According to the study, “Smart Prevention: Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements” issued by Frost & Sullivan through the Council for Responsible Nutrition (CRN) Foundation, to regularly consume supplements could dramatically reduce healthcare costs.
Since it is now clear that high healthcare costs could be reduced by disease prevention, pharma distributors should take action and look for expanding their businesses into the supplements’ market. However, it’s important to, first, understand why nations, governments and individuals are nowadays focusing more and more on preventive measures than before.
It is a fact that disposable income and middle-class populations are rising in most emerging economies. Moreover, a sedentary lifestyle is not only a characteristic in Western countries. As a result, non-communicable diseases (NCDs) are affecting developing markets at a high rate and healthcare costs are rising worldwide.
Many aspire to a healthier lifestyle and seek options for preventative health measures, hoping to avoid curative care and physical costs associated with severe diseases. Since researches have shown spending some dollars on supplementation can result in better health, supplements have been in high demand on the markets worldwide in recent years.
Key Takeaway Tip #1: It is now or never. With the Covid-19 pandemic happening, healthcare costs rising, and population aging, disease prevention is undoubtedly in the spotlight. Thus, expanding your product scope to trending products, such as nutraceuticals, should be a no brainer.
Good nutrition is the foundation for health and well-being, and many reports in the past have found health benefits in supplementation. Most commonly, intake of certain vitamins and minerals could reduce the number of medical events, protect from common colds, lower the risk of infection; and could even slow down the development of some chronic diseases and strengthen the immune system.
The supplements industry will be worth a staggering $280 billion USD by 2025, and analysis shows the growth is being boosted by the COVID-19 pandemic, since people started placing closer attention to preventive health measures. Additionally, several studies to assess the benefits of supplementation in our daily diets are being conducted because of it.
To name only a few examples of correlations between illnesses and nutraceutical use, it is now known that calcium and vitamin D supplements could have a positive impact on women with osteoporosis. The same goes for magnesium, which can save $530 million per year only in the US on the curative care of osteoporosis patients. For eye diseases, like cataracts and macular degeneration lutein and zeaxanthin are beneficial. On the side of coronary heart disease, one of the most common causes of death globally, omega-3s can offer a risk reduction of 6.9%. Furthermore, B vitamins especially folic acid, B6 and B12, have been found to be beneficial and may offer a relative 3.3% risk reduction of heart disease.
Key Takeaway Tip #2: Considering supplement benefits only as a sales proposition is nowadays outdated. Science can back up many health benefits, highlighting correlations between supplements and disease prevention. Because of this, supplements should be perceived as a long-term investment helping to save on healthcare spending, for individual consumers, pharma manufacturers, medicine distributors or government representatives for public health.
It is an obvious choice for pharma distributors to invest available capital from their business into new preventive products, such as supplements. In most markets, nutraceuticals are considered food products and are less regulated than medicines, consequently it is very important to consider these five aspects before signing a deal:
How is your selected manufacturer assuring product quality? Which areas of the production process does your partner manage? Which manufacturing certificates does your supplier possess?
AdvaCare Pharma’s quality system is divided into four areas: Production, Distribution, Inspection and Quality Control. Each area has unique processes and procedures to ensure product consistency. Moreover, our quality control system emphasizes the rigorous testing of products to prevent defects.
All AdvaCare Pharma’s facilities possess up-to-date GMP, CE and ISO certificates that reflect high-quality standards and the World Health Organization’s rules and regulations.
How globally present is your selected manufacturer? Does it have enough clients on markets similar to yours? Can you trust the experiences and knowledge of the management team?
At AdvaCare Pharma we are proud to say our products have a global presence. Highly experienced in developing markets, our products can be found in more than 65 countries in the 5 continents worldwide.
Is your selected manufacturing partner offering product importation and registration support? How much experience does the company have when it comes to regulatory affairs? Can the staff help you in case of any bureaucratic setbacks?
Even if supplements importation has a less rigorous process than regulatory requirements for distributing pharmaceutical products, AdvaCare Pharma acknowledges they are not any less relevant. With experience in registering hundreds of healthcare products, our highly experienced registration department is always at the disposal of our client’s needs.
Does your selected supplier offer a wide range of supplement products that can satisfy the needs of different target groups in your markets? Are you able to place an order that will ensure you have diverse product options on your shelf?
AdvaLife™ Nutraceuticals, an AdvaCare Pharma brand, produces over 100 products in more than 6 categories. From essentials like basic vitamins, to complex condition-specific formulas, we recognize that differentiation is vital in today’s overly saturated supplement industry.
SALES SUPPORT OPTIONS
When it comes to selling the supply of supplements on your market, does your manufacturing partner offer any support? What about marketing support and promotional materials?
AdvaCare Pharma stands behind a vested supplier-distributor relationship, setting us apart from any other manufacturer with the large-scale distribution. We make it our primary objective to ensure the success of our distributors and are proud to have a high distributor retention rate.
Key Takeaway Tip #3: Before sealing the deal with your selected supplement manufacturer, it is of utmost importance for you to consider the following five aspects of your future business partner’s abilities: manufacturing standards, market presence, regulatory affairs, product range and sales support. Make sure to also ask the right questions when negotiating your best deal.
References: Essential Nutrition Actions by the World Health Organization, article “Cashing in on the booming market for dietary supplements” by McKinsey & Company, the report “Smart Prevention – Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements” by Frost and Sullivan, and “Dietary Supplements Market To Reach USD 210.3 Billion By 2026 | Reports And Data” press release by Global NewsWire.
According to the World Health Organization, chronic disease prevalence hit around 57% last year. This means that, today, more than a half of the world population suffers from chronic conditions, the most common being cardiovascular and lung diseases, cancer and diabetes.
Chronic diseases are non-communicable illnesses which usually require long-term care and ongoing medical attention. These can sometimes cause permanent disability or can have an impact on people’s abilities for doing certain activities.
Most non-communicable diseases have a serious impact on the patients’ quality of life and ultimately many of them could lead to their premature death.
The four non-communicable diseases (NCDs) that are collectively responsible for almost 70% of all deaths worldwide are:
1. Cardiovascular disease, like heart attacks and stroke
2. Respiratory conditions, such as chronic obstructive pulmonary disease and asthma
Other, less deadly but very common, NCDs requiring special daily attention are: obesity, kidney disease, liver disease, chronic infections, such as HIV; and chronic inflammation, such as Crohn’s disease and ulcerative colitis.
Globally, the growing middle class and the fast urbanization in developing nations is causing people to adopt sedentary lifestyles and unhealthy habits. As a result, a rapid increase of the probability of mortality due to non-communicable diseases is happening.
The World Health Organization emphasizes that nutrition and eating habits are key when trying to understand the risk factors in non-communicable diseases. An unhealthy diet, mixed with a sedentary lifestyle, tobacco usage, lack of physical activity or excessive alcohol consumption increases the probability for people to develop chronic conditions.
Eating meals heavy in fat, meat, salt, sugar and processed ingredients, while forgetting about the sufficient intake of fruit, vegetables and fiber is causing the countries that are already fighting infectious diseases, to also have an equal burden of NCDs.
A variety of nutrients, vitamins and minerals is needed per day to stay healthy and most importantly to preserve a healthy system that prevents chronic diseases. For example:
Vitamin D is considered to improve people’s immune system and is often recommended for the prevention of viral and bacterial infections. Additionally, Vitamin D could ease prolonged inflammation caused by NCDs such as diabetes and obesity.
Potassium could reduce the risk of cardiovascular disease, stroke and coronary heart disease as it reduces blood pressure. The World Health Organization recommends a daily potassium intake of at least 3,510 mg/day for adults.
Multivitamin use over a long duration could reduce the risk of major cardiovascular disease. Vitamin deficiency, suboptimal folic acid levels, along with low amounts of vitamins B6 and B12, are risk factors for cardiovascular disease, neural tube defects and colon cancer. Low levels of vitamin D contribute to osteopenia and fractures; and deficient levels of Vitamins A, E and C may affect the growth and protection of white blood cells.
Unfortunately, most people may find it difficult to achieve recommended nutrient intakes through diet alone. Consequently, proper supplementation has become an important factor when addressing NCDs prevention and control.
Health professionals are already making big efforts to inform their patients about the benefits of consuming nutraceuticals. However, pharma distributors are just starting to produce and sell high quality dietary supplements for NCDs prevention.
The rising demand for nutraceutical products on account of their increasing importance in preventing NCDs has resulted in the significant growth of the global dietary supplements market.
It is important for you, as a distributor, to identify which are the best suitable products for your customers’ needs and to differentiate the products you offer from other similar ones that are already available in the market.
Understand the diversification of your client base
Identify your market’s main chronic diseases and the population groups affected by them, for example: the elderly, young children, middle-aged women. Factors like age, gender and geographical location could suggest that a person needs more or less of a given nutrient to prevent NCDs.
Once you have identified which are the most common NCDs by population group, proceed to point out what essential vitamins and nutrients to look out for before selecting which are the suitable supplements for each group.
Select the adequate range of products you will import
At AdvaCare Pharma we are conscious of the role of supplements in preventing chronic conditions, this is why we offer a wide range of nutraceutical products comparable in formulation, purity of raw materials and packaging to major US and European brands.
