European listed biotech landscape: 2020 review and outlook for 2021

Table of Content

1. Intro on COVID-19
2. How the European listed biotech companies try to help for vaccines and therapies against COVID-19
3. 2020 Highlights (financing, Genmab, Morphosys, approvals, "Billion Euro Biotech Club", valuations)
4. 2020 Lowlights (Galapagos, Genfit, DBV, IPOs, AIM)
5. 2020 Deals and M&As
6. 2020 Stock and Index Performances
7. Best Stock Performances of 2020
8. Worst Stock Performances of 2020
9. 2021 Outlook (expected newsflow density, THE EVENT, selected 2021 readouts)

2020 = COVID-19

While we were writing last year’s review, on 31 December 2019, the WHO alerted about cases of pneumonia of unknown cause, detected in Wuhan, Hubei Province of China. Obviously, only a few people really paid attention at that time. A few days later, the world, feeling safe and far away from these Chinese troubles, saw the lockdown by the Chinese authorities of this city of 11 million people. The world was wrong. The virus was already starting to spread everywhere, insidiously.

At that time, sources mentioned a possible link with the city’s seafood market. It is still not clear how / when / why SARS-Cov-2 became what it became, but the fact is that a year later, the situation remains quite unstable almost everywhere... except where it all began, in China! Whereas the panic was already there in Europe in February 2020, with a particularly worrying situation in Italy, the WHO then declared, as late as on 11 March 2020, that the novel coronavirus outbreak was a global pandemic. The word COVID-19 (Coronavirus Disease 2019) was already in every mouth. Lockdowns, soft or hard, were decided in almost every country. Though, a few countries like the UK, Denmark, Sweden, tried the “herd immunity” strategy. But SARS-Cov-2 is way too infectious and can easily lead to overwhelmed healthcare systems, even in the best and most equipped ones, like Germany. They eventually all changed back to lockdowns in the weeks or months after this initial attempt. We can decently say that nobody really anticipated the spread from China. Sometimes, one needs to really experience things for real to believe it, which leads to a state of sideration when it hits. We didn’t believe it could end badly, we didn’t anticipate things enough (e.g. some initial lockdowns should have been ordered before), but surely these decisions were not easy.

As of January 19th, 2021, there have been more than 94 million confirmed cases of COVID-19 (largely underestimated by testing capability, notably during the first wave), including over 2 million deaths (also underestimated but by how much?), as reported to the WHO. So, this is not “just the flu”, as Donald Trump (and others) liked to say early last year. It is not Ebola or the Spanish flu either, but as mentioned previously, the infectivity (materialized by the famous “R0”) is the issue. Now, we talk about waves, the first, the second, the third… And also recently about variants.

When will it stop? When we have reached a threshold of collective immunity that makes the transmissibility much harder. But can it stop? While reading some modelling preprints, we see that the bar to reach “heard immunity” is really high. But probably it is. However, what is certain is that the population will have to adhere to the only solution that exists (except having been infected): the vaccination. While the science, the new technologies, and the involvement and dedication of some individuals/companies/institutions allowed to develop, test, manufacture, vaccines in record times, the real challenge is now the implementation of the vaccination, which mostly relies on the acceptance of these vaccines by the population. Here again, we cannot say that the word “readiness” actually characterizes the status of all the countries, even among the developed ones. And there is a lot of work is some countries (e.g. in France) to increase the willingness to get the usual 2 jabs. Hopefully, these things will improve along time, when people will see that the first vaccinees don’t “turn into alligators”, contrary to what the Brazilian President said about the Pfizer BioNTech vaccine (though it is true that the manufacturers, by contract, try to reject any responsibility if anything bad happen). One of the most heard concerns is about the long-term effect of the mRNA vaccines. While we can acknowledge there are unknowns, and little long-term experience, since no mRNA vaccine was approved before, one has to keep it mind is that like in life, it’s all about tradeoffs between benefits and risks. No Pain, no gain. Experts from both the FDA & EMA panels seem to agree on the extremely low risks of DNA integration. After all, if these mRNA vaccines have to be kept a so low temperature, how can one expect them to make anything by themselves in the long-term, when human bodies are regulated at 37°C? Moreover, who would have hoped for vaccine efficacy levels of 90-95%? Very few. We are lucky that the spike protein and the RBD were so easy to target. Even with the mutations, it is likely that these vaccines will retain most of their efficacy (this is being checked). So, let’s no waste the chance. OK, all the vaccines don’t have 95% efficacy. Well, we’ll have to deal with it.

And finally, a small digression, supporting our interrogations on reaching the “herd immunity” anytime soon. The vaccine efficacies reported usually do not refer to preventing transmission, which is the ultimate highest bar possible, but to prevent symptomatic COVID-19, which is a lower bar. How close or how distant these 2 endpoints are is currently undetermined. But what is certain is that the vaccine efficacy can only be lower for sterilizing immunity (prevention of both infection AND transmission). At best, the “VE” is lower in terms of immunity but close to the “VE” for the prevention of symptomatic COVID-19, and if we are not lucky, we have to get ourselves mentally prepared to talk about COVID-19 for a long time. This is why, as stressed 2 weeks ago by Pr Jean-François Delfraissy (Head of the Scientific Advisory Committee for the French government for anything relating to COVID), vaccination is all about saving lives, and not mandatorily reaching “herd immunity” since we don’t have enough data on the prevention of transmission when vaccinated. But at least, one may assume there is still some degree of complete sterilizing immunity among those who are vaccinated.

So, in 2020, biotech & pharma companies were under the spotlight, since they were part of the solution to help ending this pandemic. And hopefully, it will remain the same in the years to come. While we can laud the efforts of the European biotech companies to try to bring solutions, these efforts were disclosed in a more or less opportunistic manner. As of today, more than one third of the European nano-smidcap biotech companies (more than 50) have officially initiated a program to tackle the unmet needs linked to the COVID-19 pandemic. These programs mainly focus on the 2 most important unmet needs concerning therapeutic interventions: first, the prophylactic vaccines, to prevent the most severe cases and save lives and ideally also to prevent transmission of the virus, and second, the therapeutics for those infected and presenting symptoms, from those with the mildest symptoms to the most critically ill patients.

The follow-up of all these programs can be found in this dedicated post: The European listed biotech companies with COVID-19 programs: status & follow-up. It also allows you track the next expected clinical milestones for each program.