Vaccines Market Opportunity Assessment

With focus on

HBV & Influenza Vaccines Market

Asia Pacific

2

02• Executive Summary

Key Findings

3

Executive Summary: Key Findings

The key Asia Pacific markets have an estimated vaccine market size of USD 2.3 billion in 2008 (50% of which is Japan), and this is forecast to grow to USD 3.0 billion by 2010. Approximately two thirds of this market consists primarily of prophylactic vaccines (mainly paediatric), which

have some form of reimbursement or subsidy from most Governments

Prevention programs are high on the agenda of all Governments, and neonatal vaccinations programs are either in place, or will soon be in place for major preventive diseases like Hepatitis B. This is expected to lead to a drop in incidence over the next 20 years. However, programs for

vaccines like pneumonia are not in place, and depend on patient awareness (which is low)

Markets like China, India and Japan are dominated by local players, while Hong Kong, Korea, Taiwan and Thailand are dominated by MNCs. Public-private partnerships are the trend in Asia,

and is one of the factors for successful market penetration, especially in China and Japan.

China, India and Japan have numerous local R&D based players that have strong pipelines with innovative vaccines, and these local production lines are expected to boost market supply of

vaccines significantly by 2012

Physician choice vaccines is primarily driven by Government policies and relationship with Government/state, and this is a crucial factor to success. The public sector is the highest user of vaccines – the private market is relatively low (<30% of value) with the exception of Korea

Pricing of vaccines purchased by the Government is very low at ~10% of the private market price (e.g. ~ USD 3-9 per course of HBV prophylactic vaccines, while cost in the private market is

approximately USD 30-90 per course)

4

Japan : US$ 1.1 bn.

CAGR: 9.9%

China : US$ 643 mn.

CAGR: 15%

India : US$ 70 mn.

CAGR: 4 %

Thailand : US$ 48.0

mn.

CAGR: 12 %

Taiwan : 44.4 mn

CAGR: 10%

South Korea :

US$ 285.0 mn.

CAGR: 12%

•Japan remains the largest vaccine market with revenues of ~USD 1.1 billion in 2007. China is the 2nd largest and fastest growing market, and is expected to be worth between 1.4 to 1.7 billion USD by 2011, and could potentially be Asia’s largest market.

• India’s market revenue is difficult to estimate, as the bulk of local manufacturing is exported. Local prices are very low, and it is estimated at US$70million in 2007.

• China and India are rapidly developing as vaccine production hubs in order to cope with the strong local demand and capitalize on increasing market potential. Local players play a key role in these markets, producing vaccines at lower costs and creating stiff competition for leading multinationals for key disease indications.

•South Korea also has a booming vaccines market comprising of a reimbursed market for major vaccines, and a strong private market. Market growth has averaged 12 percent annually and there is a strong private market and population with sufficient purchasing power for newer adult and therapeutic vaccines which show promise to grow over time.

• Thailand’s vaccine market is currently valued at approximately USD 48 million and is heavily subsidized by the government, with Sanofi Pasteur and GSK being the major market participants.

• Approximately 90% of volume use in Asia is through public programs. However, in terms of value, it represents ~70% of the market.

Asia Pacific Vaccine Market Revenues (2007 - 2011)

0

2 0 0

4 0 0

6 0 0

8 0 0

10 0 0

12 0 0

14 0 0

S out h

K or e a

C hi na Ta i wa n H ong

K ong

I ndi a Tha i l a nd

Revenues (USD) mn

2007

2011

Sources: China – Frost & Sullivan, India – IMS, South Korea-Korea Medical Device Association, Japan-Ministry of Health Labour and Welfare (MHLW), Taiwan – Import statistics, Thailand – Frost & Sullivan., Frost & Sullivan primary research

Vaccine Market SizeOverview of trends by market segment

Hong Kong : 15.0 mn

CAGR: 9%

Japan2007: 1.1 billion2011: 1.5 billion

5

Country/Sector attractiveness

Competitive Intensity

Market need vs gaps Size of bubble

represents market potential/size

JAPAN

Protective market –98% dominated by local production. Use of older, less innovative products.

Potential plans to makeforeign products more easily availablethrough simplification of regulations

CHINA

Import based market vs predominantly local manufacturing, strong MNC competition

Strong local production and local competition

Optimally specified products (Low gap)

Underspecified products (High gap/unmet need)

Sources: Secondary research, stakeholder interviews, Frost & Sullivan team analysis

For further discussion

INDIA

KOREA

THAILAND

TAIWAN

HONG KONG

China & India have >30 local manufacturers, of which 5-6 are dominant market players with >50% market share. High pipeline for manufacturing capacity and R&D

This cluster of countries mainly import vaccines, but have some limited local production. Post 2009, Korea, Thailand and Taiwan all plan to increase local production capacity to decrease reliance on imported products. Korea and Taiwan – key vaccines are all reimbursed. Strong private market for new vaccines with proven effects, e.g. HPV. Thailand and Hong Kong have smaller local markets – reluctance of patients to pay for vaccines

6

Market attractiveness & clusters identified (2007-2011)

• Governments in Asia have vaccines and prevention of diseases as priority areas in the next 5 years

• Increasing spending power of middle class, and availability of private insurance

• Slow increasing awareness of the necessary of vaccinations, specifically amongst urban areas

• Strong local R&D to produce innovative vaccines, and increase local production

PEST growthDrivers

RegulatoryChanges &

Requirements

Market &CompetitiveLandscape*

Discontinuities (Gaps) &

Opportunities

• Relationships with Government and policy makers is crucial to enable strong market penetration and

reach to physicians in key Asian countries

• Products need to be in line with international guideline

recommendations

•Subsequent to that, market

potential & growth will be dependant

on creating awareness

amongst potential users/consumers for non-mandatory

vaccines

• Limited change in countries that have had vaccination programs in place for more than 10 years (e.g. Korea and Taiwan)

• Increase in coverage of mandatory vaccines to expand to additional vaccine types (e.g. China – up to 12 vaccines on national list). Strong grounding of neonatal vaccination programs in all countries.