Our brand AdvaLife Nutraceuticals has a wide range of more than 100 supplements:
Condition Specific Formulas: Blood Sugar Support Supplements, Heart Support Supplements, Bone Support Supplements, Hemoglobin Support Supplements, Immunity Support Supplements, Liver Support Supplements, Diabetes Support Supplements, Kidney and Bladder Support Supplements
Essential Fatty Acids: Fish Oil, Omega 3-6-9
Syrups: Bone Support Syrup, Immunity Syrup, Kidney SUpport Syrup, Liver Protector Syrup, Multivitamin + OMega-3 Syrup, Multivitamin Syrup, Vitamin B Complex Syrup
Vitamins & Minerals: Daily Complete Multivitamin, Daily One Complex Vitamin, Vitamin B Complex, Vitamin B12, Vitamin C, Vitamin D3
With presence in more than 65 countries, AdvaCare Pharma is globally recognized as a leading manufacturer of high quality and affordable cost nutraceutical products. Contact us to prepare the final product list for your order!
Benefit from an Effective Point of Sale Display
We acknowledge that product differentiation is vital in today’s overly saturated market, and consequently we will work towards making sure your products are properly presented and displayed at your customers’ points of sale.
Your AdvaCare Pharma sales representative will lead you through selecting the suitable packaging design for your market and our retail and marketing experts will guide you when choosing the adequate promotional material for your target consumer.
Contact us and start distributing AdvaLife Nutraceuticals today!
References: Fact Sheets on Noncommunicable Diseases, article about noncommunicable diseases, publication Essential Nutrition Actions by the World Health Organization, PWC article on chronic diseases, article Targeted Nutrition in Chronic Disease from Peter Bergman and Susanna Brighenti, article Vitamins for chronic disease prevention in adults: clinical applications by Robert H Fletcher and Kathleen M Fairfield, article Multivitamins and chronic disease risk reduction by Natural Medicine Journal and article about Global Burden of Disease Study in the Lancet.
Just like human supplements, there are more and more options available for pets. Becoming increasingly more concerned about the health and well-being of their pets, owners around the globe are spending big on supplements and nutrition. Consumers, in developed and developing markets alike, are appropriating a larger proportion of income to maintaining health, preventing diseases and prolonging the lifespan of man’s best friend.
Dietary Supplements for pets, also referred to as “pet nutraceuticals”, provide essential nutrients that help to fill nutritional gaps resulting in a stimulated immune system, reduction in the risk of diseases, better overall health and ultimately a prolonged lifespan. Most commonly given to dogs, cats, horses, birds, reptiles, and other small animals and fishes, market leading pet supplement product categories include multivitamins, minerals, prebiotics, antioxidants and fatty acids such as Omega 3,6,9. Herbal extracts are also growing market share as further product differentiation gains traction. At AdvaCare Pharma USA, we’re constantly expanding our pet supplement product range to meet demand from our markets and to provide our distributors with specialized products needed to gain market share, including:
The pet supplement sector has been experiencing explosive growth. Mintel’s research on pet industry trends up to 2019 shows that pet owners are committed and open to spending money on the latest trends in pet supplements. Many pet owners want their pets to be as healthy as they are. This new decade will also see a continuing rise in the number of pet nutritional products containing additives such as basic vitamins and omega-3 fatty acids, further fueling the growth of the supplement industry.
The rise of pet supplements invites innovation in product development further pushing the boundaries of what owners are willing to give their pets
In fact, consumers increasingly don’t even want traditional pet supplements any longer, but instead are opting for healthy ingredients that can be verified – the ingredients listed on the label are dictating sales figures. Therefore, product awareness amongst distributors is now crucial. Retailers and consumers prefer color-coded, resealable packaging and more product information to enable informed decisions for a better end customer experience. Detailed ingredient information including the source of raw materials, indication of product usage, possible interactions and adverse effects and pet owner tips give distributors a competitive advantage over other brands. AdvaCare includes QR codes on all of our product packaging to provide valuable product information, allowing for a better customer experience with AdvaCare brands and ultimately brand loyalty and better customer retention. These QR codes link directly to the company’s page to provide detailed product information and also serves to make clear to consumers that no harmful chemicals or toxic solvents are contained in our products.
A mix of distribution channels exist. Retail stores and online stores are both improving customer engagement through omnichannel retailing as they are also selling products through the medium of e-commerce portals, which has proved a major increase in sales over recent years. The numbers will rapidly increase as soon as retailers adapt online sales channels to a post-Coronavirus marketing model.
The increasing urbanization, growing trend of nuclear families, changing perception towards animals and increased pet adoption rates are the main trend factors in emerging countries.
Some of the changes in pet ownership are due to technology and the advent of online purchasing. But most of the growth is because of changes in culture. As Millennial and Generation Z consumers have come into adulthood, they have embraced the pet-owning and pet-loving lifestyles to a far greater extent than their elders. Millennials and Gen Xers are clearly adopting more pets than older generations. As we know, Millennials with pets also tend to use technology to purchase products and services. This has helped form a powerful market with a presence of new ventures in pet-related business. With this in mind, the pet market should continue to expand in size. The most demand in pet supplements category is visible in APAC region, estimated with total 7.9% growth over the forecast in 2019. For instance, in India, dogs are more popular than cats, birds, and horses. Dog supplements will account for a significant market share in the forthcoming years.
Over the years, pet owners have dramatically changed the way they think about and care for their pets. The rising demand towards animal welfare will lead the pet supplement industry to surpass $1 billion USD in revenues by 2027, making it a major global industry. The pet healthcare industry combines veterinary pharmaceuticals, diagnostics, product distributors and services, manufacturers of pet food and pet supplies, and online and traditional pet and pet supply stores. Each of these sub-industries is responding to the demands of pet owners with continued innovation that’s led to massive growth.
At AdvaCare Pharma USA, we have dedicated R&D and focused heavily on the product development of pet supplements by drawing on the vast knowledge of our global presence in both the veterinary and human supplement sectors. Producing over 150 livestock veterinary medicines and over 130 human supplement products, we have leveraged our unique capabilities to formulate a range of quality, specialized, affordable pet supplement products which ensure our distributor’s customer demands are met and profitability is achieved. Introduction to new processing technologies along with automated systems for the production of our finished products is anticipated to drive the growth in the forthcoming years. We are constantly focused on meeting the demands of our distributors and guiding their success… see what makes AdvaCare a different kind of pharmaceutical company.
Before farmers, veterinary workers, as well as animal medicine distributors and manufacturers found themselves in the midst of a pandemic crisis, the sector was reporting steady growth. With compounded growth of over $45 billion from 2020 to 2027, statistics have estimated the veterinary medicine market to reach $119 billion USD by 2027. Even though global impacts of the coronavirus are undeniably being felt and will have an effect on the veterinary and livestock industry, the crisis has made clear that growth in the animal healthcare industry will continue.
Proper care to livestock is essential, especially in the time of a spreading virus, if we are to reduce the risk of further infections, and ensure supply chains of both local producers and global conglomerates. Additionally, it is important to enable veterinary workers access to essential equipment and medicine to not only fight normally occurring infections in animals, but also prevent other infectious animal diseases whose control may have been severely neglected due to uncontrollable consequences of Covid-19, resulting in a negative domino effect on the overall industry. Thus, for the veterinary professional, medical wear in short supply can be a challenge to procure and medicines otherwise commonly available also become more difficult to obtain. Supplies to veterinary clinics across the globe have reported more shortages than hospitals. In many countries, veterinarians have been requested, or even required to donate their equipment, such as disinfectants and PPE to healthcare providers.
Statistics have estimated the veterinary medicine market to reach $119 billion USD by 2027
Meanwhile, the industry has also been focusing on the availability of medicine products. This has not been an easy task, since not every custom control authority considers livestock or pet medicine as essential, blocking deliveries in the supply chain. The companion animal specialty drugs market, for example, remains one of the critical areas of concern during this global health crisis. Finally, the pandemic will mix up the power dynamic between different market segments itself, as the demand for some segments of veterinary medicine can be expected to grow, while others could mark a small-scale decrease.
All of this clearly shows that, in the time of such a crisis, distributors of animal healthcare products need to be agile, flexible and equipped with the knowledge of key industry changes, if they are to take on challenges smartly and successfully. To be able to structure a practical contingency plan for months to come, there are three trends a distributor should focus on. By describing the impact of Covid-19 on animal disease prevention and control, the trends can provide key takeaways a veterinary medicine distributor should take into consideration to position and grow their business during and after the crisis.
The fact remains that our food stocks rely heavily on animal sources, like proteins. Moreover, we count on livestock for our everyday dairy supplies. From milk to eggs, our supermarkets would surely look different if a big pandemic across the animal kingdom would hit. Even in South Asia, there has been a slow, but steady growth of animal product consumption recently. In China, for example, the consumption increased for poultry products, such as meat and eggs. As a consequence, on a global level, the demand for meat has more than quadrupled in the past 50 years, and the 320 million tons of meat are now produced worldwide each year. Consequently, due to the mounting risk of transferring animal diseases to humans, the need for animal healthcare products has also surged at the global level.
During the Covid-19 pandemic, the demand for basic food essentials such as animal protein has grown even more, especially on the local level. One reason for this can be found in surging demand that happened because many people have been stockpiling food supplies in the fear of the lockdowns. The other is the fact families are now left with fewer options for protein, iron and other key nutrients as supply chains of other foods are facing major disruptions. Healthy livestock is, thus, now needed more than ever to provide safe, plentiful food. And as an outbreak of animal disease could further threaten the supply chain, it is important to realize that veterinary healthcare product distributors are responsible to enable access to routine vaccinations and essential medicine to their clients, who are dealing with livestock, and need to meet food safety standards.
