Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

New Covid Vaccine Atcenter Of Debate

MIAMI -- There's no big rush to get the new covid-19 vaccine, according to health experts. Many patients are hesitant to get the shot for a variety of reasons, including vaccine fatigue, fear of side effects and the feeling that covid is over.

But there's a new variant spreading, and public health agencies and many doctors say the new vaccine, which rolled out in November, can help keep people healthy during this holiday stretch of traveling and gathering. Pharmacies and the drug companies are aggressively pushing the new vaccines in ads and texts.

The Food and Drug Administration approved the new shots for people 12 and older and granted emergency use authorization for children as young as 6 months. The agency expects that the new vaccines will be updated annually like flu shots.

CDC Director Dr. Mandy Cohen recommended the shots for everyone 6 months and older to better protect against circulating variants in the country, following the advice of an independent advisory committee.

Joseph Ladapo, the Florida surgeon general who has clashed with federal health officials on masks, vaccines and the state's covid-19 policies, says the federal government "failed to provide sufficient data to support the safety and efficacy of the covid-19 vaccine." He recommends that people under 65 not get the new vaccines and that those 65 and older speak with their doctor.

The FDA, CDC and scores of public health experts say the vaccines are safe, having undergone rigorous testing and monitoring throughout the pandemic -- and the benefits far outweigh their risks.

If you decide to get vaccinated, how many shots you need will depend on your age and the timing of your previous dosages.

Does it work against dominant strains?

The new covid vaccines were formulated to target omicron variant XBB.1.5, which was the dominant strain in the U.S. Earlier this year, in preparation for the 2023-24 fall and winter season.

Federal health officials say the updated shots will provide good protection against the circulating variants in the country. The current dominant strain in the country is HV.1, which is a descendant of the omicron variant, CDC data show. Health officials are also closely monitoring JN.1, which is the fastest-growing covid-19 variant in the country, with the variant estimated to make up between 15% and 29% of covid-19 infections, USA Today reports.

The latest covid vaccines and treatments are expected to work against the circulating variants.

Covid-19 vaccines are available at retail pharmacies across the country, including Publix, CVS, Walgreens, Walmart, Winn-Dixie, Fresco y Mas. You can schedule an appointment online or walk in.

Some stores might offer you a deal for getting vaccinated, too. CVS, for example, is offering a $5 off $20 coupon for anyone who gets immunized, including against covid, flu and RSV, at its stores.

Unlike other covid vaccines and boosters, the federal government is not paying for the shots, although most insurance companies are expected to cover the vaccine cost. Keep in mind that some insurance companies might require you to get vaccinated at an in-network provider.

For people who don't have health insurance, or whose health plans don't cover the costs, free boosters will be available through community health centers, state health departments and pharmacies participating in the CDC's Bridge Access Program. The program will give free covid-19 vaccines to adults without insurance or whose insurance won't cover all of the vaccine cost through 2024. Children eligible for the Vaccines for Children program can also get the vaccine from enrolled providers.

Novavax: Do Not Expect A Turnaround In 2024

Klaus Vedfelt/DigitalVision via Getty Images

At a Glance

In my previous analysis of Novavax (NASDAQ:NVAX), I focused on their innovative vaccine technology and strategic efforts, including the amended agreement with Canada and the EU approval of their COVID-19 vaccine. Since then, significant developments have occurred. Novavax's 2024 outlook now appears fraught with substantial operational and financial challenges. The dispute with Gavi, demanding a considerable refund, not only threatens their financial stability but also scrutinizes their market reliability. The company's struggle to maintain its going concern status, dwindling cash reserves, increasing operating cash flow usage, and looming liquidity issues highlight deteriorating financial health. Additionally, the stock's performance reflects investor skepticism and uncertainty, with a notable short interest and mixed signals from institutional investors. These elements collectively advise a cautious approach towards Novavax's stock. This article dissects these new facets, offering a comprehensive view of Novavax's current predicament and future prospects.

Novavax's Dual Dilemma: Overcoming Gavi Dispute and Going Concern in 2024

Novavax' 10-Q (page 7)

2024 presents a pivotal year for Novavax, a key player in the COVID-19 vaccine arena. This period is fraught with hurdles, especially two major risks: a dispute with Gavi, the Vaccine Alliance, and the "going concern" issue, highlighting doubts about long-term operational viability.

At the heart of the Gavi conflict is Novavax's supposed failure to fulfill delivery promises. Gavi seeks a significant refund of $696.4 million. This is not just a financial dispute; it is also a test of Novavax's credibility in the global market, which was called into question earlier this month when the company agreed to pay $47 million to settle a class action lawsuit that claimed it had made false and misleading claims about its capacity to obtain regulatory approval for its vaccine and produce it on a commercial scale. Financially, the stakes are high. Novavax's cash reserves have dwindled alarmingly, dropping from $1.34 billion to $651 million within nine months in 2023. A forced refund could further destabilize the company's finances.

This arbitration's outcome could also constrict Novavax's operational scope. Limited funds might hinder investment in vital research and development, crucial in the dynamic vaccine industry.

Simultaneously, the company is dealing with "going concern" worries. This term signifies doubts about Novavax's survival, avoiding bankruptcy or liquidation. The situation is precarious, given its heavy reliance on the COVID-19 vaccine in an unpredictable, competitive market. In 2023, there was a noticeable surge in operating cash flow usage, signaling a looming liquidity crisis. The Gavi dispute exacerbates this, threatening to deplete finances further.

To overcome these obstacles, Novavax may need to raise more capital. This could mean diluting shareholder equity or accruing more debt, adding to financial pressures.

