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Once the solar calendar year passed, perhaps Pfizer silently increased the supply, the number of Paxlovid that could be opened in hospitals in Beijing and Shanghai and other regions increased significantly, and the news circulating in major WeChat groups and friend circles to grab P medicine was much less
.
Instead: "Is there 'Jingbing', urgently needed, immediately injected!" ”
The so-called static propylene, the full name is intravenous gamma globulin, originally used to treat primary immunoglobulin deficiency, secondary immunoglobulin deficiency, autoimmune diseases and other three major types of diseases, mostly used in children and blood diseases
.
It is worth mentioning that the "intravenous COVID-19 human immunoglobulin" mentioned in the new crown diagnosis and treatment plan is an antibody specific for the treatment of the new crown virus, which is not completely equivalent to static propylene
.
In the treatment of new crown, Jingbing is mainly used for patients with a decrease in autoimmunity caused by new crown virus infection or hormone drug suppression, and the timing of clinical application is relatively special, which is related to
the patient's autoimmune function.
It is generally used only in the severe stage
.
And when the number of critically ill patients increases, Intravenous Propylene becomes a more scarce and scarce "life-saving drug"
than Pfizer Pfizer.
However, compared with posting a sentence of "ask for P medicine" in the group, you can occasionally encounter two or three scalpers who immediately throw the product legend and price over, unlike many friends who "ask for silence and Bing" often send it out for a long time without getting a response
.
This situation of "even scalpers are not in stock" has further aggravated the state of short supply of static propylene, and the price has been speculated from about 600 bottles (2.
5g) in the hospital to 3000, an increase of more than four times
.
In the experts' calculations of this wave of the epidemic, according to the 50% infection rate of the new crown and the 10% incidence of severe disease, in just one Chengdu city, the demand for Jingbing for 20 million people (including 3 million elderly population) reached 1.
5 million bottles
.
This figure is 105 million bottles under the country's 1.
4 billion population, and the national production of static propylene in 2021 is less than 13 million bottles
.
13 million and 105 million, the gap between supply and demand is a full 10 times!
Static propylene and albumin and coagulation factors are blood products, compared to P drugs are synthesized from jars, and the raw materials of blood products are human plasma
.
Unlike voluntary blood donation, pulp collection at the pulp station will give the collector a certain subsidy, and only leave it for the night, and no blood cells
are needed.
Because it is easy to involve the suspicion of "making money with human blood", the supervision of blood products from collection to production to circulation is extremely strict, and basically all are license access
.
Source: Southwest Securities
This industry attribute determines that blood products cannot increase production capacity on a large scale in the short term; In addition, the interval between the collection of blood products and the admission of products to the hospital is about nine months, which means that even if the scale of pulp collection is opened now and the production capacity is greatly increased, it will have to wait for more than half a year to be used
.
Finally, according to a research summary, China made a wave of strategic reserves of blood products at the beginning of the new crown epidemic in 2020, but because of prevention and control management, there were very few severe patients and there was no large-scale use, so the entire industry has been slowly digesting channel inventory for three years, and there seems to be no need
to continue storage at that time.
But at the end of this year, the sudden release, the number of infected people increased sharply, the number of severe patients also increased exponentially, and the inventory in the channel was just digested, so in addition to the products signed by the company, there is "not more than one bottle"
on the market.
That is to say, as of the first half of 2023, patients and new crown critically ill patients in the original indication field of Jingbing this product will continue to face a shortage of
stock.
P drug (indications approved in China) is for the prevention of severe disease, and Jingpropylene is for the treatment of
severe disease.
The crazy object changed from P drug to static propylene, which in a sense also shows that the number of critically ill patients is rising, and the new crown infection is slowly advancing into deep water
.
But the new crown as a sudden public health crisis will eventually end, China, as the second largest consumer of blood products and the second largest producer of blood products, blood products, one of the most strictly regulated sub-industries in the field of medicine, how to get to today, and what direction it will develop in the future, is also related to
its own historical origins.