320 million tons of meat are now produced worldwide each year
Distributor’s Takeaway Tip: Veterinary and animal health industry develops and manufactures much needed animal health products, like drugs, vaccines, hygiene products, diagnostics, and support tools for livestock animals. Because of this it plays an integral role in maintaining the health, safety, security and sustainability of food supply worldwide and on the local level. As the animal populations in the livestock industry rise, the demand to take care of their health will rise too, and the pandemic will not slow down the demand growth. In fact, it can even increase it. To contribute to public health in an essential way, a pharmaceutical distributor should therefore also focus on providing essential medicine for animals to its selected markets.
We can divide the animal drugs market into two segments, prescription and non-prescription. Each country has different requirements for which products a registration is needed and for which not. In some cases products must be registered with the local FDA/MOH, while in others with the Agricultural authority or agency.
But while dynamics vary slightly, in most cases there are products that are more regulated and others that are less regulated, depending on the specifics of the rules in each market. The prescription market consists mostly of vaccines, pharmaceutical injections and oral solids. On the other side, non-prescription often comprises feed additives, premixes, soluble powders, oral solutions, and nutrition or supplement products. In 2019, the larger share went to the prescription segment. However, by 2021 the non-prescription segment is estimated to register a higher CAGR. Still the overall industry is estimated to grow substantially, especially due to increase in demand for feed additives.
Post COVID-19, the global feed market size is estimated to grow from $282.8 billion in 2020, reaching $325.7 billion by 2025
Even though the coronavirus crisis is happening, there is still an increased awareness about livestock nutrition, leading a way to the rise in the consumption of meat and other livestock-based products. Because of the challenges the new virus brought to the supply chain and production facilities, feed manufacturers and producers are becoming more aware of techniques and strategies to cope up with the situation. This, in turn, is projected to lead to an increase in demand. Post Covid-19, the global feed market size is estimated to grow from $282.8 billion in 2020, reaching $325.7 billion by 2025, while recording a CAGR of 2.9%.
This being said, the highest CAGR between 2020 and 2025 is projected to go to phytogenic as feed additives. This will likely happen due to prohibited use of antibiotics in feed, stringent regulations on synthetics feed additives declared by the EU, and the growth of phytogenic use in livestock feed with a goal to enhance feed palatability and livestock performance. Geography-wise, Asia Pacific market or APAC will likely grow the most. As the largest and fastest-growing market for feed additives, the region has a large consumer and producer base. Moreover, the raw ingredients are readily available there, which has encouraged the development of new products as well. Meanwhile, the animal feed industry should still brace for higher commodity costs due to disruptions in the supply chain, resulting in limited availability and delayed deliveries.
Distributor’s Takeaway Tip: Research animal feed additive products and include them in your product range if you haven’t already, as demand will grow steadily. For starters you can check out AdvaCare Pharma Soluble Powders, Injections, Tablets and Oral Solutions. Finally, for distributors working on emerging markets, it will be beneficial to also learn about trends in the veterinary healthcare industry before Covid-19, by reading our previously published article here.
It is important that all key players across the animal medicines industry work together to guarantee veterinary workers have all the supplies at their disposal. Even more, it is important to also provide essential medicine to farmers during the corona virus crisis.
Only then, proper care will be provided to animals, and further disease spread will be contained. Governments and society overall needs to realize that vets are essentially the Covid-19 frontline workers too. Even though there is no evidence the virus can pass on from animals to humans, they need significant support through a steady essential medicine supply chain. Even more, they need to be able to stock up on PPE essentials, if they are to protect themselves and others from any cross-contamination and do their work properly.
Luckily, governments around the world have already started to raise concerns associated with livestock’s health. Many started with putting veterinary meds on the lists of essential goods to ensure smoother and easier distribution across borders even when export/import restrictions are in place. With this, tools for safe and healthy livestock production are being provided to the animal healthcare professionals. On another side, being able to ensure pet health, veterinarians can now help older, vulnerable populations to keep their companionship animals well taken care of, which is especially important in the times when long periods of self-isolation are required in many places.
Distributor’s Takeaway Tip: Even if difficult, it is of utmost importance to still ensure veterinary medicines are reaching veterinarians, farmers and pet owners during the crisis. And even if more efforts have to ensure sufficient supply, rewards will be worth it. Not only monetary, since demand is high, but also humanitarian as animal healthcare professionals have been overlooked as essential workers of the crisis for too long. Look not only at animal medicine and medical devices, but also keep in mind veterinary professionals need PPE equipment as much as other medicine professionals do. There should not be major custom restrictions for your imports, however, it is still smart to check current rules and regulations before shipping takes place from your supplier.
The new virus pandemic was first felt by players, across all industries but especially those in medical, most involved in the supply chain sector. Faced with unique challenges, supply shocks started right after the first virus outbreak. Because of the interconnectivity of major parts of the global supply chain, a domino effect continued right after Wuhan went into lockdown. As the city is one of the world’s manufacturing hubs for finished products and many raw materials, demand shocks occurred soon after. To avoid problems with goods accessibility in the short run, manufacturers and distributors started overstocking. For this reason, it is abundantly clear China carries a dominant role as the ‘world’s factory’ with more than 200 of the Fortune Global 500 companies having a presence in Wuhan. Consequently, it is also clear that any major disruption there can put the worldwide supply chain at risk, and it has happened faster than anyone predicted.
However, knowing even a single supply chain disruption can reduce shareholder value by up to 7% (World Economic Forum), China’s dominant role is bad news for the global economy. Fortunately, recent events awakened world supply, chain leaders. Even if the final outcome of the pandemic is not yet known, it is already certain that the global supply chains will never be the same. In fact, coronavirus pointed out the increasing need to transform the industry’s traditional models and address vulnerabilities the system has long been exposed to.
Single supply chain disruption can reduce shareholder value by up to 7%, the World Economic Forum reports
Yet, controlling new virus developments or changing the supply chain as a whole is not something small players like local medical distributors can do. And if preventing an outbreak is not likely for whatever reasons, mitigating risks and adapting to market opportunities and niches for their own businesses is most certainly the correct step forward. For this, realizing and admitting a distribution company faces a crisis is the first thing team leaders must do. Looking at key challenges, such as logistical disruptions, raw material shortages and changes in product demand should follow. By doing this, the coronavirus crisis just might unintentionally do something good – motivate even the smallest players to rethink their approaches and, as the saying goes “the whole is greater than the sum of its parts”, changes to the global supply chain model will be profound.
Logistic services were one of the first and most heavily affected by the Covid-19 outbreak. Not only that labor was not available to transport goods, but managers also had to face port congestion, a decrease in air freight capacity, and truck driver shortages. Furthermore, on production levels, many warehouses struggled to move the goods as national lockdowns affected the number of staff available. With a deficit in workers, even tasks like loading and unloading goods were difficult to handle in a timely manner. On the other side, delays were occurring also due to restricted border crossing, and sticker import rules or customs clearance processes. Even more drastically, Covid-19 has resulted in unprecedented planning disruptions as even some airspace has closed down and placed a major strain on essential linkages between regions. All of this resulted in many cases of congestion in the cargo flights and shipping vessels and a reduction in the number of transports carried out worldwide.
Since many logistic companies had to take on indirect routes to enable the execution of their services – delivery of goods – prices peaked as much as 400% over normal rates. Many experts now believe prices will not come down to pre-virus days even after restrictions of the pandemic are lifted. Coronavirus pandemic has, therefore, placed extraordinary demands on logistic leaders in different businesses. Even if in many parts of the world production is slowly beginning to get back to normal, it turns out that it now costs companies more to move the goods to its distributors.
Now is the time to not only set aside a plan B but also a plan C
Looking ahead, this may result in fundamental shifts in the industry footprint. Many companies will most likely consider moving a portion of their production capacities closer to their end markets, to avoid increasing logistical costs in similar situations in the future. On another note, it will be also smart for them to reassess risks and costs of production in today’s global supply hubs, such as China, known as ‘the factory of the world’. Vietnam, Indonesia, Thailand, Malaysia, Mexico, or India are likely to benefit from it. However one thing is clear, decentralization of manufacturing capacity and companies looking to bring some of the automation and small batch production home will likely be a growing trend in the near future. Diverse sourcing will be the key to building stronger, smarter supply chains and ensure quick and lasting recovery in case of crisis.
Rethink your dependencies on supplies from only one region. Now is the time to not only set aside a plan B but also a plan C. Network with manufacturers from different regions or companies such as AdvaCare that have global production capacity, which is able to shift resources to ensure production capability. Design a smarter and stronger list of your liaisons and have their contact on hand for the times of need. In this way you will be able to depend less on only one supply chain track and, in disruption times, plan ahead and pick the supplier and route from a country less affected by the problem. This will assure the timely delivery of your order to your warehouse even in times of crisis.
It is a well-known fact that on a global scale, China and India dominate API production for generic drugs. Recently, with the shutdown and effort of limiting the spread of Covid-19, this has even more clearly shown how heavily pharmaceutical chains rely on these two countries.