• Preference to public-private partnerships (China, Japan)

• More transparent regulations to enable foreign players

Segment Value (‘000)

150

300

450

0 200 400 600

HPV

Influenza

HBV

CAGR (‘07-08)

0% 10% 20% 30%

HPV

Influenza

HBV

Key PlayersGSKSanofi PasteurMSDWyethBerna BiotechShanta BiotechChina state

Gap

• Combination vaccines

• Compliance of multiple dose vaccines

• Efficacy of current vaccines

• Public awareness on need for vaccination

Value Proposition

• Ability to produce single dose or combination vaccines

• 100% efficacy vaccines

• Short lead time on manufacturing to enable easy supply & storage

*Numbers to be confirmed

7

Market Capacity & Competition

CHINA

INDIA

JAPAN

COUNTRY

• 33 local manufacturers (including 6 local state-owned giants, and rest with <15 million revenues) able to produce 49 kinds of vaccines.

• High local production capability (>1 billion doses)

• Multinational players with public partnerships (e.g. Sanofi Pasteur partnership with Shenzhen state Govt)

• National vaccine program covers 12 vaccines (USD 400 million allocated in funding)

• Low unmet market need

• Continue to be Government regulated market (control number of vaccines available, especially from foreign players)

• High local production capacity

• High local R&D

• Low patient awareness and willingness to pay

Current (2008) Future (2010 onwards)

• 25 local manufacturers, produce high quality vaccines for local and export markets (WHO)

• Local Government funding for local manufacturers for R&D

• Local production meets 98% of market needs

• Low penetration of multinational players

• Antiquated vaccination programs – low Government support

• High number of liver cancer cases and mortality

• Influenza: Produced 25 million doses in 06/07, used 19 million

• Plan to regulate production of influenza vaccine to prevent oversupply

• R&D and production of pandemic vaccine is a national project – funded by Government

• Open to foreign players, but still primarily local dominated market

8

Market Capacity & Competition

TAIWAN

KOREA

HONG KONG

THAILAND

COUNTRY

• Multinational player dominance (e.g. Engerix is market leader for Hep B)

• Low local manufacturing (only 1 major local manufacturer in each country)

• Reimbursed/subsidised neonatal vaccination programs in place (most successful in Korea, followed by Taiwan)

• Korea: Private market with capacity to pay for products that have high awareness and unmet need (e.g. Gardasil success in Korea through patient campaigns)

• Korea and Taiwan: Strong reimbursement programs

• No specific plan for vaccination of HBV carriers (Korea – plan for reimbursed booster dose to reduce carrier rate of HBV)

• Declining carrier market for Korea and Taiwan (impact of vaccination)

• Hong Kong expanding influenza vaccination to children <12 years for free (budget of 100 mio HKD)

• Local production for influenza in Korea, Taiwan and Thailand

• Potential influx of vaccines from China (into Hong Kong)

Current (2008) Future (2010 onwards)

9

Strategic overview: Influenza profile

• Data proving efficacy

• High patient awareness

• Public-private partnerships

• Reasonable cost (current at US$11 – 46 per dose –considered high)

• Need to be able to quickly expand manufacturing capacity to other lines

• Current profile seen as high potential for use – but will have high dependance on patient awareness, perceived need for use and cost

• Following are seen as high potential advantages:

• Short, quick production time (from a policy maker perspective)

• Non-needle delivery

• Non-refrigeration storage

• Non egg-based

• Protection against seasonal strains

• Areas of improvement needed to make it a high potential use product:

• Long protection per dose (as compared to current annual dosing) of ~ 5 years

• Multiple strain coverage

• Long shelf like (>9 months)

• Efficacy (>80%) – trial results show efficacy only vs placebo

How to compete Product Evaluation

Risks

• Very low patient awareness and perceived need on influenza vaccines – will take large scale patients awareness programs/campaigns and years to see awareness growth (low penetration currently <3% of population)

• Seasonal – interrupted demand, unable to predict use (e.g. Korea had oversupply in ’07 with 15 million doses)

• Local manufacturing coming into play by 2009-2012 in countries that don’t already have them (Korea, Taiwan, e.g. Thailand will be able to produce 2 million doses annual in 5 years)

• Strong local R&D & production in India and China (future requirement estimated at 65 million units, 25 million expected to be met by Sanofi Pasteur-Shenzhen JV plant. Capacity to produce 50 million doses by 2025)

10

Necessary evolvement to fit market needs

People: Need to identify and establish local relationships with Government and policy makers

2008

Stage 1

2010

Stage 2

2012

Stage 3

Technology: Product in line with market needs/improvements/ policy in place

Production planned (based on market assessment of epidemiology, competition, uptake, policy)

Structure:

Product ready for distribution, structure in place for POV, private market

(Post 2012 market is expected to be too crowded – need early mover advantage)

VACCINE MARKETS IN ASIA HAVE WELL ESTABLISHED PLAYERS WHO HAVE PUT SOUND INVESTMENTS AND RELATIONSHIPS IN PLACE. IT WILL TAKE MORE THAN A GOOD PRODUCT TO

PENETRATE THIS MARKET – REQUIRES LONG TERM COMMITMENT, PATIENT AWARENESS, FUNDING AND PEOPLE ON THE GROUND TO WORK WITH LOCAL GOVERNMENTS TO ENSURE

UPTAKE AND ACCESS TO PRODUCTS

11

03• Asia Pacific Vaccines Market Overview

This section presents an overview of the current market

scenario for vaccines and key trends across all countries

12

Vaccines Market OutlookOverview of trends by market segment

• The vaccines market can be segmented into 3 major areas, pediatric, adult and therapeutic vaccines. However definitions within these categories differ by country. For example, in Japan all cancer related (e.g. Gardasil) and hepatitis vaccines are categorized as therapeutic, even though their mode of action is primarily prophylactic.

•Pediatric vaccines are still the mainstay of the market in APAC and generally account for more than 60 percent of total market revenues. The primary drivers of this has been the implementation of national level immunization programs that cover the comprehensive range of pediatric vaccines until age 12. Across most countries these vaccinations are provided FOC or subsidized to increase compliance.

• The influenza and combination vaccines vaccines market shows the most strong growth potential over the short term, due primarily heavy investments in influenza preparedness and increasing recommendations for annual flu vaccination driving up demand.

• Therapeutic vaccines market is still in its infancy or non-existent in most countries. The use of therapeutic vaccines is expected to be more of long term prospect and targeted primarily at the private market.

0 % 10 % 2 0 % 3 0 % 4 0 % 5 0 % 6 0 % 7 0 % 8 0 % 9 0 % 10 0 %

Tha i l a nd

Indi a

Hong K ong

Ta i wa n

Chi na

S out h Kor e a

J a pa n

Ped iat r ic V accines A d ult V accines T herapeut ic V accines

Asia Pacific Vaccines Market Breakdown by Key Segments (2007)

US$ 1.1 bn.

