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Policy
Global companies expand business in expensive orphan drugs
by
Lee, Tak-Sun
Aug 20, 2020 06:24am
Vyndaql approved for the Korean market in 2015. Shares the same substance with Vyndmax but indicated for different disease. As global pharmaceutical companies are on to expanding businesses in drugs for rare diseases, the companies are now winning item approvals in South Korean markets. Rare diseases have limited patient size and insufficient treatment options, but the drugs are expensive enough for the companies to seek for profit. On Aug. 19, Ministry of Food and Drug Safety (MFDS) approved Pfizer Pharmaceutical Korea’s Vyndamax 61 mg capsule (tafamidis). The medicine is indicated to treat cardiomyopathy of wild-type or hereditary transthyretin-mediated amyloidosis (ATTR-CM) in adults to reduce cardiovascular mortality and cardiovascular-related hospitalization. Although the patient size is small, the disease is known to develop a heart failure and have a high risk of death. Prior to the drug, no other treatment option was approved. Previously, Pfizer has received approval on another drug with the same substance—Vyndaqel 20 mg capsule (tafamidis meglumine). However, its salt base, substance amount and indication are different. Vyndqel is also indicated to treat a rare disease, transthyretin familial amyloid polyneuropathy (TTR-FAP). In October 2018, Vyndqel was listed for healthcare reimbursement and priced at 141,900 won per capsule. A yearly drug expense would add up to 51.79 million won. According to IQVIA, Vyndaqel earned approximately 1 billion won last year. Considering the high upper limit pricing of Vyndaqel, Vyndamax would also be another ultra high-cost drug. When the U.S. Food and Drug Administration (FDA) approved of the drug in May last year, Pfizer put forth a yearly expense of USD 225,000, or approximately 266 million won, for the listed price. The company also announced they are in a negotiation with insurers. A growing number of global pharmaceutical companies launching ultra high-cost drugs for rare diseases is seemingly making the Korean health insurance authority anxious. Early this year, Novartis submitted an official approval application for a spinal muscular atrophy (SMA) treatment Zolgensma with yearly expense proposed at 2.5 billion won. Currently designated as an orphan drug, Zolgensma is in process of getting approved with expanded user age group in Korea.
Company
Companies are worried about a sharp decline in Rx drug sales
by
Chon, Seung-Hyun
Aug 20, 2020 06:24am
Pharmaceutical companies are again tense with COVID-19. The prescription drug market suffered a temporary sluggishness due to the aftermath of COVID-19, and while it is recovering, the market has contracted again and is worried. Business activities can be greatly affected by the spread of telecommuting. According to UBIST on the 19th, the total amount of outpatient prescriptions last month was ₩1.292 trillion, an increase of 1.8% from the same period last year. Compared to the 8.2% increase in the prescription price in July last year from 2018, the growth rate has slowed somewhat, but it has continued to rise for two consecutive months following June. Monthly outpatient Rx amount trend (Unit: ₩100 million, Source: UBIST) In June, the prescription amount was ₩1.286 billion, an increase of 11.7% from the same period last year, recording a sharp growth trend. Starting this year, the prescription drug market has been showing great ups and downs, continuing its jagged pace. In January, prescription amount decreased by 4.4% from the previous year, but in February they increased by 13.0%. As the Lunar New Year holidays this year was pulled to January, which is earlier than the previous year, it is analyzed that the rate of increase or decrease in the prescription amount in January and February showed a deviation according to the increase or decrease in the number of business days. Prescription performance in April and May fell 8.7% and 9.4%, respectively, compared to the previous year, showing extreme sluggishness. However, in June, it recorded a large growth trend, and it was observed that COVID-19 generally did not show a significant effect in the prescription drug market. The industry believes that the slowdown in the prescription drug market in April and May was the impact of COVID-19. It is analyzed that a considerable prescription gap occurred in the second quarter as patients with chronic illnesses, who are reluctant to visit medical institutions, were prescribed a large amount of necessary medicines in advance. In fact, when the number of COVID-19 patients surged, it is known that the number of cases receiving prescriptions for 3 to 6 months in advance increased significantly. Monthly outpatient Rx amount increase/decrease from the same period last year (Unit: %, Source: UBIST) In fact, there was a common trend in which the prescriptions for chronic diseases decreased significantly in April and May and then increased rapidly in June. The prescription amount of statin drugs used in the treatment of dyslipidemia decreased 2.8% and 5.1% in April and May, respectively, compared to the same period last year. But in June, it jumped 14.9% from last year. The prescription performance of the “ARB+CCB” combination drug, which is most commonly used among hypertension treatments, increased 3.2% and 1.4%, respectively, from the same period last year in April and May, but rose a