Low availability and increased struggles with transport resulted in many factories worldwide suffering from a sudden shortfall in raw materials. However, material shortages are nothing new and many industries have suffered similar struggles, when their main raw material hubs were affected by higher forces. For example, one global electronics manufacturer lost 16% of revenue in 2016 because of earthquakes in one of the Japanese cities, from where the company was sourcing important parts for its product manufacturing. Moreover, one global automaker lost $5 billion in sales due to floods in Thailand, which resulted in similar issues. Unfortunately, pharmaceutical companies have not learned from past mistakes of other industry leaders. This is why it is important to rethink global models and material supply dependencies. To adapt, more agile and strategic procurement organizations may emerge, as reorganizing assets and supply chains will create more resilience. After, when sourcing from multiple key providers, companies have to learn to move quickly and activate secondary suppliers from non-affected parts of the world even before their inventory is at critical levels. Finally, companies should also focus on production scheduling agility, meaning to clearly plan out what product will be produced in the event of raw material shortages, especially when a component can be used in multiple goods.
Even if you are distributing final products and do not have to deal with material sourcing, it is best to diversify your product portfolio as some specific products can become hard to find at one point in time, even if you are working with most trusted suppliers. Imagine that in Covid-19 times you would have only been dealing with PPE products, which were at one point impossible to find, and usually only granted to official government orders. How would your business survive the tough months? Therefore, make sure adaptability and diversification are well known to your business management team and used in everyday strategy planning.
It is important to keep in mind that even when the pandemic will pass, and the global economy will get back to its normal functioning, global supply should keep being approached differently. If in the past many companies were aiming to the lowest inventory level possible, this will increase risks in the new reality. Supply chains have truly changed on some fundamental levels.
No business should rely heavily on only one, lowest-cost supplier and minimal product stock to keep business afloat and successful
However, Covid-19 is not the one to blame. Truly it has made professional leaders overthink established processes, but this was long overdue. In the past, many crises have influenced the goods supply network, though none of them were felt worldwide and to such extent as the current pandemic. Remember the SARS outbreak in 2002? Or another example, a climate-related disaster of Katrina hurricane? Recently, even political changes with Brexit and the US-China trade war had influenced supply flows heavily. And as disruptions are increasing in frequency and magnitude, they are becoming almost unavoidable. Therefore, no business should rely heavily on only one, lowest-cost supplier, and minimal product stock to keep business afloat and successful. Even more, doing so is posing a major risk. Evidence shows the severity of individual disruptions is growing and thanks to globalization and automation one can easily spread from local parts to entire systems, which was nicely shown by coronavirus effects in its beginning. When Chinese factories closed, manufacturers struggled to pivot or find other suppliers, and consequences were felt in the global industries even before local lockdowns and outbreaks occurred in other parts of the world.
Fluctuations in purchasing patterns are the fact of the future. Even if on a smaller scale, they have been happening before the coronavirus outbreak and will happen in the future. As a part of a larger supply chain, distributors can not avoid it. The best solution is to embrace the new reality, be aware of it and work towards knowledge of risk management, visibility into potential supply chain problems, agile and transparent operations, and training of a flexible, collaborative workforce. Only by achieving increased control over every step of the business management, solutions can come and respond to demand changes can be implemented.
Many decades have passed since the global dietary industry started offering supplements to end-consumers, in order to provide essential nutrients that otherwise many wouldn’t absorb in sufficient quantities. Up until recently, sales have been booming. Vitamins, minerals, proteins, amino acids, herbal extracts, and other dietary supplements, usually in a form of capsules, tablets or syrups, have seen increasing demand in developing markets as consumers are quickly changing their outlooks on preventative healthcare and earning more disposable income. Since investing in a healthy lifestyle and taking precautions is much more affordable than the economic, emotional, and physical costs associated with severe illness, supplements have been in high demand. It has been expected that by 2025 the supplement industry would be worth a stunning $280 billion USD, compared to an already significant $125 billion USD in 2018. That was before coronavirus changed everything.
It is clear Covid-19 froze economies for months and turned supply chains upside down. The pandemic will affect trade flows for months to come. However, not all businesses will suffer losses. Surely, many sectors of the economy, such as the automobile, airline, and many service industries will have to deal with heavy burdens due to Covid-19, but conversely, the dietary supplement industry should still keep on its growing streak. Even more – if producers of personal protective equipment (PPE) were not able to keep up with demand at the beginning of the pandemic, it is not farfetched to consider the possibility of a similar trend for nutraceutical production in the months to come. Boosting immunity is taking the forefront amongst consumers as a preventative measure as other precautions are slowly being put aside in light of loosened restrictions in many countries where the infection threat has reduced. Therefore, precautions such as wearing masks and protective gloves will soon subside for many conscious and nervous citizens trying to boost their health with vitamins and minerals to fight a possible infection. If the WHO estimated in a report last year that focusing on nutrition within health services could save 3.7 million lives by 2025, the importance and urgency of preventative healthcare are now taking on a new meaning.
WHO estimates that focus on nutrition within health services could save 3.7 million lives by 2025
Therefore, it is good to understand what trends, benefits, and higher general consciousness in relation to preventative health measures, can bring to distributors of nutraceuticals in today’s times.
There have been several reasons why economic experts predicted the exponential market growth of the nutraceuticals industry even before the pandemic of coronavirus started. Among others, the most frequently mentioned ones were the growing purchase power of developing countries and increased awareness about preventative healthcare. It has been clear for a while already, that immune health is one of the most sought-after benefits in the developed world, with developing countries following not far behind. Many individuals are now highly proactive when it comes to health, and the new pandemic reality for sure will not change that. Even more, with putting precautions and protection on the front news pages, keeping the body healthy has become a high priority for many of whom before the virus hit taking supplements did not even cross their minds. Let’s face it, no one wants to get sick during the pandemic when essential health services for common illnesses, such as cold or bacterial infections, are not easily accessible, even in most developed parts of the world.
Historically, spending on health has been prioritized by consumers even in the times of lower incomes and economic struggles, especially by chronic disease patients
Increasing demand can be shown by the fact a number of APAC online sellers ran out of vitamin C stock already in April as requests for orders kept flushing in. For example, the giant online Chinese reseller JD reported a 5-times increase in vitamin C sales, as well as a significant increase in probiotics and other immunity products. Other healthcare companies have also reported sales boosts of personal care, essential oils, aromatherapy, and homecare equipment. There has been increasing chatter on social media about supplements power as well, suggesting that nearly 20% of consumers who haven’t used vitamins before, suggested they might do it now. Another interesting statistic is the growth of orange juice sales, the most known food rich in vitamins. In the US some retailers marked a stunning 25% increase. Similarly, people in the Philippines have been hoarding vitamins in the midst of the pandemic. Even more, the country’s health authorities even decided to supply supplements to school children. Finally, it is clear not only toilet paper has been in high demand on many markets recently, but the typical seasonal increase of supplements demands has risen as a result of coronavirus spreading throughout the world as well.
Yet, what will happen when the health crisis calms down? What will happen if a recession hits because of all economic consequences lockdowns of countries will most probably bring? Historically, spending on health has been prioritized by consumers even in the times of lower incomes and economic struggles, especially by chronic disease patients. As nutraceuticals can be seen as a smart, cost-effective, and preventative alternative to expensive hospital services, it is more likely for the consumption of vitamins and minerals to at least stay consistent or even increase. Moreover, data on previous economic downturns have shown resilience in the market. Comparing the historic data with today’s trends, experts suggest there are similarities. In the end, the pandemic has also restricted people’s travel plans, which will leave many with saved income. However, it is of utmost importance that all stakeholders involved in the nutraceuticals chain, from raw material suppliers to medical distributors and retailers, start preparing for the long term growth of consumer demand.
Covid-19 induced many changes to workplaces. From increased digitalization, like work from home or even establishing new online stores, to disruptions in logistics and changes in consumer demands and priorities.
The market today is clearly different, so what are the crucial tips a distributor of supplement products should follow to stay on top of its game?
It is true all of the suggested tips will require you to re-evaluate your business approach and even attitude toward taking risks. But tapping into increasing demand for vitamins and minerals that is on the horizon, can in fact help you sort out some challenges that are arising due to lower demand of other products in your portfolio, which Covid-19 pandemic most probably brought to your business. In the end, one thing is clear, a healthy immune system is one of the best defenses against illness, and even if not being able to prevent Covid-19 infection, supplements will at least help your end-customers deal with its symptoms and the disease in general.
Since its first outbreak in December 2019, the Covid-19 pandemic has devastated the world. Besides testing both the preparedness and will of individuals and governments alike, the outbreak has also tested manufacturing industries with pharmaceutical and PPE manufacturers hit with the highest rise in demand. The supply chain has been challenged unlike any time since World War II. Further exacerbating this reality is the fact that government healthcare agencies and supranational organizations worldwide have been adopting “just enough” approaches over the last few decades. This means stock supplies of PPE in many hospitals have not been sufficient even before the first wave of the crisis. However, the tide has turned and now the excess capacity of equipment needed the most to fight infections is not seen as an unnecessary expense. Unfortunately, many involved in managing the crisis do not have surge capacities – the ability to manage a sudden, unexpected increase in patient volume that exceeds available capacities.
Resulting from all of this is the growing international concern regarding the shortage in the supply chain of personal protective equipment, also known as PPE. The WHO estimated that the organization would need to ship a minimum of 100 million medical masks and gloves, 25 million N95 respirators, gowns and face-shields, and 2.5 million diagnostic tests each month to meet the demand of its partners.
For example, the UN has delivered over 6.4 million gloves, 1.8 million surgical masks, and 1 million gowns to countries across the world in Q1 of 2020 only. Still, an enormous gap remains. Likewise, UNICEF estimates that needs through the end of the year could reach 2.2 billion surgical masks, 1.1 billion gloves, 13 million goggles, and 8.8 million face shields.