USD 285 mn

US$ 624 mn.

US$ 44 bn.

US$ 15 bn.

US$ 70 mn.

US$ 48 mn.

13

Healthcare and Demographic Indicators

Particulars Japan South Korea China Taiwan Hong Kong India Thailand

Population 127.4 48.1 1,321.8 22.9 6.9 1,131.3 65.6

Birth rate (per 1000) 8.4 4.5 12.1 9.0 10.2 22.3 13.7

Population growth rate 0.5% 2.4% 5.3% 0.3% 0.1% 1.6% 0.7%

Infant Mortality rate (per 1000) NA 4.5 19.0 6.5 5.8 34.6 18.0

Life expectancy (female) 85.5 80.9 73.3 80.7 85.4 65.3 70.2

Life expectancy (male) 78.5 73.9 69.6 74.7 79.3 67.2 75.0

Healthcare Infrastructure

Public Hospitals 1,656 158 15,616 *24 41 166,993 1,871

Private Hospitals 7,370 1,331 3,575 **55 12 13,203 475

Health Clinics (government) 97,442 3,445 122,023 ***344 90 30,000 9,765

Private Clinics 98,609 26,119 156,844 18,667 NA NA 14,953

Healthcare Financing

Total Healthcare Expenditure (USD) bn 406.6 41.8 152.9 23.8 10.2 59.8 9.3

Public Healthcare Expenditure (USD) bn 327.0 21.7 48.4 14.9 4.3 12.0 3.6

Private Healthcare Expenditure (USD) bn 79.6 20.1 104.5 8.9 5.9 47.8 5.6

Per Capita Healthcare Expenditure (USD) 2,918.0 1,318.0 116.0 981.2 1,857 54.0 141.3

Source : Frost & Sullivan (Base Year : 2007)

Japan, South Korea, Taiwan and Hong Kong have the highest per incomes among the countries surveyed. As developed market, these countries have strong healthcare infrastructure and well established immunization guidelines and strong healthcare access. China, India and Thailand are more populous countries, with less well established infrastructure. However, strong population and economic growth has been coupled with strong investment in healthcare related expenditure, this coupled with growing privatization of healthcare services creates strong market potential in these countries.

Legend: * Medical Centers, ** Regional Hospitals, *** District Hospitals

14

Market Segmentation & Snapshot

TYPE AHigh Growth &Volume China, India & Thailand

TYPE BPotential for Penetration

Japan

TYPE CUniversal Coverage,

High DemandSouth Korea, Taiwan &

Hong Kong

Market Size, Revenues and Demand

Market Growth over the next 5 years

Vaccine Usage Trends

Price Sensitivity

Reimbursement Status (Current)

Competitive Landscape

Key Growth Segments

Large market size reflective of large population heterologously distributed

population with high birth rates.

Strong market growth anticipated throughout the forecast period > 15 percent.

Pediatric vaccine market represents > 70-80 percent of market volume. Low penetration

of adult & therapeutic vaccines.

High price sensitivity with central government playing role in large quantity

based tender purchases.

Subsidization of key childhood vaccinations only. Adult vaccinations e.g. Influenza, HepB may be subsidized for high risk groups.

Strong local production (except TH) for vaccines through private & gov. linked

entities. Focus on high volume production with low cost products.

Combination vaccines, Influenza, Hep B (China)

Large market size due to mature market status.

Moderate growth <10% expected to sustain over the forecast period.

Current vaccination guidelines recommend the usage of out-dated vaccines. Market is likely to see a shift to newer products if appropriate legislation is approved.

Pricing controls are in place for key vaccinations within the national vaccination schedule. Out-of-pocket vaccination costs

are among the highest in Asia.

Key vaccinations in the national schedule are fully subsidized However the number of disease indications covered under the

national schedule are less than international standards.

Market is dominated by local domestic producers. Foreign penetration is < 2%.

Combination vaccines, Influenza

Moderately sized market that are reaching maturity and are increasingly competitive.

Market growth is anticipated to remain between 10-12 percent annually, driven primarily by adult and therapeutic market

growth.

Pediatric vaccines account for 65%or more of the market – combi-vaccines. However, adult and therapeutic vaccines are begin to

penetrate the market.

The pricing structure of key vaccines is determined by pricing controls put into place by the local universal healthcare

system.

Universal healthcare coverage subsidizes or reimburses a larger range of

vaccinations, including those in then national schedule.

International manufacturers still dominate the market with strong local production

only in SK.

HPV, Pneumococcal vaccines

15

Drivers & Restraints of Type A Markets(China, India & Thailand)

DRIVERS

RESTRAINTS

IMPACT

The high population demographic within the 0-6 years and < 12 years segment drives a high volume demand for pediatric vaccinations.

Threat of pandemics (e.ginfluenza) drive investment in vaccine manufacturing self sustainability

Low purchasing power creates a high price sensitivity which drives down profit margins for vaccine manufacturers

Government initiatives encourage local based production as well as research and development to meet local needs

Lack of awareness of immunization creates low demand for vaccines especially for non-mandatory/optional vaccinations

Private-public partnerships provide source of funds for immunization programs and initiatives

Lack of comprehensive healthcare infrastructure limits accessibility and reach of immunization programs

16

Drivers & Restraints of Type B Markets

DRIVERS

RESTRAINTS

IMPACT

Growing elderly population creates a demand for annual adult vaccinations

Combination vaccinations are not widely available in the local market in spite of the demand and projected growth in the pediatric vaccines market.

Lack of alignment of local vaccination guidelines to international standards has created a lack of innovation in the local vaccine production industry and lack of penetration of new innovative vaccines to the market.

The current healthcare and reimbursement in Japan is focused primarily treatment based medicine. And thus preventative treatments such as vaccinations have not been very well received.