whopping 22.6% in June. It is also observed that the number of visits to hospitals itself may have decreased as the incidence of disease among infants and children has decreased due to factors such as delaying school opening, social distancing, and strengthening personal quarantine. Prescription performance of oral Cephalosporins in the first half was ₩110.4 billion, down 16.6% from the previous year. In the first half of last year, it decreased by 1.5% from the previous year, but the decline was even more pronounced after a year. Prescriptions of oral PCNs in January and February increased by 7.0% and 2.9%, respectively, compared to the previous year, but decreased by 42.9% from last year in March, and in April (-60.8%), May (-52.8%), 6 All months (-24.5%) showed a sharp decline. As the number of COVID-19 confirmed cases rapidly increases, pharmaceutical companies are again tense. COVID-19 confirmed patients by city (Unit: persons, Source: the KCDC) According to the KCDC, 297 new cases of COVID-19 occurred compared to the previous day as of 0:00 on the 19th. Since 103 confirmed cases on the 14th, more than 100 new cases have occurred for 6 consecutive days. On this day, 283 out of 297 new confirmed cases are infected locally, and the number of confirmed cases is increasing rapidly in Seoul and other metropolitan areas. Since most pharmaceutical companies are headquartered in Seoul, there is no choice but to be more tense than when the number of COVID-19 confirmed cases surged in Daegu and Gyeongbuk. Many companies have started working from home. Core personnel are also banned from entering factories or research centers, which could be severely affected when COVID-19 confirmed case occurs. This is because major damage is inevitable if the laboratories and factory workers are confirmed for COVID-19 and are closed for a certain period of time. Pharmaceutical companies are also concerned about a decline in sales activity. It is a difficult condition for active sales in a situation where they are reluctant to visit a salesperson centering on clinics. If there is a confirmed case among the sales staff of a pharmaceutical company, the affiliated company cannot avoid accusations of promoting the spread of the virus. This is because even though there is a possibility of being a super propagator, if the spread of new coronas is socially promoted by visiting dozens of medical institutions, it cannot be good for the company. An official from a pharmaceutical company said, "Recently, there are many confirmed patients with COVID-19 and the market is intensively occurring in the metropolitan area, so we have a lot of worries about our sales strategy." "It's time to find a variety of strategies so that there are no disruptions in our activities."
Policy
Drug Approval system under direct control of the MFDS
by
Lee, Tak-Sun
Aug 20, 2020 06:23am
#Drug Approval System, which was in charge of the National Institute of Food and Drug Safety Evaluation, will be carried out at the headquarters of the MFDS. The 'Convergence Innovation Product Support Group', a temporary organization that has been in charge of licensing affairs since last year, is formally incorporated into a department under the direct control of the Deputy General Manager. The MFDS (Minister Eui-kyung Lee) and the Ministry of the Interior and Safety (Minister Chin Young) reinforce the expertise of medical product approval and review, and to ensure the right to life for the people and strengthen the international competitiveness of companies through rapid productization support. It was announced on the 18th that the system will be reorganized. With the reorganization of the medical product approval/examination system, the approval task that had been carried out by the National Institute of Food and Drug Safety Evaluation will be carried out by the vice-minister of the MFDS, and the review will continue to be carried out by the National Institute of Food and Drug Safety Evaluation. Specifically, for medical product licensing, two new divisions are established and operated, the 'licensing general manager' and the 'high-tech product licensing manager' under the deputy of the headquarters. The NIFDS continues to carry out the evaluation work, and two new divisions are established and operated under the director, the 'pre-counseling department' and the 'expedited examination department'. First of all, among the two divisions of the headquarters, the licensing general manager generalizes the approval of medicines (including herbal medicines) and the improvement of the approval/examination system for all medical products, while the high-tech product licensing manager is responsible for converging medical products and biologics and medical device approval. In addition, the pre-counseling department conducts preliminary consultation on the application for approval of clinical trial plans and product approval of pharmaceuticals, medical devices, and new drugs subject to rapid review, and the expedited examination department designates rapid review of drugs, medical devices and new drugs. Review data on the application. Targets for rapid review are products that contribute innovatively to responding to public health crises or treating diseases such as life-threatening diseases, new infectious diseases, and digital-based medical devices, and categorized into crisis response drugs, innovative new drugs, and innovative medical devices. Since last year, the MFDS has formed a temporary