FluVal in Influtera

1° Your job.
You have been appointed on the FluVal marketing team in the Middle Eastern country called
Influterra.

The country has slightly over 20 million inhabitants, were children represent 40% of the
population and close to 20.000 practicing General Practitioners and 1500 pediatricians.

2° The Influenza Disease

Influenza, more commonly called flu, is an acute illness caused by a highly contagious infection of
the upper respiratory tract, caused by a unique family of viruses (influenza type A,B and C).

Typical symptoms include sudden fever, headache, joint and muscle aches, fatigue and cough.

The acute phase lasts five to seven days. Complications including bronchitis, pneumonia,
sinusitis and middle-ear infections, occur with 15% of adults and more frequently with children or
patients with underlying diseases.

Influenza epidemics occur every year in winter and spread explosively, but only last a few weeks.
3° Epidemiology
About 10% of the adult population catches flu once a year, but 30 % of the children are affected
within one particular year. Given the percentage of patients who develop complications, hundreds
of thousands of flu sufferers develop complications requiring hospitalisation. The annual death toll
of influenza related complications ranges from 10.000 in good years to 40.000 in years with
heavy epidemics in the US alone.

A person can spread the flu starting one day before they feel sick. Adults can continue to pass the
flu virus to others for another 3-7 days after symptoms start.

Children can pass the virus for longer than 7 days. Symptoms start 1-4 days after the virus enters
the body. Some persons can be infected with the flu virus but have no symptoms. During this
time, those persons can still spread the virus to others

4° Diagnostic and Treatment habits

52 % of the Adults population which has flu does not see a doctor, but takes aspirine and/or
paracetamol related substances which are available OTC. Some also take cough remedies.
These medications may relieve the symptoms mentioned above, but do not alter the course of the
disease, where as 73% of children sees a doctor when they have a flu (pediatricians)

The remaining patients visit a General Practitioner, who diagnoses Influenza. Some GPs &
Pediatricians simply prescribe analgesics and sometimes cough medicine, but quite a few GPs
and Pediatricians in Influterra prescribe Antibiotics (up to an estimated 50% in adults and 80% in
childrens), even though these have no antiviral effect.

It is not fully understood if GPs prescribe antibiotics because they want to satisfy their patients
(patients come to their physician, not expecting to be sent home with OTC medication only) or
whether they are trying to anticipate and or prevent further complications.

It is sometimes difficult to diagnose flu on the basis of symptoms only as patients infected by
other infectious agents such as pneumonia report similar symptoms.

Test kits, using samples from throat swabs, sputum or nasal washes, can give a precise detection
rate. Viral cultures give the most precise results, but may take 5 to 10 days (by which time the flu
is nearly over). Other test kits from companies like Becton Dickinson are more rapid (30 mins to 2
hours), but are less precise.

Even when patients have presented themselves to the doctor and the physician has prescribed a
prescription drug, at least 15% of adult patients do not go and fill the prescription order and/or
comply to the treatment.

5° Prevention
Vaccination for influenza is possible. Vaccines need to be changed every year, depending on the
viral strains that are expected to turn up next year. Strains are given names by the local
authorities which identify them (for example : A/Beijing/32/92 is virus type A (most severe,
identified in Beijing, virus strain number 32 in 1992)
Current vaccination practice only reduces the risk of influenza in about 30 to 40% of the cases.
Vaccines prevent death in about 80% of the cases, probably as a result of reducing incidence of
complications. For this reason, the Influterra government has limited the reimbursement of the flu
vaccine to risk populations
 patients over 65 represents (10% of total population)
 Children.
An insignificant percentage of adults currently seek vaccination because it is not reimbursed in
Influterra.

This situation is not expected to change as new, to be launched, vaccines are expected to be
even more expensive.

Government authorities in Influterra are unaware of the heavy cost of influenza. Direct and
indirect costs which includes :

- a large number of working days lost

- a substantial number of hospitalisations of patients with complications
- casualties in the higher risk populations.

They have not engaged in a very proactive prevention campaign as a result of the high out of
pocket cost of vaccination and the imperfect protection they offer.

A new class of drugs, called anti-virals, have emerged in the recent past, which have
some combination of treatment and prevention effects.

Antiviral Drug Information

Antiviral drugs are other tools that can be used to help prevent and treat influenza.
The four available drugs are:

These drugs can be divided into two groups based on how they work.
First, amantadine and rimantadine can be used to treat and prevent influenza A infections.
Both of These drugs are not widely prescribed in Influterra because :
(i) they do not work against influenza type B viruses and
(ii) both of these molecules have shown some occasionally severe CNS side-effects.

The second group of drugs includes zanamivir and oseltamivir, which can be used to treat
influenza A and B infections. Although the main label of oseltamivir is treatment, it can also be
used for prevention of influenza A and B.
Studies show that treatment with any of these drugs can substantially shorten the time a person
infected with influenza feels ill, if treatment is started during the first 2 days of illness.

Unfortunately, only half of the patients who see a physician, see them during the first two days of
their illness. All of these drugs require a prescription from a doctor.

The Task Ahead

You are requested by the management to prepare the marketing plan for the FluVal launch.