Increasing initiatives from the Ministry of Health Labour and Welfare (MHLW) to promote increased innovation in the local vaccine production industry through research and development

17

Drivers & Restraints of Type C Markets

DRIVERS

RESTRAINTS

IMPACT

Universal healthcare coverage through social health insurance scheme which provides subsidization and reimbursement for basic scheduled vaccinations

High per capita expenditure on healthcare and demand for private healthcare services Strong consumer awareness

drives up demand for both therapeutic and combination vaccines

Low public awareness hinders growth of non-mandatory/ scheduled vaccinations

Highly competitive market due to large number of market participants

Government initiatives focused on preventive healthcare drive investment in vaccination programs

18

Disease and Immunization TrendsReported cases of key vaccine preventable diseases

0

1,988

371,598

49,920

589,864

3,399

2,829

2,829

292,964

1,288

114,002

4,660

62,067

638,390

7,803

1,327,225

79,349

1,094,402

China

NA0-Rotavirus

2214519 Meningococcus

9246181114,557Mumps

27314114200,345 Pertusis

139028141,504 Pneumococcus

442377899,339 Japanese Encephalitis

1731110Influenza

NA67246131N/A Shingella

3053853352 Rubella

40131509 Tetanus (neonatal)

NA1108Tetanus (total)

253610097N/A Yellow Fever (Dengue)

3256887194Measles

93004141978225 HIV

4658HPV (cervical cancer)

408874196316 Hepatitis B

37267202Hepatitis A

98630747 Cholera

6186117,949020284264,915 Chicken Pox (Varicella)

ThailandHong KongTaiwanSouth KoreaJapan Disease Indication

19

Disease and Immunization TrendsCountry specific trends

JAPAN

- 08 : Measles was re-designated as a notifiable infectious disease. 2,648 cases between Jan-Mar 08 alone

- Strengthening of surveillance & increased vaccination ( with MR vaccine)

- Outbreak of pertusis in 2007, over 200 confirmed cases with a higher percentage (31%) of adults affected

- Over 1,0 million influenza cases are reported annually through the sentinel system however less than 50% of the population over 65 are in compliance with annual vaccination under the Preventive Vaccination Law.

SOUTH KOREA

- Outbreaks of measles, mumps and varicella are on the increase.

- Overall, immunization penetration is high but sporadic outbreaks have occurred.

TAIWAN

- Measles, mumps, varicellaoccur in sporadic outbreaks in Taiwan in spite of strong vaccination coverage. ‘Importation” of the disease from neighboring China and Japan has also occurred.

- Strong influenza surveillance and vaccinations has seen a decrease in number of reported cases between 2007 and 2008.

THAILAND

- Influenza remains a key concern in the Thailand market with approximately 150,000 to 600,000 cases annually in 2007

-AIDS and HBV continue to be areas of concern, while outbreaks of measles and mumps do occur.

INDIA

- India remains a hotspot for infectious diseases with current immunization lacking the penetration and reach to achieve effective elimination due to disparate healthcare access of large proportion of the population.

- Measles, hepatitis B, polio, and tuberculosis are still areas for concern.

-The threat of increased zooneses includihginfluenza, leptospirosis, rabies and anthrax have occurred.

- In 2008 alone, outbreaks of anthrax have occurred in 3 India states.

CHINA

- China is also a potential hotspot for emerging infectious diseases with high incidence rate of mumps, varicella, rotavirus infections and shingella in 2008.

- Influenza remains a pandemic concern with China, increasing thedemand for vaccinations which are provided free to high risk groups.

HONG KONG

- Influenza outbreaks remain a key area of concern with the latest influenza outbreak occurring in early February 2008 – forcing even school closures.

- The annual Influenza Vaccination Program was has successfully administered over 275,000 flu vaccine doses to eligible, high risk target groups in year 2007 alone.

- SARS which drew critical concern in year 2003, has no new reported incidence so far, but it is still the most threatening disease outbreak ever.

20

Percentage of Target Population Immunized (%)

50 60 70 80 90 100

Thailand

India

Hong Kong

Taiwan

China

South Korea

Japan

Percentage of the population immunized (%) by key antigens

Pol3

MCV

HepB3

DTP3

DTP1

BCG

Disease and Immunization TrendsPercentage of target population immunized against key diseases

Japan’s immunization schedules and vaccine specifications differ from WHO and international standards. Lack of innovation has hamperedinnovative vaccine development. Lower coverage and the use of outdated vaccines have led to a higher incidence of outbreaks ofpreventable diseases that would be expected in a developed country.

Source : WHO (2006)

Vaccination coverage in India has yet to achieve levels above 90percent. This is due to disparate healthcare access across states and also the lack comprehensive reporting and monitoring systems which hampers analysis of the effectiveness of the monitoring activities.

South Korea has a strong immunization program and coverage – with immunizations with the NIP being subsidized by central and localgovernments.

Immunization coverage in China high with national immunization schedule being effectively administered through China’s Center for Disease Control (CDC) network.

Taiwan has also achieved strong immunization coverage with all scheduled vaccinations being subsidized through the NHI and provided through public hospitals and health centers.

Hong Kong has also achieved high immunization coverage. Vaccinations for key diseases in the national immunization schedule are provided free-of-charge. A recent change in the recommended immunization schedule in 2006 to utilize more combination vaccines has been well received.

Thailand has achieved very high levels of immunization coverage through extensive government funded immunization initiatives. The vaccine market is been heavily dependent on government funding, with theprivate market still in its infancy. The government introduced 30THB universal healthcare scheme helped improve coverage from 76 percent to 96 percent since 2002. The Thai system has been so successful I t has been recommended as role model for other low income countries.

F&S note: Immunization coverage figures presented here are sourced from WHO and UNICEF. Coverage representation is at a national level, however, reporting coverage may be incomplete due to lack of surveillance data. Immunization coverage is also mainly for pediatric vaccinations and does not cover adult vaccinations.

21

Reimbursement & Pricing Scenario

ReimbursedSubsidizedReimbursedReimbursedSubsidizedSubsidizedReimbursed

Tetanus (neonatal)

ReimbursedSubsidizedReimbursedReimbursedSubsidizedSubsidizedReimbursedRubella

NANANANANANANARotavirus

Self PaidSelf PaidSelf PaidSelf PaidSelf PaidSelf PaidSelf PaidRabies

ReimbursedSubsidizedReimbursedReimbursedSubsidizedSubsidizedReimbursedPoliomyelitis

Self PaidSelf PaidSelf PaidSelf PaidSelf PaidSelf PaidSelf PaidPneumococcus

Reimbursed

ReimbursedReimbursedReimbursedSubsidizedSubsidizedReimbursedPertusis

ReimbursedSelf PaidReimbursedReimbursedSubsidizedSubsidizedSelf PaidMumps

Self PaidSelf PaidSelf PaidReimbursedSubsidizedSubsidizedSelf PaidMeningococcal

ReimbursedSubsidizedReimbursedReimbursedSubsidizedSubsidizedReimbursedMeasles

Self PaidSelf PaidSelf Paid

(Inactive only) SubsidizedSubsidized

(Inactive only) SubsidizedReimbursed

Japanese Encephalitis

ReimbursedSelf PaidSelf PaidSelf PaidSelf PaidSelf Paid

Reimbursed (>65 yrs)Influenza

Self PaidSelf PaidSelf PaidSelf PaidNAHPV (cervical

cancer)