organization called the 'Convergence Innovation Product Support Group' within the NIFDS and has been carrying out the licensing work. Instead, the person in charge of the approval work of the NIFDS-related department was dispatched to the Convergence Innovation Product Support Team. This time, it has become a formal office through reorganization. In addition, in accordance with the recently enacted 'Advanced Renewable Bio Act' and 'Medical Device Act', advanced biopharmaceuticals and innovative medical devices (software) permits and reviews, advanced regenerative medicine high-risk clinical research plans, etc. expand technical experts and introduce and operate a customized screening system. With this reorganization, the government is expected to establish a dedicated review system for high-quality rapid review of new concept medical products in accordance with the 4th industrial revolution and biohealth trends by strengthening policy linkage under comprehensive review of permits and screenings in a rapidly changing era. Through the reorganization of the medical product approval/examination system, the Ministry of the Interior and Safety added rational policy judgment on the basis of scientific basis for approval, and consulted in advance from the R&D stage for the review, while conducting a rapid review for innovative treatments. By shortening the productization period, such as, the opportunity for patient treatment will expand, and it will greatly contribute to rapid response to public health crises. The MFDS has reinforced the policy functions of the headquarters of the license and maintained the evaluation expertise of the NIFDS through the reorganization of the approval/examination system. By shortening it, it has made efforts to strengthen the global market competitiveness of the pharmaceutical industry while putting the life and safety of the people first. The MFDS plans to complete the revision of the 'The MFDS and the Directive Enforcement Regulations of its affiliated organizations' with the goal of the 25th. However, the procedure for passing through the Ministry of Public Administration and Security, which is the main ministry related to the organization, remains. related personnel are expected to proceed in line with the revision.
Policy
Kwang Dong is continuing the business of Pomalyst
by
Lee, Tak-Sun
Aug 20, 2020 06:23am
Kwang DongKwang Dong is continuing the business of specializing anticancer drug first generics by challenging the patent for Celgene's multiple myeloma treatment 'Pomalyst' (Pomalidomide). Recently, Kwang Dong is showing a prominence in the anticancer drug business by introducing the first generic drug for multiple myeloma treatment, Revlimid and breast cancer treatment, Afinitor. According to the MFDS and the industry on the 13th, Kwang Dong requested a trial for a confirmation of passive rights scope to evade the formulation of Pomalyst (expired on July 21, 2030). Earlier, on the 31st of last month, Boryung also filed a trial to confirm the scope of passive rights to the same patent. Exclusivity generic drug, which grants market monopoly to drugs after successful patent challenge, applies to companies that have requested within 14 days of the initial request for trial. After Boryung's initial request for judgment, other companies must file it by the 14th of this month for the condition to be established. It is worth noting that Kwang Dong has succeeded in evading the patent of Celgene's other multiple myeloma treatment, Revlimid (Lenalidomide). Kwang Dong confirmed the patent evasion by receiving a citation trial in the 2016 trial to confirm the passive scope of rights filed against the crystal-form patent of Revlimid . Kwang Dong is the only pharmaceutical company that has succeeded in the patent challenge of Revlimid. Kwang Dong has launched and sold the first generic drug 'Lenaldo' since 2018. Last year, Lenaldo recorded sales of about ₩600 million based on IQVIA. Kwang Dong was the first Korean company to challenge the patent for Novartis' breast cancer treatment drug 'Afinitor' and received a license for the first generic drug in March. Through a long patent dispute with Novartis, Kwang Dong won the trial for invalidation of a patent for use earlier this month, and was granted a first generic drug. Afinitor’s first generic 'Elinito', which was approved in March, is a drug imported from Synthon Chile Ltda. in Chile. It has obtained generic exclusivity right to the market by December 31 of this year. In the case of generic for Afinito, only two companies of Kwang Dong and Samyang Biopharm were licensed, and generics for Revlimid were licensed only from Kwang Dong, Chong Kun Dang, Samyang Biopharm and Alvogen Korea were licensed. It is relatively free from competition as there are few generic companies. However, in the case of anticancer drugs, the original preference is high and the probability of using them in general hospitals is high. Pomalyst, which has been challenged by Kwang Dong this time, is a drug that can be used in patients with multiple myeloma that do not respond to Revlimid. The product lineup can be strengthened if Kwang Dong, which has the first generic for Revlimid, Lenaldo, succeeds in acquiring drugs that are generic for Pomalyst. Multiple myeloma is one of the three major hematologic cancers with a high incidence, along with lymphoma and leukemia, and the market size of the drug has been increasing since the introduction of the target treatment, Revlimid.