Therefore, manufacturers are ramping up production like never before to respond to the coronavirus crisis. This has resulted in significant price increases, making the challenge to ensure critical PPE products, not only including basic masks and gloves, but also a wide range of necessary protective medical wear, are distributed to frontline workers in all affected countries.
The fact China is one of the world’s largest producers of PPE, making the supply chain intensively one-sided, and concentrated on one area of the world, creates even bigger problems, exposing the shortcomings of globalization. The unfortunate reality is that most countries are unable to produce sufficient supplies of essential goods, such as medicine and food, to its citizens.
Personal protective equipment or shortly PPE is medical wear that is used every day by health care workers for protection against infections. Moreover, PPE ensures protection also for patients and other people medical professionals are providing the care for. Besides infections, like the novel coronavirus, it also protects against toxic medications or other potentially dangerous substances that are used in the healthcare industry. PPE includes gloves, aprons, isolation and surgical gowns, goggles, fluid-repellent surgical masks, face visor, protective medical clothing, respirator masks such as N95, FFP2 and KN95 masks. It is always recommended for a healthcare worker to wear at least some pieces of the protection, and even more so when there is a risk of contact with blood, body fluids, secretions, and excretions. It also protects the wearer from unnecessary injuries or the spread of infection. Raw materials required for the production of these products, usually being cotton fiber, polyester, and polyamide, are usually outsourced to low-cost suppliers.
In 2018, the global market for PPE, and only in the health sector, was estimated to be worth $2.5 billion USD. The highest revenues come from gloves (25%), followed by different suit or coveralls pieces (22%), and face masks (14%). By region, the US had the largest market share (33%), followed by Asia and the Pacific (28%), and Europe (22%) Mordor Intelligence 2020 reported for 2018.
Besides healthcare, PPE is also used in other industries. Items such as safety helmets, hazmat suits, safety footwear, safety harnesses, earplugs, ear defenders, and respiratory protective equipment are often used in factories or professions like civil engineering, especially for construction workers.
The world has jumped on overstocking the PPE supplies, and shortages are leaving many at high risks of exposure
In the hierarchy of risk control, PPE is considered to rank lowest and represent the option of last resort. It is only appropriate where the hazard in question cannot be totally removed or controlled in such a way that harm is unlikely. As this is obviously specifically true for the pandemic of a virus, the world has jumped on stocking or even overstocking the PPE supplies, and shortages are leaving many doctors, nurses, and other frontline workers of the crisis at high risks of exposure and contamination.
It is obvious that well running medical supply chains are essential for a well-functioning healthcare system. In most parts of the world, the system was running rather smoothly, but then the pandemic hit. Supplies of once easily found PPE products on the market became scarce, and to make it even more troublesome, the demand increased significantly on the verge of fighting the novel coronavirus.
The sector was hit hard and right at the beginning because suppliers from China make up the largest share of the market. Some estimate the percentage could go up to 80-90% of the global production capacity. Lockdowns in the country resulted in lowered manufacturing capabilities, and, at the beginning of the pandemic, when Chinese people were at the epicenter of infections, once the biggest producer of PPE had to rely on other nation’s help with the supplies.
Later on, came distribution problems, and even if China quickly enabled factories to start manufacturing PPE products at the highest capacity levels in the midst of their pandemic crisis, other nations faced problems with supply transport. Mostly, because many borders were closed, and customs regulations tightened so the global network faced unprecedented problems due to an overwhelmed system. It is true some airlines stepped up by repurposing their civilian airlines to carry cargo with PPE, and some governments, like UAE, speeded up the costumes clearance processes for essential goods, such as PPE and medicines. But although actions like this helped, they did not prevent the supply chain congestion. Countries all around the world were and some still are, facing shortages of different pieces of necessary medical wear. The UK, for example, reported critical shortages of gowns. Already in March, when the Western world was only starting to enter into the pandemic, WHO Director-General emphasized that “supplies of PPE, such as the gloves, medical masks, respirators, goggles, face shields, gowns, and aprons used by health workers fighting coronavirus are rapidly depleting,” and warned against hoarding and misuse.
Another big problem is the price increase. Surgical masks, for example, saw a sixfold increase, while respirators have tripled and gowns have doubled, according to the WHO data. To make things even more complicated even exports of some raw materials that have also been running short in many places, were banned for some countries. This includes Bangladesh, Canada, Czech Republic, Egypt, France, Germany, India, Indonesia, Japan, Iran, Jordan, Kazakhstan, Kenya, Malaysia, Pakistan, Poland, China, Russia, Korea, Thailand, and Ukraine (information for March 2020). This happened for N95 masks key components – non-woven polypropylene. Learn more about supply chain disruption in the midst of the pandemic in our previous article.
No matter the supply chain challenges, there was no lack of efforts worldwide to overcome them. How did big companies and international organizations respond to a particular crisis? What actions did WHO, The Global Fund, and alike take, to help the people around the world? How did some of the biggest governments secure PPE supply for its nations?
The WHO and UN responded by setting up a Supply Chain Task Force to establish Covid-19 Supply Chain System or CSCS. The aim of the body is to bring clarity to the process of requesting and receiving globally sourced Covid-19 critical supplies, ensure a humanitarian response to the pandemic, and help national authorities and their partners request the products for their markets.
On country levels, many are implementing measures to help companies expand their production capacities. For example, in China, the government introduced support to face masks manufacturers by helping with their purchases of raw materials and hiring new workers. Additionally, they will offer tax breaks as another incentive for the factories to work at their full capacities during this critical time. Even some automobile companies, for example, have been asked to produce PPE. Similar request was made to the vehicle production industry in the US. In Japan, the government provided support for companies to increase capital investment in mask production, while securing a supply of over 600 million masks per month, and even the WHO’s director, Theodoros Adhanom Ghebreyesus, has called on governments to increase domestic manufacturing of PPE by 40%.
The WHO’s director, Theodoros Adhanom Ghebreyesus, has called on governments to increase domestic manufacturing of PPE by 40%
On the NGO side, project HOPE mobilized one of the first shipments of personal protective equipment to Wuhan, when the pandemic first emerged. Nowadays, The Global Fund assesses the PPE situation daily and is a good resource for updates on its supply chain. As of June 2020, for example, 11% of orders face delays of more than thirty days, including 19% of orders already in transit. The information can serve well to distributors to better develop contingency plans and plan their delivery times.
Many banks have stepped up too. Asian Development Bank has, for example, committed to providing more than $6.8 billion, including an initial support package of $6.5 billion for sovereign and nonsovereign operations while more resources are expected to be mobilized. Even more, an $800-million increase in their Trade Finance Program has already been implemented.
Finally, young companies did also not sleep through the pandemic. Many start-ups saw the opportunity to innovate and act with social responsibility in mind. One key player in logistics improvements in Nigeria was, for example, the country’s start-up Kobo360. The company uses electronic platforms to connect drivers with cargo companies to make transport of goods across the country more efficient and transparent. The company officials claim that the system can significantly reduce the traveling time of the cargo. Similarly, in Indonesia, a company called Kargo Technologies is doing the same, as it aims for regional supply chains to remain intact even in the times of crisis. As a response to Covid-19, the company also implemented an electronic proof mechanism to minimize person-to-person contact in the chain.
Covid-19 pandemic has brought troubled waters to the supply of PPE. However, some good can still come from it. There are many lessons that can be learned from the challenges distributors have been facing ever since December 2019.
Short-term disruptions can, firstly, result in a supply chain of PPE moving from China and India to more local industries, either in other emerging markets or even home markets of many countries as many countries are now realizing the benefits of self-sufficiency in the field of medical wear. On the alternative side, many governments are also considering more stockpiling, contingency planning, and better stock management in the country’s public reserves.
Covid-19 pandemic has brought troubled waters to the supply of PPE, however some good can still come from it
Moreover, one of the biggest is the lack of innovation in the field. There has not been enough literature or research published on the reprocessing of PPE, as they have always been considered a single-use product. More work on options of sterilizations and repurposing of the equipment should follow. This would not only bring more security to any contingency plans for possible higher demands of the PPE products in future pandemic events but would also offer greater resource utilization and sustainability.
Nonetheless, all these solutions will have to be done on a larger industry-based scale. Yet, even a smaller local distributor can follow some guidelines to overcome obstacles of the pandemic era. Here are some tips from AdvaCare’s Sales team experts on procurement and supply process of PPE:
After the pandemic hit, scientists have conducted several research studies to help fight the disease. Most of these qualified studies focus on developing a vaccine or effective treatment in the form of existing medications or new antiviral medications with the goal of slowing and eventually eliminating the spread. At the same time, some scientists have been focusing on understanding the virus transmission paths in order to suggest appropriate preventive measures.
The first measures presented by public health agencies were focused on sanitation, such as educating the public on personal hygiene and extensive disinfection of public areas, followed by promoting the use of masks and required social distancing. But as many countries have been opening up and shifting back to normal life, continuing such measures will be difficult especially in light of the ongoing negative economic impact. This is why boosting immunity might be the best preventative method to fight the virus, or at least reduce the severity of symptoms. Consequently, long term growth of immunity-focused nutritional supplements will be the highest growth segment of the industry.