ReimbursedSelf PaidSelf PaidReimbursed

Subsidized for childrenSubsidizedSelf PaidHepatitis B

Self PaidSelf PaidSelf PaidSelf Paid

Subsidized for children Self PaidSelf PaidHepatitis A

Reimbursed

Self Paid Self Paid Self Paid Self Paid Subsidized Self Paid Haem. Influ. Type B

ReimbursedSubsidizedReimbursedReimbursedSubsidizedSubsidizedReimbursedDiphtheria

Self PaidSelf PaidSelf PaidReimbursedSelf PaidSubsidizedSelf PaidChicken Pox (Varicella)

ReimbursedSubsidizedReimbursedReimbursedSubsidizedSubsidizedReimbursedBCG

ThailandIndiaHong KongTaiwanChinaSouth KoreaJapan Disease Indication

PEDIATRICVACCINES

ADULTVACCINES

THERAPEUTICVACCINES

PEDIATRIC vaccines in the national immunization schedules are generally reimbursed (BCG, DPT, MMR, HepB, OPV). Type C markets are generally shifting to higher usage of combination vaccines with the inclusion of these in national level immunization programs with reimbursement. Meningococcal vaccinations are also increasingly being reimbursed.

Most adult vaccinations are not reimbursed with the exception of influenza vaccinations for the elderly and high risk groups which are increasingly being reimbursed.

Currently, all therapeutic vaccines are self paid, although there have been moves by advocacy groups to promote inclusion into national; level immunization programs, the high cost per dose remains the key barrier.

22

Reimbursement ScenarioSelf paid (out-of-pocket) vs reimbursement scenario

Reimbursement Scenario

Though there is no public reimbursement system. However, the central government subsidizes vaccine supply to the local governments who in turn subsidize the cost of providing the vaccinations at a provincial level at public health centers.

All scheduled vaccinations are fully reimbursed by the government, however, vaccinations have to obtained within the scheduled time frame (of the national schedule) after which the cost of immunization will be self borne.

All of immunization vaccines in EPI are reimbursable as it is covered by 30 baht scheme by NSHO (National Security Health Office). However these are provided by public sector only.

The CDC network provides vaccinations under the national immunization schedule free of charge through its extensive network.

All vaccinations within the national immunization schedule are fully reimbursed under the NHI.

The Childhood Immunization Program provides full immunization covers vaccinations for children up to the age of 12. Free influenza vaccinations are provided to the public who

meet certain requirements (high risk groups).

Basic pediatric vaccinations under the national immunization schedule are subsidized and provided FOC through public health

clinics and vaccination camps.

The majority of South Koreans opt for self paid private channelsfor vaccinations (60 percent), as the access to public health centers is not always convenient Recommended and other optional vaccinations are self paid and not reimbursed.

There are several vaccinations that are recommended but are not mandatory under the national schedule that are self paid. These include annual influenza shots, chicken pox and hepatitis

B are among the most common self paid for vaccinations.

Non reimbursable vaccine which are self paid include vaccines not listed in the EPI, vaccinations take at private clinics or hospitals as well as certain combined vaccines.

Optional vaccinations that are recommended but not mandatory under the national immunization schedule as well as non-recommended vaccinations are all borne as out-of –pocket expenses.

Vaccinations not with the national immunization schedule, or that are recommended as optional vaccination are borne as out-of-pocket expenses.

Vaccinations against other diseases (optional, recommended or travelers vaccinations) could visit private institutions in which

the vaccinations will be charged at different rates.

Vaccinations not in the national immunization schedule and recommended vaccinations are borne as out of pocket

expenses. There is no centralized reimbursement system.

SOUTH KOREA

JAPAN

THAILAND

CHINA

TAIWAN

HONG KONG

INDIA

Out-of-Pocket / Self PaidCOUNTRY

Source : Frost & Sullivan

23

Competitive Landscape – Approved Vaccines by MarketTier 1 : Leading Multi-nationals

HepB

HepA+HepB

HepA+Hib

Hemorrhagic Fever

DTap-IPV

HepA

DTaP-Hib-IPV

DTaP-Hib-IPV-HepB

DTaP-Hib

DTaP

DT (Dipthera-Tetanus)

MerckSanofi PasteurGSK

Source : Frost & Sullivan

24

Competitive Landscape – Approved Vaccines by MarketTier 1 : Leading Multi-nationals

Rabies

Typhoid

Rotavirus

Varicella

Tetanus

HPV

Hib

Influenza

OPV

IPV

Meningococcal

MMR

Pnemococcal

MerckSanofi PasteurGSK

Source : Frost & Sullivan

25

Leading Approved Vaccines by Country

GSK

GSK

GSK

Adimmune Corp., GSK, Novartis, Sanofi Pasteur

Adimmune Corp.

GSK

GSK

GSK

GSK

GSK

GSK

Adimmune Corp.

Taiwan

GSKBernabiotech Korea, Korea VaccineHandaibikenVaricella

Cadila Pharma, GSK, VHB Lifesciences, Zydus CadilaSIBP,LIBP,CIBPBoryung BiopharmaGSK, Sanofi AdventisTyphoid

MSDRotavirus

WyethCIBPWyethWyethPnemococcal

Serum InstituteBeijing Tiantan, MSD, GSKGSK

Takeda (individual vaccines for each

indication)MMR

Sanofi PasteurLIBP, SanofiGSK, WyethMeningoccocal

Bio Med, Panacea BiotechSanofi PasteurJapan PolioPolio

MSDHPV

GSK, Sanofi PasteurLIBP, Ealong, GSK, Sanofi, NovartisKorea VaccineInfluenza

Shantha BiotechCIBP, Beijing TiantanTakedaJE

GSK,WyethGSKGSKHib

GSKHepA+HepB

GSK, Serum Institute, Wockhardt

Shenzhen Kangtai, Beijing Tiantan, SIBP

Bernabiotech Korea, Korea VaccineMSD (Banyu)HepB

GSKGSK, Sinovac,

Bernabiotec, Zhejing Pukang

GSKKaketsukenHepA

Sanofi Pasteurhighly competitiveBoryung Biopharma, Korea VaccineTakedaDTaP

Serum InstituteSK ChemicalTakedaDT (Dipthera-Tetanus)

