COVID-19 "Round 2" - Findings & way forward - Summary June 12th, 2020 - Efpia
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COVID-19 “Round 2” – Findings & way forward Summary June 12th, 2020
Legal disclaimer – This report is preliminary. Analyses and conclusions may change
subject to additional data.
– To the fullest extent permitted by law, no representation or warranty,
express or implied, is or will be made and no responsibility, duty or
liability is or will be accepted by Medicines for Europe or Kearney, any
other person or by any of their respective directors, officers, servants,
advisers, agents or affiliates as to or in relation to the accuracy,
sufficiency, reliability or completeness of this document or the
information forming the basis of this document or for any errors,
omissions or misstatements relating thereto.
– Neither Medicines for Europe nor Kearney, nor any other person
accepts any duty of care nor undertakes any obligation to provide the
recipient with access to any additional information or to update this
document or additional information, or to correct any inaccuracies herein
which may become apparent.
2 Source: Medicines for Europe; Kearney
Objectives of this
document
Briefly introduce scenario planning for a potential second
COVID-19 wave
Compare supply vs. demand for the next months under
various scenarios
Present results from API survey
3 Source: Medicines for Europe; Kearney1. Executive Summary 2. Demand 3. Supply vs. demand 4. API Survey 4
1 2 3
Executive
summary
We have developed … EU/ EEA shortage …preliminary analyses
three scenarios for a during the summer suggest a second
second COVID-19 wave months is unlikely, COVID-19 wave may hit
indicating that... but… member states hard!
Scenario planning The available data Preliminary analyses
suggests that indicates that suggest that
– A best case, base – Stock levels will drop – Shortages in Oct/ Nov
case and worst case significantly from their are a real possibility,
could occur peaks in May especially for NMBs
– Governments need to – But a shortage of any – The industry needs a
consider additional class of molecules clear demand signal
factors (e.g., tourism) during June, July and from member states to
in their planning August is unlikely prepare adequately
5 Source: Medicines for Europe; Kearney1. Executive Summary 2. Demand 3. Supply vs. demand 4. API Survey 6
Demand Estimations are based on the following:
forecasting model
– This calculator is not an epidemiology model. The inputs, such as projected deaths, no. of days on
Legal disclaimer ventilation, choice of ventilation medicines are based on the available information as well as expert and
academic opinion.
– This calculator is not a prediction of the expected effects of COVID-19.
– This model was created solely to estimate the potential demand for critical medicines due to Covid-19.
– The parameters in the scenario are estimates intended to support public health preparedness and
planning.
– These inputs and corresponding outputs may not reflect the reality of what users will ultimately see.
– The forecasting does not reflect the impact of any behavioral changes, social distancing, or other
interventions.
– Users are discouraged from drawing strong conclusions about deaths or new cases on the basis of
these estimates.
– To the fullest extent permitted by law, no representation or warranty, express or implied, is or will be
made and no responsibility, duty or liability is or will be accepted by Accord, Kearney or Medicines for
Europe, any other person or by any of their respective directors, officers, servants, advisers, agents or
affiliates as to or in relation to the accuracy, sufficiency, reliability or completeness of this document or
the information forming the basis of this document or for any errors, omissions or misstatements relating
thereto.
– Neither Accord, nor Kearney, nor Medicines for Europe, nor any other person accepts any duty of care
nor undertakes any obligation to provide the recipient with access to any additional information or to
update this document or additional information, or to correct any inaccuracies herein which may
become apparent.
7 Source: Medicines for Europe; Accord Healthcare; KearneyA model was Demand forecasting model
developed to – Initially developed by Medicines for Europe and Accord Healthcare for the first COVID-19 wave
estimate the
– Enhanced with additional parameters by Kearney for a potential second COVID-19 wave
demand of critical
medicines for a
potential second
COVID-19 wave Approach Data sources Key assumptions
– Favoring overestimation of – Actual data of number of daily – Herd immunity will not be
cases due to the fact that the deaths as of May 21st 2020 achieved by any country
risk of underestimating is during first COVID-19 wave
higher than the risk of – Worldometer Coronavirus
overestimating reports – Individual country
responses to a second
– Not reflecting the impact of – WHO Situation Reports COVID-19 wave will be
any behavioral changes, social – Expert opinions identical to responses to the
distancing, or other first wave
interventions which could – Secondary research, e.g.