-01-
-01-Strong regulation caused by blood disasters
Strong regulation caused by blood disastersWhen it comes to the strict supervision of the blood product industry, there is an inescapable past, that is, the blood disaster
that happened in the Central Plains in the 90s.
As a strategic reserve, albumin, one of the main products of blood products, has been in short supply since the war
.
At the end of the 80s, with the process of reform, the consumption level of residents increased, and the demand for albumin increased
.
In order to reverse the national "blood shortage", the policy design directly sends pulp collection indicators to various provinces and cities to develop the domestic blood product industry and reduce import dependence
.
The country needs, the industry is highly profitable, several factors jointly promote the large-scale epidemic of the blood selling industry chain, and for farmers who are still solving the problem of food and clothing, it is also an extremely good source of income, this very large base group has pushed this matter to the peak, so that in Henan appeared "if you want to run to a well-off, hurry up to sell plasma" propaganda, local TV stations also participated, and even shouted out the slogan
"not selling blood is not patriotic".
According to reports, at its peak, there were more than 230 blood stations in the entire Henan Province, what is the concept of this number? In comparison, in 2021, the number of pulp stations in the whole industry of blood products in China was 287
.
The matter of large-scale blood collection itself is understandable, but the regulatory standards have not kept up, blood scissors and blood forceps are often insufficiently disinfected during blood collection, and cross-contamination of blood cells often occurs during apheresis and transfusion
.
.
As a result, almost all blood-borne diseases in this process of a large number of cross-infection, in the mid-90s in central China, north China, in addition to malaria, hepatitis C and other diseases incidence soared, hepatitis B high incidence is also related to this, the most serious is AIDS, there is a view that China's high incidence of AIDS, largely due to the nearly ten years of irregular pulping work
.
In 1995, Henan Province completely suspended the operation of county-level blood stations due to the high incidence of various diseases, but underground illegal blood collection continued, because the information was not public, and no one could specifically count how many people had participated in this "plasma economy"
.
In 1998, the central government promulgated the Blood Donation Law, outlawing blood trading, and in 2001, the Ministry of Health personally led a working group to Henan to investigate the spread of HIV/AIDS
.
According to CCTV, the cumulative number of AIDS patients in the country that year exceeded 600,000
.
At that time, the bloody incident in Henan shocked the country and abroad, but the huge mistake was followed by strict supervision
.
In 2001, when CCTV reported on the bloody disaster, the State Council issued the Action Plan for Containing and Preventing AIDS in China, affirming that it would be effective from 2001
Since then, no new blood product manufacturers have been approved, and since then there has not been a single new blood product company
in the country.
Since then, the blood product industry has entered the competition
between existing enterprises.
Since then, the blood product industry has finally formed a set of comprehensive regulatory measures
for enterprise business qualifications, plasma sources, import and export through various patching documents of various ministries and commissions.
Source: Southwest Securities
The number and layout of pulp stations in the blood product industry will be formulated according to the national demand for raw plasma for production approved by the Ministry of Health, which has basically become a planned economy
.
In addition, in clinical blood salvage, China has completely banned this situation; Moreover, the quarantine cycle of blood products in China is also longer
than overseas.
Finally, there is another point that China's blood products follow the approval, that is, after a MAH holder collects plasma, he can only produce as many products as he has in his hands with the blood product product registration certificate, and other valid components can neither be used to extract them themselves nor be allocated to other companies, even under
the same group.
For example, Company A has several pulp stations, collecting 10 tons of pulp every year, but only two approvals of albumin and coagulation factors in hand, then the plasma collected by Company A can only produce albumin and coagulation factors, as for the plasma still contained in the static propylene and crazy exemption and other products, can only give up extraction, because the extraction can not be sold, nor can the ingredients be transferred to other companies
.