Serum InstituteSSI, SXIBP, LIBP, CIBP, SIBP, CCIBP, BIBP

Statens Serum Institute, Japan B.C.G.Japan B.C.GBCG

IndiaChinaSouth KoreaJapanVaccine Name / Type`

Source : Frost & Sullivan

26

Competitor ProfilesLeading MNC players

SanofiPasteur

GSK

Merck

Wyeth

Bernabiotec

Source : Frost & Sullivan

Asia Pacific presence by country

Product Range

24

19

9

Key Products

Avaxim (HepA), VaxiGrip (Influenza), Fluzone (Influenza),

Boostrix (DTP), Infanrix (DTP), Havrix(HepA), Fluarix (Influenza), Priorix (MMR), Engerix-B (HepB)

VAQTA (HepA), MMR-II (MMR), Pneumovax(Pnemococcal), Gardasil (HPV)

BCG (tuberculosis), Prevnar(meningococcal)

Epaxal (HepA), Hepavax (HepB), Inflexal(Influenza), Gripvax (Influenza)

3

10

Recent Approvals and TrendsRecent Approvals and Trends

- GSK’s Rotarix was recently approved in South Korea (Mar-08) while Cervarix has been approved in Hong Kong, Taiwan and South Korea. Cervarix has recently been submitted for approval in Japan.

- MSD has already pursued approval in Thailand, Taiwan, and South Korea for Gardasil, and is currently pursuing approval for use in older women within the age bracket of 30-45 years.

-Sanofi Pasteur leads the market in influenza vaccines and has invested heavily in a USD 100 million production facility in China to produce 25 million doses annually by 2012.

- Wyeth’s key product across all markets where it is approved is Prevnar. Prevnar has been recently submitted for pre-qualification status with WHO in order to gain access to inclusion in mass immunization programs.

27

Profile of Global Players

In terms of revenues, GSK Biologicals is the largest player in the global vaccines market.

GSK Biologicals had around 23% share in the global vaccines market in 2006.

GSK Biologicals is set to become an increasingly important part of GSK's business and has been transformed from a tiny company with one product and $3 million in revenues, into a $2 billion behemoth

With six vaccines in late-stage development , GSK's vaccines business has doubled in growth over the past five years and the company expects it to double again over the coming five years.

With a 20% share in 2006, SanofiPasteur is the second largest player in the global vaccines market.

Sanofi Pasteur, together with its European joint venture with Merck & Co, Sanofi Pasteur MSD, is a leader in flu vaccines.

In 2006, Sanofi Pasteur accounted for 8.9% of Sanofi-Aventis' sales.

Sanofi Pasteur is well-positioned for growth, as it has a leadership position in influenza, meningitis and boosters, and is also strong in polio, Pertussisand Hib with at least two major product launches anticipated in these areas during 2007

Merck & Co expects the sales of its vaccines in 2007 to be in the range of $2.8-3.2 billion, up from a figure of $1.7 billion in 2006 (an increase of 73% on 2005).

Merck in 2005/2006 launched three vaccines: Gardasil for cervical cancer/human papilloma virus, RotaTeq for childhood diarrhoea caused by rotavirus, and Zostavax for shingles.

With around a 10-12% share, Merck is the fourth largest player in the global vaccines market

The joint venture with Sanofi-Pasteur in Europe (Sanofi-Pasteur MSD), has given Merck a major strategic edge in penetrating in the European market.

All global players have private-public partnerships or joint ventures in key markets like China and Japan

28

Profile of Regional Players

Serum Institute of India

• Serum Institute of India was founded in 1966

• Serum Institute has established itself as the world's largest producer of Measles and DTP group of vaccines. It is estimated that 2 out of 3 children immunized in 2004, with a vaccine, received one manufactured by Serum Institute. Serum Institute’s range of products have been used in 145 countries across the globe.

• Serum Institute of India, world’s fifth largest vaccine manufacturer registered approximately $180 million in revenues in 2005-06. At present, Serum is the number 1 biotechnology company in India. In 2006, the growth rate of Serum Institute of India was around 40 percent.

Sinovac Biotech

• Sinovac Biotech Ltd.specializes in the research, development, commercialization, and sales of human vaccines for infectious illnesses such as Hepatitis A and Hepatitis B, influenza and “SARS”. Sinovac is one of the leading emerging biotechnology companies in China.

• Sinovac is the first and currently the only company in the world to have been granted permission to begin clinical trials for a vaccine to prevent SARS.

• Sinovac is developing inexpensive, modern vaccines that target the emerging market and that can compete with older technology vaccines for large-scale government and international health organization vaccination programs.

• As the largest vaccine market player in terms of revenue in Japan, Takeda Pharmaceutical Company Limited is a research-based global pharmaceutical company.

• Offering a range of vaccines that covers in immunization schedule such as DPT vaccine, DT vaccine, Measles Vaccine, Tetanus vaccine, Rubella, Mumps, MR combine vaccine, Japanese Encephalitis vaccine and Influenza HA vaccine.

• KAKETSUKEN is a Juridical Foundation which researches, develops, manufactures and supplies biological products such as vaccines for humans and animals, and blood plasma derivatives. Based in Kumamoto, Japan, the foundation has pursued the preventive medicine fields of microbiology, immunology and serology, towards the improvement of health and hygiene, and is a leading company in the fields of human vaccines and animal vaccines.

29

Market Players : Competitive Positioning

Low High

Breadth of Current Applications

Degree of Innovation

Biotechnology Companies developing vaccines

Pharmaceutical Companies with vaccines division

Low

High

GSK Biologicals

Merck

Wyeth

Sanofi Pasteur

Serum Institute

Crucell

Bharat Biotech

Solvay

PowderMed

Medimmune

BaxterAcambis

PT. Bio Farma

Novartis

Sinovac

30

Alliance and Partnership Analysis

To jointly develop an experimental hepatitis B vaccinePartnershipNov 2007Dynavax

TechnologiesMerck

Company 1 Company 2 Time Deal Structure Objective

Sanofi Pasteur Merck 1994 MergerTo form Sanofi Pasteur MSD,a jont venture European company dedicated exclusively to vaccines

GSK Corixa Corporation Apr 2005 AcquisitionTo gain access to novel vaccine adjuvants and antigens

GSK Wyeth Sep 2005 Acquisition To expand its ability to increase vaccines supplies

Novartis Chiron Oct 2005 AcquisitionTo gain access to the vaccines market

Pfizer Powdermed Oct 2006 Acquisition Strategic opportunity to enter the vaccine market

GSK China Sinovac Biotech Aug 2007 Partnership To promote a flu vaccine in China

Merck Crucell Sep 2007 Partnership To gain access to vaccine production technologies

Serum Institute Akorn Oct 2007 Partnership

MOU with an intent to commercialize Serum Institute’s six vaccines in the US market

Sanofi Pasteur

Shenzhen Government (China) Dec 2007 Joint venture

To develop and manufacture flu vaccines to meet ~1/3 of local needs. Potentially the largest vaccine manufacting plant in Asia

31

05• Influenza Vaccine Market Assessment : Overview

32

Influenza in Asia Pacific : Disease and Management Trends

JAPAN

- Japan has reported close to 1.0 million influenza cases annually between 2006 and 2007.