Opinion
[Reporter’s Note] Playing the fair game of NHI coverage
by
Kim, Jin-Gu
Aug 20, 2020 06:23am
In a sports game, a referee takes over the game from time to time. When the set rules are not applied fairly, the players would naturally dispute over the biased refereeing. Such is the case for South Korea’s Ministry of Health and Welfare (MOHW) regarding the National Health Insurance (NHI). Recently, MOHW convened a general meeting for the Health Insurance Policy Deliberation Committee (HIPDC) and ultimately decided to narrow the coverage on the controversial substance, choline alfoscerate. When the revised administrative notice is preannounced within this month, the coverage would only apply to dementia patients from September and patients with other diseases would have to pay for 80 percent of the expense. Although another big issue of clinical reevaluation is yet to come, the controversy over the proven efficacy of choline alfoscerate raised since the National Assembly audit last year has been concluded for now. Regardless of the pharmaceutical industry’s strong opposition, MOHW remains unmoved with the stance of ‘no evidence, no coverage.’ The point is not the reduced coverage on choline alfoscerate. MOHW’s stance of not granting healthcare benefit on pharmaceuticals and medical practice without sufficient evidence, according to the NHI principle, is surely agreeable. But the real point is what comes next—the government announced a pilot program for the Korean herbal medicine coverage. From coming October, NHI reimbursement would be provided in Korean herbal medicine prescribed for specifically treating three diseases—menstrual pain, facial paralysis and cerebrovascular disease aftereffect. Did the government forget about the reduced coverage on choline alfoscerate, all because of lack of sufficient evidence in efficacy? Why should the billions of taxpayer’s money go to cover herbal medicine that has not even confirmed its efficacy, let alone safety? Pharmaceutical companies strictly conduct clinical trials from Phase 1 through Phase 3 to prove the efficacy and safety of a drug in development. The cost is astronomical. But why is the government voluntarily offering evaluation on efficacy and safety of the herbal medicine during the pilot program? Was the Moon Care shooting for unfairness? Their stern stance on the principle seems contradictory, or even brazen. If a referee calling two balls thrown into the same strike zone a strike and a ball, the players’ trust in the referee would plummet. Untrustworthy referee’s existence itself becomes a contradiction. MOHW should take a look back at its game of NHI coverage system and see if they are playing a fair game as a referee.