This has led to a significant discount in the production efficiency of domestic blood products, while overseas differences are that only active ingredients can be freely blended, and even raw blood can be traded
.
This is thanks to its accommodative policies and experience accumulated over a long period of time
.
And China, after the full contraction of Henan's bloody policy, still has a long way to go
.
-02-
-02-A giant strangled by the neck
A giant strangled by the neckUnder strong supervision, it is determined that blood products are a resource-based industry, that is, pulp stations and the number of approvals determine revenue and scale
.
Therefore, after the strict control of the industry in 2001, there was a series of vertical and horizontal mergers and acquisitions, and large-scale horizontal mergers and acquisitions appeared several times, until today, forming a competitive pattern
with five giants: Temple of Heaven, RAAS, Hualan, Palin and Boya.
Source: Zheshang Securities
The blood product industry was originally a track with great scale effects, that is, who had a large pulp production volume and a high
profit margin.
An expert mentioned that under the scale effect, the current domestic blood product manufacturers cannot make profits if they do not reach a certain scale, and this key node is about 300 tons
.
Therefore, the pulp station has become the only logic for each blood product company to compete in the secondary market, who has more pulp station, who must be large
.
.
However, at present, the product approvals in the hands of the subsidiaries of the giants are incomplete
.
Take the Temple of Heaven as an example, only one company has coagulation VIII.
approval, and another factory has prothrombin complex (PCC), because the plasma mentioned above is not allowed to be mixed with each other, except for these two, all the remaining subsidiaries of these two types of components will be wasted, which also greatly reduces its profit margin
.
It also leads to the profitability of the Temple of Heaven, which extracts 1,800 tons of pulp per year, which is not comparable to Hualan
.
But that's just above
the water.
There is also a large amount of profits in the blood product industry that are not written into the financial statements of listed companies, but flow into middlemen
.
The clinical characteristics of blood products represented by Jingbing are similar to antibiotics, paying attention to the principle of "adequacy", that is, an adult must use enough according to the amount of 300mg / kg, insufficient amount and no beating, so feedback to the clinic, often a patient a dozen is 10 bottles, only 5 bottles, 7 bottles are completely ineffective
.
This poses a new problem for the use of static propylene, that is, the proportion of
drugs.
10 bottles down, in a treatment project is easy to pull up the total cost of drugs, which affects the performance evaluation
of the department.
After DRGs land, in the same situation, the large amount of blood products can easily pull the score of a patient or even a department to exceed the standard
.
The coping strategy is that few blood products are prescribed in the hospital, and most doctors prescribe prescriptions, and then let patients go to the pharmacy outside the hospital and scalpers to take them
.
As a result, a large amount of profits from blood products actually flow outside
the hospital.
the hospital.
Or take Jingbing as an example, the market price in the hospital is generally the factory price of the drug, about 500-560 yuan per bottle, but there will be a certain percentage of the premium
in the hands of scalpers.
In this new crown epidemic, it is rumored that Jingbing has sold a bottle
of 2,000 yuan.
The state strictly controls the price of blood products, so the factory price of products has not fluctuated
much historically.
But in fact, ordinary people use products that are overpriced, and middlemen and scalpers will also help this matter
.
This part of the profits should have been given to blood product manufacturers for product renewal registration and the development
of new blood banks.
To some extent, this also limits the expansion rate of the entire blood products industry, but under the rapid growth of China's consumption level, the demand for blood products is also growing rapidly, and the relationship between supply and demand has actually become tense
in recent years.
of new blood banks.
To some extent, this also limits the expansion rate of the entire blood products industry, but under the rapid growth of China's consumption level, the demand for blood products is also growing rapidly, and the relationship between supply and demand has actually become tense
in recent years.
However, the supply and demand of blood products also determines that such products are difficult to be collected
.
In February 2022, Guangdong released a regional alliance collective procurement plan investment promotion, involving 5 varieties
, including intravenous human immunoglobulin (pH4), human immunoglobulin, human albumin, human fibrinogen, and human coagulation factor VIII.