- Japan utilizes approximately 18.7 million doses of influenza vaccines annually or 74.5 percent of local production.

- For 2007-08, approximately 20 million doses are planned to be required.

SOUTH KOREA

- South Korea has a well developed commercial market for influenza vaccines with 15 million doses being consumed annually.

- However, the disease is viewed as a seasonal trend with lower awareness levels than neighboring countries.

TAIWAN

- Taiwan has developed an increasing strong network for Influenza surveillance and monitoring post SARS.

- This includes the developments of National Influenza Center which monitors all related influenza cases and disease surveillance.

- Taiwan has a target to achieve immunization of 30 percent of the population annually against influenza by 2011.

THAILAND

- The WHO reports that there are an estimated 150,000 to 600,000 influenza patients annually in Thailand.

-With the threat of potential pandemics, Thailand has invested in influenza manufacturing facilities with the capacity to produce more than 2 million doses annual within the next 5 years.

-However, current annual consumption is low at approximately 30,000 doses annually.

INDIA

- Influenza is not currently considered a major health threat in India. However, recent outbreaks of avian influenza in West Bengal have raised the profile of the disease.

- The estimated potential demand from the market is 2.5 million doses annually, most of which would be channeled through the private market.

CHINA

- China as with most countries in Asia Pacific currently has a low influenza vaccination rate of 1.5%.

-The potential demand for influenza vaccinations is close to 60 million doses annually.

HONG KONG

- Influenza scares hit Hong Kong hard this year with the death of 3 children during the annual flu season.

- Prompt government response resulted in closure of affect schools during the outbreak and prompted testing of influenza pandemic preparedness plans.

33

Overview of Influenza Management in Asia PacificSummary of Disease and Management Trends

Current and Future Disease Trends

Influenza is viewed as seasonal respiratory disease in South Korea. Currently approximately, 30 percent of the population (15 million doses) is vaccinated annually.

Influenza is viewed as a seasonal disease in Japan and there is a relatively high demand for vaccinations from the aging population – however the coverage of the population over 65 is less the 50 percent.

According to WHO Thailand 2007 study, it estimated that 150,000 to 600,000 influenza patients in Thailand annually from 2008 onward.

The incidence of Influenza (common) is considered low, it is not the concern for public or government except when national events such as the Olympics are occuring.

Influenza is a closely monitored disease in Taiwan, with the annual number of confirmed cases being low for major strains.

Hong Kong is subject to seasonal influenza scares when outbreaks occur due primarily to its densely population situation. Common influenza outbreaks are expected to continue to occur on an annual basis.

Influenza is viewed as a seasonal respiratory disease, and outbreaks generally occur post the rainy seasons

The government promotes seasonal influenza vaccinations through public healthcare centers during flu season as do academic societies.

National level surveillance is in place and national stockpiles are determined on an annual basis. Japan utilizes 20 million doses annually.

Thailand has invested heavily in production facilities for influenza vaccines (USD 331.7 million) with the capacity to produce 2 million doses annually.

Beijing is at the forefront of influenza management with the city government finances to get all its citizens get vaccinated last year (local brands free for the olds and imported brand half price for children).

Taiwan has a strong centralized surveillance network in the National Influenza Center in collaboration with the CDC and national level pandemic preparedness plans are in place.

The Influenza Vaccination Program is run annually under the Dpt of Health and provides free influenza vaccinations to high risk groups, elderly and pregnant women coverage under social insurance programs.

There are currently no major national level initiatives aimed specifically at managing influenza, with government responding to outbreaks on a case by case basis.

SOUTH KOREA

JAPAN

THAILAND

CHINA

TAIWAN

HONG KONG

INDIA

Current Management InitiativesCOUNTRY

Source : Frost & Sullivan

34

Overview of Influenza Disease Management in Asia PacificKey Challenges in the Management of Influenza

AWARENESS / EDUCATION

PRICE / ECONOMICS

• Awareness is one of the key challenges in the management of influenza. Although the profile of the disease has been raised following pandemic scares and recent avian influenza outbreaks, the majority of the population across all countries surveyed do not consider influenza vaccinations an annual requirement.• Government campaigns, promotional activities by manufacturers along with news reports regarding influenza outbreaks have all contributed to increased awareness of the disease across Asia Pacific. However, awareness of vaccinations as a prophylactic measure remains low.

• Influenza vaccines are not reimbursed across all countries surveyed.• Taiwan, Hong Kong, Japan, Thailand and South Korea provide subsidized / free influenza vaccinations for elderly (>65 yrs). • The cost of the vaccination is seen as prohibitive, while the need for an annual dose is viewed as a burden in countries such as South Korea.

ANNUAL DOSING

REQUIREMENT

• The requirement for annual dosing for influenza vaccines and the inability of the product to provide effective protection against all strains are challenge to gaining public acceptance and more wide spread administration of the vaccine.• Furthermore, Hong Kong physicians feel that the release of the annual guidelines from WHO is too slow for an adequate response prior to the flu season.

35

Overview of Influenza Management in Asia PacificTreatment & Diagnosis Guidelines

Included in the National Schedule

COUNTRY

Source : Frost & Sullivan

YESVoluntary

YESVoluntary

YESVoluntary

YESVoluntary

YESVoluntary

YESVoluntary

NOVoluntary

SOUTH KOREA

JAPAN

THAILAND

CHINA

TAIWAN

HONG KONG

INDIA

Influenza vaccinations in South Korea are solely on a voluntary basis with free vaccinations being provided for the elderly (>65 years).