– The development of the
influence case numbers – Robert-Koch-Institute,
second COVID-19 wave will be
Germany
– Not addressing the impact of similar to the first wave
tourism potentially occurring in – International Long-Term Care
late summer/ early autumn Policy Network – Only COVID-19 related deaths
(https://ltccovid.org/) occurring in ICUs will cause
– Using number of reported – ICNARC – Intensive Care demand in critical medicines
deaths per country as base National Audit & Research
for estimation – Number of daily deaths will
Centre decrease around 28-days
– Using three different – Various scientific articles post-lockdown
parameters to plan for future (e.g., Grasselli et al., JAMA;
demand scenarios (# deaths, Bhatraju et al., NEJM)
MV usage, treatment duration)
8 Source: Medicines for Europe; Accord Healthcare; KearneySelected scenario overview for a second COVID-19 wave
Three different Key characteristics
scenarios – best,
base and worst
case – will indicate Best Case Base Case Worst Case
medicines demand Scenario
for a potential illustration for Lowest absolute Likely demand (kg) Highest likely
second COVID-19 molecule demand demand (kg) demand (kg)
wave
# of new deaths
- 50% Same + 50%
vs. first wave
Model parameters % patients
50% 50% 100%
on MV
Treatment
Likely
duration
Total # new ICU
patients (October 1st – 33’153 66’306 99’459
November 30th 2020)
9 Source: KearneyExpected number of new COVID-19 ICU patients per million inhabitants (01.10.-30.11.2020)
13 26 39
Even countries Austria
Belgium 166 331 497
that were less Bulgaria 5 10 14
affected in a first Croatia
2
5 11
3
16
5
Cyprus
COVID-19 wave Czechia 6 13 19
need to prepare Denmark 25 50 76
Estonia 11 22 32
for a potential Finland 14 27 41
second wave France 82 164 245
Germany 18 35 53
Greece 3 6 9
Hungary 16 32 49
Iceland 5 11 16
Ireland 60 121 181
Italy 81 162 243
Illustrative – Latvia 3 6 9
based on data from 21.05.2020 Lithuania 5 10 15
Luxembourg 35 69 104
Malta 3 6 9
Netherlands 66 132 198
Norway 6 11 17
Poland 6 13 19
Portugal 30 60 89
Romania 14 28 43
Slovakia 1 2 4
Slovenia 12 24 36
Spain 57 114 172
Sweden 95 191 286
Switzerland 36 73 109
UK 185 370 555
10 Source: Medicines for Europe; Kearney Best case Base case Worst caseGovernments Illustration “Tourism factor”: Explanation
should consider a Example: – Situation:
“tourism factor” Tourism in Greece during summer months – Popular holiday destinations are likely to re-
open for tourists during summer months
when planning for – This is currently not figured into the second
a second wave projection
COVID-19 wave
– Impact:
– Population within holiday destination will grow
by factor X during summer months
– Number of cases will be larger than assumed
in the model (due to increased number of
visitors) for both host and destination country
Illustrative – Example:
– Greece had 28mn visitors in 2018, which is
almost 3x its population
– Tourism numbers for 2020 are likely to be
significantly lower
– Assuming around 10mn visitors in the summer
of 2020 would double Greece’s population
susceptible to a COVID-19 infection
– Recommendations:
– Governments should include a “tourism
factor” in planning for second COVID-19 wave
– This factor needs to consider tourists within
Tourism streams
the country as well as returning citizens
11 Source: Medicines for Europe; Kearney1. Executive Summary 2. Demand 3. Supply vs. demand 4. API Survey 12
Demand was Reported supply vs. – Two scenarios:
extrapolated supply – Only actual supply reported back by MAH
compared against
supply under – Actual supply reported back by MAH,
extrapolated to full market size (based on 2019
twelve different figures)
scenarios
Second wave scenario – Three scenarios:
planning – Best case:
lowest absolute demand
– Base case:
likely demand
– Worst case:
highest likely demand
Available supply for – Two scenarios:
COVID-19 patients – Avg. 50 % of supply available for COVID-19
– Avg. 75 % of supply available for COVID-19
13 Source: Medicines for Europe; Kearney1 2 3
Summary:
The summer
months should be
used to restock in
preparation for a
potential second
COVID-19 wave in
autumn
The industry scaled The industry However, in the
up supplies analysis, based on event of a second
massively during experts’ wave in autumn,
April/ May 2020 – hypotheses, there are supply
however, this may suggests risks for Europe,
not be maintained shortages across most poignantly in
over the summer Europe are less neuromuscular
months! likely during the blockers.
summer months.
14 Source: Medicines for Europe; Kearney1. Executive Summary 2. Demand 3. Supply vs. demand 4. API Survey 15
Our survey of We asked MAH the following question:
participating MAH “Do you experience notable API
suggests that API challenges that pose a significant
challenges threat to manufacturing in terms
currently do not of quantity, quality or time of
seem to pose a delivery?”
major risk for the
industry
Illustrative;
data based on 08.06.2020
Results Implications
– Only few manufacturers report at least – Generally, API supply does not seem
one notable API challenge to be a major risk factor
– These are restricted to neuromuscular – However, capacity constraints may
blockers and sedatives cause manufacturing bottlenecks
– Common themes are short-term – This conclusion needs to be
supplier capacity, committed volumes corroborated from the perspective of
and own use of API by supplier non-EU manufacturers
16 Source: Medicines for Europe; KearneyThis document is exclusively intended for selected client employees. Distribution, quotations and duplications –
even in the form of extracts – for third parties is only permitted upon prior written consent of Kearney.
Kearney used the text and charts compiled in this report in a presentation; they do not represent a complete
documentation of the presentation.
Image by Ch. Germino1. Appendix 18
Key model Rationale and sources for key demand model parameters
Non-exhaustive, high-level
parameters were
defined using
various sources, Model
Rationale Key sources
parameter
including from
governmental Number of – The number of deaths is a more reliable – Worldometer
COVID-19 indicator than the number of cases
agencies related deaths
% of COVID-19 – Only patients who are admitted to ICU – Robert-Koch-Institute, Germany
related deaths consume ICU medicines – therefore, patients – International Long-Term Care
in hospital who died outside of hospitals should not be Policy Network
included – ICNARC – Intensive Care National
Audit & Research Centre
MV rates for – There is a mounting trend towards putting – Grasselli et al., JAMA, 2020
COVID-19 fewer patients with COVID-19 on MV as an – Bhatraju et al., NEJM, 2020
patients adverse impact on treatment outcome as been – Yang et al., Lancet Resp Med,
observed in some studies 2020
– A 50% MV rate was used as a “lower-bound” – Wang et al., Annals of Intensive
estimate based on available studies Care, 2020
– All patients not on MV are assumed to be on – Gattinoni et al., AJRCCM, 2020
non-invasive ventilation – Clinical experts
ICU treatment – Dosage and duration of ICU treatment differs – Clinical experts from various
by molecule class countries
– Country-specific differences need to be – Various scientific articles (e.g.,
“averaged out” Grasselli et al., JAMA, 2020)
19 Source: Medicines for Europe; KearneyYou can also read