The results were released in May, with a maximum decrease of no more than 10%, and the vast majority of quotations were basically the same
as the original price.
Behind this is that the logic of centralized procurement is to exchange price for quantity, but for blood products, the production capacity of less than 300 pulp stations in the country can not cover the demand for blood products in the whole Chinese, and albumin still needs to rely on imports to this day
.
-03-
-03-A life-saving medicine with a gap of 10 times the gap between supply and demand
A life-saving medicine with a gap of 10 times the gap between supply and demandBack to the new crown epidemic, the large demand for static propylene is still suddenly released, resulting in a large increase in severe patients in the short term, which has seriously aggravated the mismatch between supply and demand
.
According to an expert's calculation, based on the 50% infection rate of the new crown and the 10% incidence of severe disease, just one Chengdu city, the demand for 20 million people (including 3 million elderly population) for Jingbing reached 1.
5 million bottles
.
This figure is 105 million bottles under the country's 1.
4 billion population, and the national production of static propylene in 2021 is less than 13 million bottles
.
13 million and 105 million, the gap between supply and demand is a full 10 times
worse.
It is revealed that in 2020, in the face of a sudden epidemic, Jingpropylene as a (possible) new crown treatment drug, coupled with the epidemic may cause a decline in the number of pulp extractors, the state has urgently implemented the strategic reserve of Jingpropylene products, and a large number of blood product manufacturers have expanded a wave of production capacity
in the short term.
But in the past three years, the country's attitude towards the new crown epidemic has been to choose isolation and protection, a large area of severe patients have not appeared, and Jingbing has not appeared in the expected "short supply"
.
Therefore, from 2021, blood product companies have reduced production of Jingbing, so as to slowly digest and adjust inventory, so as not to affect
the subsequent "production-demand".
.
Therefore, from 2021, blood product companies have reduced production of Jingbing, so as to slowly digest and adjust inventory, so as not to affect
the subsequent "production-demand".
In order to speed up the digestion of inventory, many blood product industries once set their sights overseas
.
At the beginning of 2021, Palin Biotech began exporting Jingbing to Brazil, Southeast Asia and other regions, and has since cooperated with Brazilian retail giant Hypera
Pharma has signed a long-term strategic cooperation agreement of no less than 5 years, and Shanghai RAAS and Boyaa Biotech have similar businesses
.
The cycle of inventory digestion is exactly three years
.
However, three years later, the inventory was exhausted, but the epidemic was also completely liberalized, and the number of severe patients soared
sharply in the short term.
sharply in the short term.
The shortage of blood products is somewhat similar to the four types of cold medicines: during the three-year lockdown, the sale of cold medicines was banned, the supply was greatly limited, and the production capacity did not increase but declined
.
After the sudden liberalization, under the surge in demand, short-term capacity construction could not keep up
.
However, compared with ibuprofen, which can be increased to 400 million tablets per day in a month and a half, blood products due to historical reasons and industry characteristics, the increase in production capacity is like a thread
.
.
Before 2003, the ingredient was almost not produced by blood product companies, when most of the profits were in albumin and coagulation factors, and most of the other components isolated were directly dumped
.
The SARS epidemic has allowed Jingbing to find her place
outside of rare diseases.
In a sense, the epidemic has increased the awareness of the entire industry about the product, and the supply and demand of Jingbing have slowly risen
.
And now, the impact of the new crown is not a one-time one-time, according to overseas experience, there will still be follow-up variants to hit, and the proportion of secondary infection is not low
.
In the future, there will still be a huge mismatch
between supply and demand for the product of static propylene.
This puts forward higher development requirements
for the industry.
It also gives supervision, from the collection, processing, deployment and circulation of blood products after marketing.
.
.
In terms of scientific and efficient development, new challenges
have been posed.