Influenza vaccinations in Japan are solely on voluntary basis with free vaccinations being provided for the elderly (>65 years).

Influenza vaccinations are provided for the elderly (>65 yrs), however there are no specific guidelines in place. Physicians generally respond to WHO and MOPH recommendations when available.

Influenza vaccinations in China are solely on a voluntary basis with free vaccinations being provided for the elderly (>65 years). Some cities such as Beijing provide extra subsidies for children.

Influenza vaccinations are provided free to the elderly above 65 years since 1988 which has reduced the hospital admission rate for this demographic to 54%.

Influenza vaccinations are provided free to the elderly. The annual influenza vaccination program also provides for high risk groupscovered under social insurance.

There are no current guidelines in place for the prescribing influenza vaccinations, with most physicians referring to WHO and related medical associations.

36

40

0

5

20

40

46

60

80

12

5

45

10

41

30

10

28

35

35

10

13

10

10

60

55

0% 20% 40% 60% 80% 100%

T h a i l a n d

I n d i a

H o n g K o n g

T a i w a n

C h i n a

S o u t h K o r e a

J a p a n

N ewb o rns 0 - 14 yrs 15- 6 4 yrs > 6 5 yrs

Overview of Influenza Management in Asia PacificPrescription Guidelines & Patient Trends

Prescription GuidelinesCOUNTRY

Source : Frost & Sullivan

There are no pre-existing guidelines specifically for prescribing influenza vaccinations. However, the vaccinations are recommended under the national schedule for children (6-24 mths) as well as seniors.

Influenza vaccinations are primarily prescribed to the elderly (>65 years), however vaccinations coverage for the elderly is approximately only 50 percent.

National level guidelines for influenza vaccines are currently not present. However, the vaccine is widely available and physicians are free to prescribe as they see fit.

Physicians in China generally prescribe influenza vaccinations to high risk groups through the Points of Vaccinations (POVs). The primary patient segment through this channel are children.

National level guidelines are developed by the CDC in Taiwan. Physicians generally take these into consideration along with internationalrecommendations from the WHO and related organizations.

The majority of physicians refer to WHO recommendations on the annual influenza vaccinations. Children and seniors are the main patient segments prescribed to.

There are no pre-existing guidelines specifically for influenza vaccines. Recommendations from relevant medical bodies (MOH) and the WHO are the primary reference points for guidelines.

SOUTH KOREA

JAPAN

THAILAND

CHINA

TAIWAN

HONG KONG

INDIA

Patient Segments which receive vaccinations (%)

37

Influenza: Physician Prescription Criteria in Asia PacificWhen do physicians administer Influenza vaccinations

Physicians in general would prescribe/recommend influenza vaccinations to patients who may have weaker immune systems and thus are at a greater risk of being infected. The elderly and

young children are the primary high risk groups.

The Elderly The majority of physicians consider a patients age in prescribing Influenza vaccinations with the elderly being a key patient segments due to their higher risk of weaker immunity.

Children (under the age of 2 yrs)Physicians also generally prescribe influenza vaccinations to young children, as they are also considered at risk of having weaker immunity against the disease.

EveryoneThe majority of private physicians in Hong Kong, would recommend influenza vaccinations to all patients during flu season. This trend does not seem to be echoed across other markets as price is seen as a barrier.

Likelihood of prescribing Influenza vaccinations

38

Influenza Vaccine Prescription LandscapeWhat are the KEY DRIVER & RESTRAINTS in prescribing Influenza vaccinations

DRIVERS

RESTRAINTS

Safety profile of

Flu vaccines

National Guidelines and

government efforts

Recommendations from WHO and relevant medical bodies

Proven data on disease prevalence and efficacy of

early prevention

Low awareness of influenza vaccinations

Fear of contradictions with existing medication / side

effects

Fear of needles

The short protection period of the vaccine i.e. 9 months before the next flu season is a restraint to increased

prescription.

Physicians do not find it necessaryAffordability

High value products

IMPACT

39

Influenza Vaccine Prescription LandscapeMarket Leading Brands and Brand Perception

GreencrossInfluenza HA

Influenza HA(Takeda, Kitasato)

Hibest(AdventisPastuer)

Fluarix(GSK)

SOUTH KOREA

JAPAN

THAILAND

CHINA

TAIWAN

HONG KONG

INDIA

Greencross vaccines are viewed as having good efficacy and safety profile.

Local brands are preferred as there are a wide variety of choices. Product choice is primarily by availability.

Vaxigrip is again the brand of choice as it has the widest product availability.

The efficacy of all brands are considered equal, although foreign brands are better packaged.

There are only about 4 major brands in the Taiwanese market, all perceived to have good efficacy.

Vaxigrip is perceived as better packaged and accessible while Fluarix is a trusted brand.

Vaxigrip is used by more than 50% of physicians.

Top 3 Brands by CountrySummary of Brand Perception on

the Leading Brand

SK Influenza

Biken HA(Biken,

UoOsaka)

Vaxigrip(SanofiPasteur)

Vaxigrip(SanofiPasteur)

Vaxigrip(SanofiPasteur)

Vaxigrip(SanofiPasteur)

Fluarix(GSK)

Vaxigrip(SanofiPasteur)

K1 Flu(Adimmune)

Fluarix(GSK)

Vaxigrip(SanofiPasteur)

Influenza vacine

(Falong Bio)

Influenza(Beijing Tiantan)

40

Regulatory and ReimbursementApproved vaccines

Fluarix

Vaxigrip

Fluvirin

Agripal S1

Inflexal V

Influenza HA

GreencrossInfluenza HA

Fluzone

Influenza HA

GSK

Sanofi Pasteur

Novartis

Novartis

Berna Biotech

Boryung Biopharma

Berna Biotech (Korea)

Sanofi Pastuer

Takeda, Kitasato,

Brand Name Manufacturer

41

Influenza Vaccines Product OutlookPerspectives on Unmet Needs

REIMBURSEMENT

•Physicians in South Korea, Thailand, China and India see reimbursement as one of the key unmet needs in the management of influenza through vaccinations.

• Influenza vaccinations are expensive, and self paid for the majority of the general population and as such uptake is generally low.

PATIENT AWARENESS

•Patients do not see the need for influenza vaccines – equate it to the common cold

•Disconnect between awareness of vaccine, perceived need and willingness to pay

SHORTEFFICACY

•Current vaccines have to be taken on a yearly basis, and there is a need to update

•Vaccines that can last for longer periods (up to 5 years) and work across cross strains are desired

42

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