Policy
Chong Kun Dang recruits consignment companies for Atozet
by
Lee, Tak-Sun
Aug 19, 2020 06:28am
Atozet by MSDChong Kun Dang submitted an application for approval in April for Atorvastatin-Ezetimibe, generic for Atozet and recruiting consignment companies is also gaining popularity. Chong Kun Dang applied for item approval of Atorvastatin-Ezetimibe through its own clinical trial. Considering the maximum period of 6 months for the approval review period, it is expected around October. On the other hand, generic companies must apply for approval after the expiration of Atozet's PMS on January 22, next year, so it is possible to approve product permission as early as February of that year. However, if generic companies sign an entrusted production contract with Chong Kun Dang, which allows early approval, to obtain product permission, not only will the market entry be accelerated, but it will be advantageous in terms of drug price registration. Only 20 companies can receive benefits. According to the industry on the 18th, more pharmaceutical companies expressed their willingness to participate in the recruitment of 20 consignment manufacturers of generic for Atozet by Chong Kun Dang. Chong Kun Dang started recruiting consignment manufacturers, seeing that product approval was possible within this year. In particular, Chong Kun Dang's products are drugs for data-based re-evaluation that have undergone clinical trials, and are not generic drugs. Therefore, the consignment licensed items produced by Chong Kun Dang become authorized generics rather than generic drugs. Authorized generics can receive the highest price regardless of the conditions for DMF listing or direct bioequivalence test. However, prices for generics that are applied for permission after the end of the PMS of the original drug, drop at a certain rate if they do not directly go through the bioequivalence test. Currently, 29 cases have been approved for bioequivalence protocols to conduct bioequivalence tests directly with Atozet. However, they can apply for permission on January 22, when PMS ends, so there is a high possibility that the approval of the item will be delayed than that of Chong Kun Dang consigned products. Moreover, when the number of Chong Kun Dang commissioned production items reaches 20, the drug prices for generics that are applied for permission after the end of the PMS will drop again due to stepped pricing system. For this reason, many pharmaceutical companies are expressing their intention to participate in the recruitment of Chong Kun Dang's consignment companies. An industry official said, "Pharmaceutical companies that do not directly proceed or fail the bioequivalence test want a contract for consignment production with Chong Kun Dang. It is known that more companies than the 20 recruitment limit already expressed their intention to participate." On the other hand, companies that have already conducted bioequivalence tests and have been successful are complaining that they may be disadvantageous in drug prices due to Chong Kun Dang's consignment companies. Some say that companies of incrementally modified drugs should regulate the tricks of recruiting contractors using stepped pricing system.
Company
Big 5 except Severance clear Novartis’ Kisqali prescription
by
Eo, Yun-Ho
Aug 19, 2020 06:28am
South Korean general hospitals are ready to prescribe a third cyclin-dependent kinase (CDK) 4/6 inhibitor Kisqali approved after Ibrance and Verzenio. According to the related industry sources, Novartis’ Kisqali (ribocilib) has passed drug committees (DC) at all Big Five general hospitals—Samsung Medical Center, Seoul National University Hospital, Seoul St. Mary’s Hospital and Seoul Asan Medical Center—except Severance Hospital. And other major institutes like National Cancer Center, Korea University Anam Hospital and Konkuk University Hospital have completed the processing for the drug. Late last year, Kisqali submitted applications for both item approval and healthcare reimbursement listing and the Drug Reimbursement Evaluation Committee (DREC) recently labeled it as a non-reimbursed drug after the Cancer Deliberation Committee passing it in last January. If Novartis accepts the drug pricing offered by the health authority, National Health Insurance Service (NHIS) would initiate a pricing negation with the company. The CDK4/6 inhibitor market competition would be heightened when Kisqali is listed, as the first-in-class Ibrance (palbociclib) and the second Verzenio (abemaciclib) have been covered already. Unlike Ibrance and Verzenio, Kisqali can be prescribed to perimenopausal patients who have not had an oophorectomy. The Phase 3 MONALEESA-7 clinical trial evaluated Kisqali combined with endocrine therapy (either an aromatase inhibitor or ovarian function suppression) as a first-line treatment in pre and perimenopausal women with HR+/HER2- advanced or metastatic breast cancer, and confirmed the drug’s effect of significantly extending patient’s overall survival (OS). Specifically, the Kisqali combination group demonstrated median progression-free survival (mPFS) of 23.8 months, whereas endocrine therapy only group had 13 months. In a subset analysis on Asian patients only, the Kisqali combination group’s mPFS was at 24.7 months, which was about 14 months longer than the endocrine therapy only group’s. Also in Phase 3 MONALEESA-3 study, Kisqali confirmed its effect of extending the OS in pre and postmenopausal women. At the point of 42 months, the OS in Kisqali combination group was at 58 percent, and fulvestrant only group was at 46 percent. Professor Im Seock-Ah of Hemato Oncology Department at Seoul National University Hospital explained, “The MONALEESA-7 study was mainly proposed and led by an Asian researcher, and had 30 percent of Asian patients as registered sample. These findings reflect how Asian region still has a great need for a new treatment option in premenopausal women with breast cancer”.