It is prudent for a smart distributor to also keep in mind that further research on supplementation benefits for Covid-19 patients is growing rapidly. Therefore, it can be expected that new results showing in more detail how nutraceuticals are helping to prevent the virus spread, will increase the demand significantly. For example, in Alberta, Canada scientists are rushing to prove the relationship between vitamin D and Covid-19. On the consumer side, 73% find products fortified with added nutrients appealing, and more than 87% are expressing an interest in immune health, according to a Global Data report. In addition, nutritional supplements have been receiving more attention from healthcare professionals, as more and more doctors are supporting public health officials in including nutritional supplementation as a means to cope with the spread of infections. And since the threat of the COVID-19 pandemic doesn’t seem to be abating any time soon, distributors of pharmaceuticals and healthcare products are positioning to support the increased demand, and make sure they are prepared to offer suitable nutraceuticals to the market.
In Alberta, Canada scientists are rushing to prove the relationship between vitamin D and Covid-19.
To learn which products will experience the greatest growth, our team dug deep into published scientific research from all over the globe and surveyed our global distribution network. As a result, we are uncovering six types of supplements that the scientific and medical community are promoting in the fight against the new disease.
Having sufficient levels of vitamin D in our system is an important part of optimal immune function. As a fat-soluble nutrient, it is essential to the actual health and functioning of the body’s immune system, and it has been shown vitamin D helps fight acute respiratory infections. Conversely, low levels are associated with increased risk of upper respiratory tract infections, such as influenza or allergic asthma. Depending on blood levels, anywhere between 1,000 and 4,000 IU of supplemental vitamin D per day is sufficient for most people, though those with more serious deficiencies often require much higher doses. In general, many populations are deprived of vitamin D, as there are not many foods, such as mushrooms, rich in this nutrient. It is true that another source of it is the sun, however, staying indoors because of lockdown measures in many Covid-19 infected areas, has left many deprived of this essential vitamin.
So, even if there is no conclusive evidence that taking vitamin D supplements will significantly reduce the risk of catching coronavirus, experts assume it may have benefits during the pandemic. Not only because it is believed to have anti-inflammatory effects, but also because vitamin D deficiency could possibly be linked with worse clinical outcomes in case of catching the virus. Some studies suggest people with low vitamin D levels will suffer from more severe symptoms and will have a higher risk of being admitted to the ICU, as well as be twelve times more likely to die because of it. Additionally, vitamin D is known to have a crucial role in the regulation of the immune system, and the results of a Philippino study suggest, increase in D level in the body could improve clinical outcomes or mitigate severe to critical ones. It is true that conclusions form several studies are not enough to make claims with certainty, but the fact people with darker skin have been shown to be affected more heavily by the pandemic might be explained by the fact that those populations are more prone to vitamin D deficiency. Even more, they have this in common with elderly people, people with chronic diseases, and people in nursing homes, who were all hit by the virus more than other demographics. On the other side, researchers in Ireland reviewed data showing Covid-19 infections and deaths are actually lower in Nordic countries, such as Finland and Norway, where vitamin D is added to food or where daily supplement intake is widely encouraged. Conversely, vitamin levels are severely low in Spanish, Italian, and Swiss populations due to the aging population – all countries hit hard by the pandemic.
Beta-glucans are known sugars that are found in the cell walls of fungi, yeasts, lichens, bacteria, algae, and plants, such as oats. The product usage has been driving growth in the nutraceutical industry. Since beta-glucan can increase immune health, and count as a nutritious food supplement instead of a synthetic ingredient, consumers wanting to take health precaution steps have been preferring it over other products.
Even before the pandemic, which is expected to boost the market even more, the global beta-glucan market was projected to reach $3 billion USD by 2027, growing at a CAGR of 7.26%. For example, in 2016 its market size was already estimated at $410.6 USD million, with the largest chunk going to soluble beta-glucan form, amounting to 33.96% of the market.
Geographically, this nutraceutical market is segmented into seven regions: North America, Latin America, Eastern Europe, Western Europe, Asia Pacific, Japan, and Middle East & Africa. In 2014, the dominant share of the market went to Western Europe, however, Asia-Pacific has been the fastest-growing region since then, anticipated to expand at a CAGR of 5.75% between 2020 and 2025.
Growth and function of immune cells, antibody production, enhancing cell protection abilities, clearing out and replacing old cells with new ones – all the roles why vitamin C is probably the most known and popular supplement to take in order to protect yourself against viral infections. It also functions as a powerful antioxidant. This is why it also protects against damage induced by oxidative stress, occurring with the accumulation of free radicals, which negatively affect immune health. In the past, research has shown that taking vitamin C can reduce the duration and severity of upper respiratory tract infections, like the common cold. For example, a regular dose of 1 to 2 grams per day has been demonstrated to reduce the duration of the colds by 8% in adults, and 14% in children.
Vitamin C is probably the most known and popular supplement to take in order to protect yourself against viral infections.
Moreover, intravenous vitamin C treatment can help with more severe infections, such as sepsis or acute respiratory distress syndrome (ARDS), by mending the symptoms. In particular, vitamin C, polyphenols, and flavonoids can play a protective role in lung infections, being immune modulators, and inflammatory mediators.
How about the coronavirus? More studies have to occur to link vitamin C supplementation directly with the effect on the development or spread of coronavirus disease. However, many results confirming vitamin C supplements significantly affect immune health, especially if individuals don’t get enough of it through proper diet, should not be diminished, as it has been proven it can help fight viral infections in general. This is why clinical trials with vitamin C infusion for the treatment of severe Covid-19 patients have already been suggested. In the end, it is smart to note the upper limit for vitamin C, which is 2,000mg, even though supplemental daily doses typically range only between 250 and 1,000mg.
The global blackseed oil market is projected to progress by almost 22% CAGR from 2019 to 2023, rising by $23.74 million USD. This herbal supplement capsule segment will be seeing the highest growth and will, together with other forms, bring high sales revenues in the next 10 years, mainly in the Asia Pacific region. The reasons for this are low costs and great availability of the raw ingredient. Additionally, significant technological advances have been made in the cold-press extraction methods for this oil, making high-quality products easily available and positively impact the global market growth even before Coronavirus pandemic hit. As black seed oil contains many vitamins and nutrients such as vitamin B1, B2, B3, folate, calcium, phosphorus, copper, and zinc, and thus supports body functions such as immunity, growth on the global market is imminent.
From protection against respiratory tract infections to reducing the duration of the common cold, sufficient levels of zinc are crucial for the health of an individual. This is because zinc is essential for an immune system function. The body needs it to develop immune cells and proper inflammatory response, and deficiency in this element can significantly affect your immune system’s ability to function properly. Additionally, studies have suggested zinc may slow the ability of viruses to make copies of themselves inside your body. Still, deficiency is common in older adults. Thus, supplementation with daily dose under the 40 mg limit is recommended, but it is important to follow medical advice and instructions when taking it, as too high dosages can make you sick and actually lower your body’s immune system response. Zinc can interfere with other dietary nutraceuticals as well.
In relation to Covid-19, zinc sulfate may be effective for better patient treatment, especially in combination with antimalarial drug hydroxychloroquine.
Echinacea is another herbal supplement expected to grow heavily, as its market size is expected to reach USD 8.5 billion by 2025. From 2018 to 2025 it is projected to expand at a CAGR of 6.2%.
Widely used for a range of medicinal benefits, it can not only improve immunity but also deducts inflammation and helps fight infections, such as a common cold. One of the largest studies demonstrating its benefits, published by William Reed Business Media, indicated that this herbal ingredient can reduce recurrent colds by 60%, and its duration by 26%.
Echinacea market size is likely to grow because awareness about its health benefits are growing. For example in 2018, when we haven’t even imagined the Covid-19 pandemic and its influence on preventative health needs yet, sales of echinacea already amounted to $110 million in the US. Even more, in 2017, the Echinacea segment accounted for the largest revenue share of 34.9% of the global market. The up-and-coming herbal supplement is regarded as the third most popular product in the US distribution network. However, it is quickly gaining on trendiness in other regions such as Asia-Pacific as well, where high adoption of the supplement for infection prevention is starting to happen.
With at least six types of supplements showing potential benefits in relation to the Covid-19 fight, it is clear a well-informed medical distributor won’t only seek out personal protective equipment and testing devices for its imports. To thoroughly provide its community means to limit the spread and be completely prepared for the future ‘second-wave’ outbreaks, one can therefore also:
The COVID-19 pandemic has brought many changes to different aspects of lives for many people and businesses across the globe. The pharmaceutical and medical products sector is no different. Communities are looking at their local governments to provide medical, financial, and social assurance. However, the role of governments in providing medical assurance through testing and treatments has been limited in comparison to the scale of the outbreak. Individuals, including healthcare workers, are relying on private distributors to help fill in the gap, both in developing and developed countries. Pharmaceutical and medical product distributors are in a key position to help provide assistance in maintaining and pushing forward the progress that we have made thus far in the fight against the pandemic.
For pharma and medical product distributors, the currently developing situation makes it difficult to maintain and predict their operations. Many have taken the steps to help their communities in fighting the outbreaks to fill current gaps and operate based on the current critical needs and shortages of medical products. The many changing variables make it hard for distributors to find a direction to follow in the current business climate. Distributors need to understand the importance of long-term planning and have a bigger picture view of the situation.
Unfortunately, some businesses have seen the pandemic only as an opportunity to make quick returns. Meanwhile, other businesses might not be willing to take the risks to meet growing demands in fear of changes over time. Businesses must understand how to navigate the current situation by taking steps that will benefit the community and their entity in the long term. Here, we have analyzed some steps that might help pharma and medical product distributors “make it” through this pandemic, by understanding key roles that they need to undertake in the long term in their markets.