In 2024, how Novavax resolves the Gavi issue and addresses "going concern" concerns will be critical. These challenges are multifaceted, encompassing financial, strategic, and operational dimensions, as well as its standing in the global health sector. The steps Novavax takes soon will shape its journey through these tumultuous times.

Q3 Performance

In Q3 2023, Novavax reported a sharp drop in quarterly revenue, down from last year's $734.58 million to $186.99 million. A major factor was the steep fall in product (COVID-19 vaccine) sales, plummeting from $626.09 million to just $2.23 million. However, grant income rose, reaching $164.92 million, up from $106.27 million. The company's overall expenses fell as well, from $861.77 million to $312.62 million. The net loss showed improvement, decreasing to $130.78 million from $168.61 million. There was a noticeable increase in share count, up from 78.27 million to 103.43 million.

Financial Health

Novavax's balance sheet presents a nuanced picture. Their available cash has declined to $651.1 million from $1.34 billion. This decrease is a significant shift. Novavax reports various liabilities: $101.9 million in 'Accounts payable', $311.2 million in 'Accrued expenses', and $192.2 million in 'Deferred revenue'. Their "current ratio" is approximately 0.68, which, based on my review of dozens of balance sheets over the past year, is abnormally low and may indicate liquidity problems.

In nine months, Novavax used $537.2 million in operating activities. A key factor here was repaying 2023 convertible notes, amounting to $325 million. Excluding this, their monthly cash burn averages $23.6 million. This rate offers a clearer view of regular expenses. With this burn rate and their cash reserves, Novavax could operate for roughly 27.6 more months.

There's a moderate-to-high chance Novavax will need extra funds within a year. Remember, these assessments are based on past data and might not capture future dynamics.

Because so much hinges on the result of the Gavi arbitration, Novavax's short-term financial stability appears precarious. Their long-term financial stability, too, is uncertain, influenced by how they manage expenses and secure future financing.

Market Sentiment

Seeking Alpha reveals NVAX's valuation at $601.08 million. The company's future growth seems tepid: sales are expected to rise slightly in 2024 by 4.33%, but then drop by 4.75% in 2025. Additionally, analysts have significantly lowered FY1 earnings forecasts. NVAX's stock performance is lackluster, consistently trailing the SPY across various periods, reflecting investor reluctance.

Data by YCharts

A noteworthy short interest of 40.83%, with over 43 million shares bet against, further underscores this skepticism.

Institutional holdings present a complex picture. While Vanguard, State Street, and Blackrock remain key investors, their actions differ. Vanguard upped its stake by 9.259%, contrasting State Street's 12.884% reduction. Moreover, insider transactions over the last year, with more selling than buying, may signal internal doubts regarding NVAX's direction.

In summary, NVAX's market position seems precarious. Marked by skepticism, unconvincing growth projections, substantial short interest, and insider unease, its future appears uncertain.

My Analysis and Recommendation

In summary, Novavax faces significant hurdles in 2024. Key concerns include the Gavi dispute and the "going concern" issue, both casting doubt on the company's future. These elements suggest a "Strong Sell" recommendation for their stock. This is a rating downgrade from my previous assessment due to major financial concerns heading into the new year.

Investors must note the high risk of Novavax struggling to survive the next year. With limited cash and a possible Gavi refund looming, the company's prospects are dim. Consequently, I think it is likely that in 2024, Novavax's enterprise value-which is currently $209 million-will drop below zero. Although its stock is trading at 52-week lows and the market has priced in many of these concerns, do not underestimate the stock's ability to crater further following the realization of key events (e.G., arbitration decisions, equity dilutions, etc.).

For investors aiming to reduce risk or gain from Novavax's possible decline, buying puts on NVAX is an option. This approach involves speculating on the stock's fall, limiting losses to the option's premium. Still, options trading carries its own complexities and risks.

It's important to consider the risks of my "Sell" recommendation too. A positive resolution with Gavi and new funding or partnerships could improve Novavax's situation. Such developments could lead to a "short squeeze" and significantly boost its stock price.

To conclude, Novavax currently presents a risky investment. Caution is advised, leaning towards selling NVAX shares. Although a turnaround is possible, it's a slim chance, overshadowed by substantial financial and operational challenges.

CVS Health Buy Rating: Innovative CostVantage Model And Medicare Advantage Growth Propel Positive Outlook

Ann Hynes, an analyst from Mizuho Securities, reiterated the Buy rating on CVS Health (CVS – Research Report). The associated price target is $86.00.

Ann Hynes has given CVS Health a Buy rating due to a combination of factors that bolster the company's outlook. Among the key drivers is the launch of CVS's new CostVantage Reimbursement Model, which aims to redefine drug costs with increased transparency and simplicity. This strategy is expected to be widely adopted in the industry, as it aligns with governmental scrutiny on spread pricing, potentially mitigating CVS's annual reimbursement pressures estimated at approximately $1 billion. The anticipated successful implementation could stabilize the company's gross profit per prescription, which has been under pressure.Additionally, Hynes' optimism is fueled by CVS's robust Medicare Advantage (MA) growth projections, with an expected membership increase of around 600,000 in 2024. Despite investor concerns regarding the 140 basis point rise in 2024's medical-loss ratio (MLR) guidance, CVS is confident in its forecasts and points to a significant portion of its growth coming from 'switchers', who generally represent a more profitable segment. These factors, combined with the potential for multiple expansion driven by manageable PBM legislation, strong execution on 2024 MLR guidance, and progress in the retail pricing model, support the analyst's Buy rating and $86 price target.

In another report released on December 11, TD Cowen also reiterated a Buy rating on the stock with a $99.00 price target.

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CVS Health (CVS) Company Description:

Headquartered in Rhode Island and founded in 1963, CVS Health Corp. Is a healthcare company in the U.S. That owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; Aetna, a health insurance provider, among many other brands.

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