm)

% of

pop.

Full vax

(mm)

% of

pop.

Boosters

(mm)

% of

pop.

Lebanon 2.69 39% 2.36 35% 0.59 9%

Libya 2.25 33% 1.17 17% 0.11 2%

Lithuania 1.95 72% 1.88 69% 0.93 34%

Malaysia 28.00 87% 27.11 84% 16.11 50%

Maldives 0.40 74% 0.38 71% 0.16 30%

Malta 0.48 100% 0.47 100% 0.39 90%

Mexico 88.05 68% 79.95 62% 53.06 41%

Morocco 24.93 68% 23.41 63% 6.43 17%

Myanmar 31.35 58% 26.11 48% 2.00 4%

Namibia 0.65 26% 0.58 23% 0.06 3%

Nepal 22.46 77% 19.97 69% 5.06 17%

Netherlands 12.81 75% 11.98 70% 9.28 54%

New Zealand 4.29 89% 4.11 85% 2.70 56%

Nigeria 30.68 15% 20.10 10% 0.94 0%

Norway 4.34 80% 4.04 75% 2.95 55%

Pakistan 135.41 61% 123.69 56% 9.62 4%

Panama 3.48 81% 3.11 72% 1.69 39%

Paraguay 3.94 55% 3.44 48% 1.43 20%

Peru 29.37 89% 27.36 83% 18.64 57%

Philippines 74.63 68% 70.01 64% 14.25 13%

Poland 22.73 60% 22.50 59% 12.12 32%

Portugal 9.72 95% 8.87 87% 6.51 64%

Qatar 2.63 91% 2.63 91% 1.64 57%

Romania 8.17 42% 8.11 42% - -

Russia 81.10 56% 74.00 51% 14.36 10%

Saudi Arabia 26.60 76% 24.96 72% 10.79 31%

Serbia 3.35 38% 3.28 37% 1.90 22%

Seychelles 0.08 85% 0.08 81% 0.04 38%

Singapore 5.02 86% 4.99 85% 4.14 71%

Slovakia 2.82 52% 2.77 51% 1.65 30%

Slovenia 1.27 61% 1.22 59% 0.66 32%

South Africa 21.86 37% 18.88 32% 3.29 6%

South Korea 45.06 88% 44.60 87% 37.56 73%

Spain 41.24 88% 40.51 87% 25.11 54%

Sri Lanka 17.07 80% 14.52 68% 7.99 37%

Sweden 7.84 78% 7.65 76% 5.40 53%

Switzerland 6.09 70% 6.00 69% 3.76 43%

Taiwan* 21.08 88% 19.09 80% 15.89 67%

Thailand 56.58 81% 52.62 75% 28.40 41%

Trinidad and Tobago 0.75 54% 0.71 51% 0.16 11%

Tunisia 7.23 61% 6.37 54% 1.26 11%

Turkey 57.84 69% 53.07 63% 36.82 44%

Ukraine 15.77 36% 15.15 35% 0.74 2%

United Arab Emirates 9.89 100% 9.70 98% 5.29 53%

United Kingdom 53.49 79% 50.00 74% 39.75 59%

United States 258.85 78% 221.60 67% 119.37 36%

Uruguay 2.99 86% 2.88 83% 2.63 76%

Uzbekistan 19.46 58% 15.23 46% 7.59 23%

Venezuela 22.16 78% 14.29 50% 0.65 2%

Vietnam 84.80 87% 79.46 82% 58.35 60%

Zambia na na 3.88 21% 0.03 0%

Zimbabwe 6.26 42% 4.55 31% 1.02 7%




10

Variant prevalence by country

The table shows variant prevalence for select countries from GISAID, an open-source global science information sharing initiative. Only a handful of countries are sequencing more than 250 people per month, which is the threshold we use for inclusion. GISAID data may reflect data aggregated two weeks prior. In a world of rapidly changing variant shares, the numbers can change a lot when they’re updated.

Prevalence of variants of interest or concern in countries with significant sequencing in past 4 weeksB.1.1.7 - Alpha

(UK)

B.1.1.529/BA.2 - Omicron

(S Afr/Botswana)

B.1.640

(Congo/France)

B.1.617 - Delta

(India)

Australia 0.0% 100.0% 0.0% 0.0%

Belgium 0.0% 99.9% 0.0% 0.0%

Brazil 0.0% 99.8% 0.0% 0.0%

Canada 0.0% 100.0% 0.0% 0.0%

Costa Rica 0.0% 100.0% 0.0% 0.0%

Czech Republic 0.0% 100.0% 0.0% 0.0%

Denmark 0.0% 100.0% 0.0% 0.0%

France 0.0% 99.9% 0.0% 0.0%

Germany 0.0% 100.0% 0.0% 0.0%

India 0.0% 100.0% 0.0% 0.0%

Ireland 0.0% 100.0% 0.0% 0.0%

Italy 0.0% 99.9% 0.0% 0.0%

Japan 0.0% 100.0% 0.0% 0.0%

Mexico 0.0% 100.0% 0.0% 0.0%

Netherlands 0.0% 99.9% 0.0% 0.1%

Norway 0.0% 100.0% 0.0% 0.0%

Portugal 0.0% 100.0% 0.0% 0.0%

Poland 0.0% 100.0% 0.0% 0.0%

Singapore 0.0% 100.0% 0.0% 0.0%

South Africa 0.0% 97.8% 0.0% 1.8%

Spain 0.0% 99.9% 0.0% 0.1%

Sweden 0.0% 100.0% 0.0% 0.0%

Switzerland 0.0% 100.0% 0.0% 0.0%

Thailand 0.0% 100.0% 0.0% 0.0%

United Kingdom 0.0% 100.0% 0.0% 0.0%

United States 0.0% 100.0% 0.0% 0.0%

Source: GISAID, CDC. June 10, 2022. Includes countries with 250 or more total genomic sequences analyzed over trailing 4

weeks. Table does not show prevalence of specific mutations e.g. the D614G mutation, which was found in many circulating

variants in 2020.



11

New vaccines and antivirals

Pfizer expects to deliver an Omicron-specific vaccine by March 2022. mRNA vaccines are relatively easy to alter compared to other vaccine types. Once the change is made to recognize the new spike protein, only 2 dozen people need to enroll in a trial to make sure the updated vaccine works after which it can be distributed (i.e., no need for Phase III trials and/or regulatory approval). This process could take 4-6 weeks. As you can imagine, the process of revaccinating everyone for a new variant would be logistically challenging if required

Some very good news now that that the clinical trial data for Pfizer’s COVID antiviral pill Paxlovid is available:

Paxlovid does not rely on the body’s immune system to combat the virus: it directly binds to the SARS-Cov-2 main protease before the virus begins high-level replication

The part of the virus that Paxlovid binds to has only undergone 1 mutation, rather than the 30 that occurred in the spike protein

Paxlovid must be taken within 3-5 days of symptom onset, and is taken with twice a day for 5 days along with Ritonavir (another viral protease inhibitor)

Trial results: reduced hospitalization risks by 89% in unvaccinated high risk patients, 94% risk reduction for those over 65. For lower risk individuals and vaccinated people, hospitalization risks declined by 70%

Trials were conducted during summer Delta wave; Pfizer believes based on lab studies that Paxlovid should retain “robust antiviral activity” vs Omicron

The FDA issued an emergency use authorization for Paxlovid in December 2021



12

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