The demand for COVID-19 products, namely test kits, PPE, and other hospital equipment and disposables, has surged across the globe at an unprecedented level since the disease was declared a pandemic. Now, with efforts of containment and mitigation in place, numerous regions are experiencing a slower increase in the number of new cases per day compared to before. The problem is, data has shown that while the growth rate of new cases might have slowed down, the demand for these medical products will remain high as newly emerged cases will start showing worse symptoms and more people are receiving treatment. Not to mention, preparatory and preventative measures are still being taken as the trend too might be changing.
The WHO has released technical guidance to help the planning of essential resources needed. The tools provide an estimate for the need of personal protective equipment, diagnostic equipment, biomedical equipment, essential drugs for supportive care, and consumable medical supplies.
As distributors, you may find where your current region is positioned in terms of essential resources needed. Current projections suggest that overall most regions still fall short on testing capabilities and PPE in particular. Supportive care drugs should also be of concern for many, as the number of patients needing care follows the increase in the number of cases with increasingly worse symptoms.
Demand for some products will wane as the pandemic diminishes, but many products will continue to have strong demand indefinitely. It is important for distributors to position now to get ahead of this trend. As this pandemic has changed public perception and overall consciousness and awareness of sanitization, hygiene and immunity, products such as face masks, hand sanitizers, disinfectants will remain strong for the foreseeable future.
…although new COVID-19 cases rate is slowing down, demand for medical PPE remains high.
Fear of under/over stocking remains to be a hindrance for distributors to maximize their supply capabilities.
Firstly, testing capability is currently seen as a factor of whether or not social distancing measures can be slowly loosened. Testing will remain important even as the number of cases is reducing, as it can help not only the containment of spread but also community assurance despite a low infection rate.
Secondly, the global scientific community has predicted that COVID-19 outbreaks might come in waves over the next year or two. So while a slowing growth trend can be observed now, a comeback might occur as the world starts to resume its activities. The availability of COVID-19 products for the time of recurrence is crucial, for quick containment of the outbreak. It is important for distributors to have sufficient stocks of their products ready for the fight now, and also for the upcoming waves of outbreaks. Distributors should factor in their stocking capabilities, and also the shelf life of the test kits.
To learn more about how to efficiently optimize your pharma supply chain you might be interested in reading our dedicated article here!
The COVID-19 pandemic has driven communities to look to government and private healthcare providers, pharmacists, and pharma distributor for help. The roles of private sector distributors are so important in keeping their communities physically and mentally healthy where the governments fall short. Yet, many have instead taken the opportunity of the pandemic to rake in the most profits. Prices of medical supplies for consumers such as masks, gloves, digital thermometer, and hand sanitizers have increased at an unprecedented level over the last couple of months. Not only is it limiting some individuals from protecting themselves, but it has also forced some to look for other alternatives for means of preventative measures that might be harmful.
For example, some individuals have looked to homemade masks that do not offer much protection or homemade hand sanitizers that might burn sensitive skin. Price gouging could also cause distrust from the community. In the times where information can be obtained easily via the internet, consumers know to look for fair prices. Distrust aside, price gouging will cause the loss of competitiveness of the business. Understand that the long term fight of this outbreak will require mutual trust and respect of distributors and consumers. In this time of crisis, healthcare providers and distributors should refrain from price gouging and instead try to provide values in other forms to increase profit and community trust.
Price gouging, unfortunately, does not just start at the local distributors. Numerous suppliers are also looking into short-term gain by taking advantage of high demands. To ensure that your customers receive a fairly-priced product, working with trusted suppliers is important. Fraud is also rampant as scammers wait for times of need to jump at any opportunity to profit. Currently, prices of COVID-19 products have undeniably increased due to exploding demand and a limited supply of materials.
However, make sure that you are working with trusted suppliers that give fair prices reflecting the market price. In addition, quality assurance should also be prioritized at this moment where many manufacturers may be producing poor-quality products due to maximized capacity. When importing products especially, a trusted supplier should have all the necessary certifications that can provide certain quality assurance. Working with a qualified and trustworthy supplier will ease your business process. You want to work with suppliers that could give you quality products at a fair market price.
All the world seems to be talking about is COVID-19, and understandably so. Yet, just because the novel coronavirus disease has exploded, does not mean TB, measles, and other infectious diseases have just stopped. Due to efforts in mitigating the current outbreak, national immunization programs have been halted in many countries. There is certainly a fear of a surge in infections of other diseases as COVID-19 infections slow down and the community is back to its social activities.
Currently, as many as 100 million children might be at risk for measles. UNICEF shared this concern, urging countries to not lose focus on other diseases while putting their efforts in fighting the pandemic. Distributors must consider the surge in other medical supplies such as syringes, diagnostic kits, and supportive care medicines to ensure the community is better prepared. Similarly, in non-infectious disease cases, hospitals have halted many of their surgical procedures deemed as “elective”, so as not to risk the patients being in close proximity with those being treated with COVID-19. A surge in elective procedures is expected with a decrease in the number of cases.
Now more than ever, communities are looking to obtain as much information as possible to stay healthy and ready against any diseases. Individuals are looking for reliable information which unfortunately is muddled due to the abundance of information online. Distributors can use their products and platforms as a way to provide accurate and based knowledge. Instead of just providing basic information about your products, use your marketing channels to share helpful tips with the community.
Posters, pamphlets, or even the packaging of your products can be a way to help educate your community. You can remind your customers of the importance of handwashing or using hand sanitizers, or even share ways on how they could boost their immune system.
It is well known that pharmaceutical distribution is all about solving the right medical needs, at the right time and place. To do this, information is the key, and even if all resources show a steady growth of non-communicable diseases (NCDs), such as cardiovascular conditions, diabetes, and cancer, one must still understand patterns of infectious communicable diseases on the other side of the equation. While its overall percentage number is decreasing in relation to the NCDs, containment and control are still of high importance.
By looking at last year’s disease outbreak patterns in emerging markets, pharma distributors can look beyond OTC medication and antibiotics, when thinking about their client’s future needs. While some of the developing world is truly fighting the pandemic increase of ‘western’ type of diseases due to the changes in lifestyle and growing megacities, unpredicted outbreaks of highly viral infections still occur. Not so rarely, those outbreaks are the leading cause of many fatalities and economic loss. This is particularly true for emerging countries where the businesses are already struggling, mainly because containment is not managed properly. Consequently, massive transmissions occur rapidly. Many governments and industry sectors have been acknowledging the necessity of better healthcare availability, however, changes are happening slower than we would hope, and hindrances are still expected to halt the control of some emerging and re-emerging diseases in the years to come.
Even more, from the beginning of 2019, the world is seeing the spread of communicable emerging diseases at an unprecedented rate. The World Health Organization’s archive shows that out of 37 various global outbreaks in 2019, 33 of them occurred in emerging countries. Moreover, some happened over a short period of only a few months. As a result, diseases like Ebola and Yellow Fever continue to affect the most vulnerable of the population.
By looking at last year’s disease outbreak patterns in emerging markets, pharma distributors can look beyond OTC medication and antibiotics, when thinking about their client’s future needs
Renowned healthcare professionals have already expressed their forecast and concerns for various emerging and re-emerging infectious diseases. On top of all this, even the WHO has in the past stated that various health challenges will be inevitable in the upcoming decade. For proof, one has to only look at the pattern of outbreaks in 2019. Climate change along with much increasing antimicrobial resistance are just some of the biggest barriers in repressing these outbreaks. Others include external factors, such as hyper-connected world economies where travel is frequent and common, political conflicts with refugee movements and security problems, as well as ever-increasing popular anti-vaccination movements with popular personalities endorsing them.
To be better prepared for tackling worldwide health epidemic concerns in the new year, here is an overview of 5 top outbreaks of the last year, with tips on how you can help contain them as a distributor.
Ebola virus disease (EVD) is a viral hemorrhagic fever caused by ebolaviruses. It is a high-risk disease with a mortality rate of up to 50%. The disease was first identified in 1976 in South Sudan and the Democratic Republic of Congo (DRC). However, the largest outbreaks to date happened between 2013 and 2016. Additionally, Ebola continues to cause outbreaks in the years following. By March 2019, the second-largest Ebola outbreak ever was recorded in the DRC. Consequently, in June 2019, two people also died of Ebola in neighboring Uganda. Soon after, the WHO declared the outbreak a world health emergency. Due to its high contagiousness, communities with infected people as well as health care workers are highly exposed to this virus.
On the opposite side of prevention, diagnosis, and treatment, significant progress in fighting the Ebola outbreak was seen in November 2019. Ebola vaccines passed pre-qualification tests as two experimental treatments were found to be 90% effective.
Ebola outbreaks occur mostly in regions fighting political conflict where displacement is recurrent. While medical professionals are now able to contain Ebola virus contamination and provide recovery, poor water and sanitation caused especially by environmental hostility post great challenges. Not to mention, the areas most inflicted by Ebola have a history of weak health systems, leaving people to only be able to rely on non-profit organizations for care.
Medical professionals are at most risk and the importance of their roles in the fight against the disease in high. Therefore keeping them safe and healthy should be of utmost importance. By providing sufficient and high-quality medical wear products, risk of contamination can be reduced significantly.
On the side of Ebola patients, basic health interventions can significantly improve the survival rate of the infected. Therefore, medical devices such as infusion sets or oxygen masks besides pharmaceutical products, will be beneficial as virus symptoms can be treated by:
Yellow fever is a viral disease spread through mosquito bites. While it is typically of short duration, 15% of cases enter a second, toxic phase accompanied by jaundice. With this development, the fatality rate rises to 20-50%. Moreover, severe cases have a mortality rate even greater than 50%. Problems occur not only because the diagnosis is slow since the virus can be only confirmed after six to ten days after the infection, but also because there is no specific treatment for the disease. Fortunately, vaccinations exist, can prevent the disease and provide immunity for life. However, due to the high demand in prone areas such as Angola, DRC, Uganda, Nigeria and Brazil, global vaccine supply is currently strained.