Company
Daewoong signs an export contract for Fexuprazan
by
Kim, Jin-Gu
Aug 19, 2020 06:28am
Daewoong announced on the 14th that it has signed an export contract with EMS in Brazil for the P-CAB-affiliated gastric secretion inhibitor Fexuprazan. The contract amount is $72.58 million. EMS will be responsible for the local approval of Fexuprazan in Brazil. The export is expected to proceed in earnest after obtaining permission to Brazil. The contract period is 10 years after approval from Brazil. In the future, Fexuprazan will be supplied according to the sales forecast agreed upon by the two companies, and the minimum purchase quantity is 70% of the contract amount excluding technology fees. Fexuprazan is a P-CAB family of drugs called the next-generation gastric secretion inhibitor. HK inno.N's Kcab (Tegoprazan) and Takeda's Vocinti (Vonoprazan) were approved in Korea. Daewoong also applied for Fexuprazan's approval earlier this year.
Policy
No more approval on all appetite suppressants
by
Lee, Tak-Sun
Aug 19, 2020 06:28am
New approval on appetite suppressant amfepramone, also known as diethylpropion hydrochloride, and mazindol drugs would be restricted. These substances were added to the list of restricted approval substance due to the risk of abusing narcotics for medical purposes. Now, the list of restricted narcotic drugs includes amfepramone, mazindol, GHB, phentermine, phendimetrazine and propofol. On Aug. 14, South Korea’s Ministry of Food and Drug Safety (MFDS) announced appetite suppressant amfepramone and mazindol would be designated as narcotics for medical purpose (psychotropic drug) ad restricted from new approval. Currently, 14 amfepramone items and two mazindol items are approved and available in the market. The ministry explained the restriction has been ordered to protect the safety of the people as concerns of abusing these drugs have been raised, regardless of the effort made so far to promote the adequate use of appetite suppressants. The production volume of appetite suppressants have increased from 244,213 in 2017 to 283,042 in 2019. Also 128 users have been reported for using the products from July last year through last May. Other appetite suppressants like phentermine and phendimetrazine have been restricted from new approval since 2013. With the new action, MFDS stated all appetite suppressants would be restricted from new approval. However, a product in new formulation or for export purpose would be able to seek for approval, regardless of the new restriction. Prior to the action, MFDS noted the government has explained the need of tightened control over these drugs through industry meetings and opinion survey. MFDS official said, “For the safe use and appropriate prescription of narcotics for medical purposes, the government would draw up plans to raise awareness of safe use of narcotics among the public and medical professionals. And by cooperating with relevant institutes and companies, the ministry would do the best to prevent any harm caused by abusing narcotics for medical purpose.”
Policy
Vaccine by Novavax, produced by SK Bioscience
by
Kim, Jung-Ju
Aug 19, 2020 06:27am
The government has signed a letter of intent (LOI) for cooperation in domestic production and supply in order to smoothly supply the vaccine developed overseas for COVID-19. The domestic supply chain is SK Bioscience, which has joined the production of AstraZeneca products. The MOHW (Minister Park Neung Hoo) at SK Bioscience Research Institute (Pangyo, Seongnam) at 9 p.m. on the 13th, together with Novavax (CEO Stanley C. Erck) and SK Bioscience (CEO Ahn Jae-yong), COVID-19 being developed by US Novavax. A letter of intent (LOI) was signed for cooperation in global production and domestic supply of vaccines. Currently, about 160 COVID-19 vaccines are being developed worldwide, and these vaccine candidates are largely classified into ▲viral carriers ▲synthetic antigens ▲nucleic acids (DNA, mRNA) ▲inactivated types (platforms) according to the type of technology. The vaccine being developed by Novavax is a synthetic antigen method, which is different from the virus carrier vaccine being developed by AstraZeneca, UK, which signed a LOI for cooperation in securing domestic vaccine supply for the first time in July. As it aims to enter phase III clinical trials in October this year, it is evaluated that the development speed is the fastest among synthetic conjugated vaccines. The MOHW said, "This agreement signifies that a domestic company has been recognized for the production capacity and technology level of vaccine supply from other platforms, and participates in the global production and supply chain. It is of great significance in that it has prepared a channel for cooperation to secure vaccines from Novavax, which has a different vaccine platform following AstraZeneca in July.” At the signing ceremony, The MOHW (Minister Park Neung Hoo) said, "Following July, the signing of a LOI has been a very big achievement as it has been able to further increase the possibility of supplying vaccines to Korea by diversifying available vaccines in preparation for the uncertainty of the success of vaccine development. The government supports domestic companies' own vaccine development until the end, while making great efforts to quickly secure excellent overseas vaccines with a fast development speed based on a two-track strategy."
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