Besides, new regions in Nigeria have been seeing numerous cases of yellow fever infection in 2019, with nearly a three-fold increase in the number of confirmed cases since 2018. Brazil is confirming new cases since 2015, and Venezuela has also seen the first confirmed autochthonous case of yellow fever after 2005.
Vector-borne diseases such as Yellow Fever are very much affected by climate. With climate change causing differences in temperature and rainfall patterns, the disease has emerged in regions where it has never been recorded before and in seasons for which it has been previously uncommon. Additionally, climate change causes the disease to spread wider as the increase in temperature causes previously more temperate areas to experience climate similar to tropical areas.
While there is no specific treatment for the already infected, the disease is preventable with vaccines that provide lifetime immunity. The pharmaceutical companies together with NGOs and health authorities of countries previously not prone to the disease, should make vaccines widely available as climate changes will bring more cases to new regions. Prevention can also include vector control.
On the side of Yellow Fever patients, treatment of symptoms is crucial to reduce the severity of the disease as there is no cure for it. This can include but is not limited to use of pain-relieving medication such as Dipyrone (tablets, injections), AVOIDING anti-inflammatory drugs and using IV in hospital supportive care when moderate to severe cases occur.
Basic support of distributors to the Yellow Fever communities can, however, also include campaigning with authorities to make vaccines more available, as well as promoting the use of mosquito repellent nets, clothing and sprays for protection against infection.
Polio, short for poliomyelities, is an infectious disease caused by the poliovirus. The disease is preventable with the polio vaccine, however, cases of vaccine-derived polio happen more predominantly since 2018 compared to the wild disease. The progress against polio is so significant that total eradication is expected in the near future. Currently, only 3 polio-endemic countries remain (Afghanistan, Nigeria, and Pakistan) with Nigeria not showing any wild cases in 2018. However, circulating vaccine-derived cases have been happening in multiple countries due to virus mutation. In 2019, ten countries reported this kind of cases.
Polio eradication is a goal that health world organizations worldwide would like to see in the near future
Polio eradication is a goal that health world organizations worldwide would like to see in the near future. Circulating vaccine-derived cases are the leading cause of outbreaks in polio. These cases are preventable, but are unfortunately occurring due to fragile and vulnerable settings generally circulating among poorly vaccinated children. Famine, conflict and population displacement can lead to the unavailability of not-live vaccines nor qualified vaccinators, who are giving injections.
For polio eradication in its totality, vaccines outreach, availability and quality is a priority. Firstly, the switch of live oral vaccines to not-live ones must be made worldwide. Secondly, the availability of trained vaccinators to give injections has to be assured, which will for sure be a challenge for some governments and healthcare agencies.
On the side of Polio patients, as no cure is available, the focus should be on increasing patient’s comfort, ensuring speedy recovery and preventing possible complications. This can be done by, but not limited to providing:
Measles is a highly contagious viral infection, with high rates of complications and a case-fatality rate of up to 15%. Common complications of measles include diarrhea, middle ear infection, and pneumonia. In 2019 alone, there were over 660,000 confirmed measles cases worldwide, a three-fold increase of the previous year. The largest outbreaks of the year hit the hardest in the African region, most severely in Madagascar, Nigeria, and DRC. Over 250,000 cases alone were found in the DRC. However, in the last year, the outbreak affected more than just the African region. In fact, confirmed measles outbreaks occurred in multiple countries across the Eastern Mediterranean, European, Americas, South-East Asian, and Western Pacific regions. Following the African region, a large outbreak was observed in the European region, where Ukraine reported over 56,000 cases.
Measles is a highly contagious viral disease that can affect susceptible individuals of all ages. Measles had been historically declining in outbreak number, and were at one point, in the year 2000, even declared eliminated in the United States, all thanks to the availability of the measles vaccine. However, due to the nature of this highly contagious virus, any community with less than 95% population immunity is still at risk of an outbreak. The gap of vaccinations in the low-middle income countries, in addition to vaccine hesitancy in higher-income countries, has created a vaccination gap that was never before seen, causing a resurgence of the highly contagious and fatal disease.
To ensure vaccination coverage of over 95%, government agencies and distributors alike should primarily work on raising awareness of the importance of vaccinations
Knowledge and community understanding is the key in fighting measles. To ensure vaccination coverage of over 95%, government agencies and distributors alike should primarily work on raising awareness of the importance of vaccinations, especially in high-income countries where the resistance is gaining in popularity more and more. However, more awareness to seek measles vaccinations will help emerging countries as well, although ensuring possibilities to do so is also of high importance there. If not advocating with authorities to help out with more vaccination for areas in lack of it, as a distributor you can still at least remind your community of the importance of vaccinations. Use platforms you have available, such as store posters and brochures.
On the other side, while outbreaks of measles might still be unpreventable, there are ways to minimize the severity of those already infected by the disease. Methods include but are not limited to providing:
Dengue fever is a mosquito-borne disease caused by a dengue virus. Similarly to malaria, it is transmitted by the bite of an infected mosquito, that got infected by biting a person with dengue virus in their blood. Though it can’t be spread directly from one person to another, it can be spread via infected blood products, organ donation or from mother to child. There are four closely related dengue viruses, meaning a person can potentially be infected four times. Besides Dengue Fever, the same viruses can also cause West Nile infection or Yellow Fever. Nonetheless, dengue can cause a variety of diseases, and many people may not even know they are infected. Some of those develop severe dengue, first recognized in the 1950s during dengue epidemics in the Philippines and Thailand.
Every year around 390 million cases occur worldwide, out of which around 96 million proceed to illness due to infection. Regions with the greatest risk because of the tropical environments are the Indian subcontinent, South-East Asia, Southern China, Taiwan, the Pacific Islands, the Carribean, Mexico, and Africa. However, the WHO reports a significant rise in global incidence of Dengue Fever and estimates that around half of the world population is now at risk. Between 2010 and 2016 the reported cases increased from less than half a million to 3.34 million, but then a significant reduction was detected in 2017-2018. Unfortunately, in 2019, there has been a worldwide increase again. Since last January many infections have emerged in the Western Pacific, Latin America and Caribbean region, with a lot of cases also observed in Australia, Cambodia, Malaysia, Singapore, Vietnam, Congo, Ivory Coast, Tanzania, and African region. Additionally, in countries like Honduras, Philippines, and Bangladesh the escalating number of patients lead to nationally declared outbreaks of this mosquito-borne disease.
Fragile and vulnerable settings, such as living in areas of crises caused by drought, famine, conflict or population displacement, can lead to Dengue Fever outbreaks. Global warming causing rainy seasons to be longer in some regions even increases the risks of the disease. Countries like this are for example Bangladesh and India. In addition, Dengue infections are also spreading towards countries with temperate climates, like Nepal, that has not had to fight the disease in the past. After outbreaks in 2019, due to international travel, the WHO even estimated a possible outbreak in Europe.
Since Dengue Fever can show mild symptoms, commonly mistaken for the flu or other viral infection, proper diagnosis is significant. To reduce mortality rates from severe cases, distributors can help by supplying their hospitals and clinics with quality and accurate dengue test kits. This is especially important for people with weakened immune systems or those that have been infected by dengue virus in the past, as they can be at greater risk of developing severe cases. Additionally, prevention efforts by promoting the use of mosquito repellent nets, clothing and sprays for protection against infection are also always valuable when talking about mosquito-borne diseases.
On the other side, while there is still no specific treatment, there are ways to minimize the mortality risks from 20% to 1% for those infected. Methods include but are not limited to:
In the end, there has been a vaccination developed and approved in 2015, with the first use beginning in 2017. However, analysis of trial participants showed that some of them had a higher risk of more severe Dengue and hospitalizations from Dengue compared to unvaccinated participants. Because of this, the use of the vaccine is limited to people living in endemic areas, who are 9 to 45 years old and have already lived through one or more documented infections.
Learn more about key market movements of the pharmaceutical industry in our sources for the article and report: “2020 Tropical Infectious Disease Forecast” article by ASTMH; “Getting Ahead of Crises: The 2020 Global Humanitarian Overview” article by Christina Potter on Outbreak Observatory; “Emergencies preparedness, response” articles archive by the WHO; “Climate Change and Health in Pictures” article by the WHO; “Everything You Need to Know About the Measles” article by Healthline; “Measles” article by the WHO; “Measles History” article by CDC; “Measles – Global situation” article by the WHO; “Measles cases up in the U.S. and globally” article by Rita Giordano in The Philadelphia Inquirer; “Polio” article by Mayo Clinic; “WHO just declared another polio virus strain eradicated. There’s one more to go.” article by Julia Belluz on Vox; “Our Progress Against Polio” article by CDC; “Yellow Fever” article by Christina Terra Gallafrio Novaes and Max Igor Banks Ferreira Lopes in Revista da Associação Médica Brasileira; “Ebola (Ebola Virus Disease)” article by CDC; “Yellow fever – Bolivarian Republic of Venezuela” article by the WHO; “Yellow fever – Brazil” article by the WHO; “Dengue and severe dengue” article by WHO; “Dengue Fever” article by WebMD; and “Yellow fever – Nigeria” article by the WHO.