EYE ON THE MARKET • MICHAEL CEMBALEST • J.P. MORGAN Last updated 9/30/2021 [1] Vaccination update Table of Contents: 1. US vaccination overview ................................................................................................................................2 2. Vaccination vs infection, mortality, hospitalization and 2020 Trump voting share ............................................3 3. “A pandemic of the unvaccinated” .................................................................................................................4 4. Vaccine update by country and US state .........................................................................................................5 5. Population shares, vaccine efficacy and the amalgamation paradox ................................................................8 6. Vaccine efficacy tracker ..................................................................................................................................9 7. Vaccination vs previous COVID infection (acquired vs natural immunity) ....................................................... 10 8. Vaccine risk-benefit data .............................................................................................................................. 12 9. Variant prevalence by country ...................................................................................................................... 13 10. Delta variant facts and figures ...................................................................................................................... 13 11. What about new variants and the possibility of “immunity escape”? ............................................................ 14 The table outlines the approaches that vaccine companies are taking to provoke an antibody response. Vaccines train the immune system to recognize the disease-causing part of a virus so that when people are infected, their bodies are prepared to fight the virus with a combination of antibody and T-cell responses. Historically, most vaccines contained either weakened viruses or the signature proteins of the virus (Types 1, 2 and 3), but the first approved vaccines for COVID were genetic (Types 4 and 5). See Section 5 for more information. Method of provoking antibody response Drug companies Existing licensed Type to SARS-CoV-2 (bold = approved) vaccines 1 A live but weakened coronavirus that will infect cells and cause Measles, yellow fever, Codagenix Attenuated them to make viral proteins mumps, smallpox, polio 2 A "killed" coronavirus that will get recognized as foreign matter Sinovac1, SinoPharm2, Polio (dev countries) Attenuated by the immune system Covaxin3 Recombinant coronavirus proteins, produced industrially in 3 GlaxoSmithKline/Sanofi, Tetanus, pertussis, flu, outside cell cultures, which are recognized as foreign matter by Recombinant Novavax4 shingles the immune system 5 4 A different virus (human or ape adenovirus, measles, etc) that is CanSino , Genetic engineered to include genetic components coding for the SARS- Oxford/AstraZeneca6, Ebola (vector vaccines) CoV-2 spike proteins, which causes the body to produce them J&J7, Gamaleya8 5 DNA or RNA that will be taken up by cells and will cause them to Moderna, Inovio, Genetic make coronavirus proteins BioNTech/Pfizer 1: Sinovac has been approved for use in China, Hong Kong, Indonesia, Philippines, Brazil, Chile, Mexico, Turkey and several other countries 2: Sinopharm has been approved in China, UAE, Bahrain, Egypt, Hungary and Jordan and several other countries 3: Covaxin has been approved for emergency use in India, Iran, Philippines, Paraguay, Guatemala and several other countries 4: Protein vaccines are not new, but the Novavax vaccine is combined with a proprietary adjuvant which has not been approved for use before 5: CanSino has been approved for use in China, Mexico and Pakistan 6: Oxford/AstraZeneca's vaccine has been approved for use in the UK, Europe, South Africa, Brazil, Chile, and several other countries 7: J&J's vaccine has been approved for use in the US and Bahrain 8: Gamaleya's vaccine has been approved in Russia, Argentina, Venezuela, Mexico, Hungary, Iran, UAE, and several other countries Source: J.P. Morgan Asset Management. 2021. 1 INVESTMENT AND INSURANCE PRODUCTS: • NOT A DEPOSIT • NOT FDIC INSURED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY • NO BANK GUARANTEE • MAY LOSE VALUE EYE ON THE MARKET • MICHAEL CEMBALEST • J.P. MORGAN Coronavirus US vaccination overview Note: the CDC estimated in August that more than 1 mm people in the US had received a third shot without being registered as taking a booster shot. The result is a small overstatement of first time and full vaccination shares of the total population, and likely a small understatement of reported booster shots (shown in the third chart). US vaccination progress US % of US population 70% 300,000 4000 Unique people vaccinated Daily infections levels (LHS) 3500 60% 250,000 Fully vaccinated 3000 50% 200,000 Current hospitalizations levels (LHS) 2500 40% 150,000 Daily deaths levels (RHS) 2000 30% 1500 20% 100,000 1000 10% 50,000 500 0% 1/1 1/31 3/2 4/1 5/1 5/31 6/30 7/30 8/29 9/28 10/28 0 0 02/20 05/20 08/20 11/20 03/21 06/21 09/21 Source: OWID, JPMAM. September 29, 2021. Dotted lines indicate estimated vaccination rate based on trailing 7-day average vaccination rate. Source: JHU, IMF, HHS, JPMAM. Sep 29, 2021. 7 day smoothing. US daily vaccinations US vaccination progress Millions of people, 7-day average % of US population 3.5 70% 3.0 60% 2.5 Full 50% vaccinations 2.0 (2nd of 2 doses) 40% Unique Fully 1.5 Full people vaccinated vaccinations Booster 30% vaccinated 1.0 (1 dose) shots 20% 0.5 Partial vaccinations (1st of 2 doses) 10% 0.0 Partially 1/7 1/28 2/18 3/11 4/1 4/22 5/13 6/3 6/24 7/15 8/5 8/26 9/16 0% vaccinated Source: OWID, JPMAM. September 29, 2021. Source: OWID, JPMAM. September 29, 2021. Lowest vaccination counties with more than 100,000 people 1 Shelby AL 24.4% 11 Houston AL 29.7% 21 Jackson MS 31.9% 31 Ouachita LA 33.2% 2 Etowah AL 27.2% 12 Calcasieu LA 30.3% 22 Richland OH 32.0% 32 Flathead MT 33.3% 3 Robeson NC 27.6% 13 Allen OH 30.6% 23 Mohave AZ 32.1% 33 Baldwin AL 33.3% 4 Livingston LA 28.3% 14 Bradley TN 30.6% 24 Mobile AL 32.3% 34 Merced CA 33.7% 5 Mesa CO 28.7% 15 Craighead AR 31.0% 25 Wayne OH 32.7% 35 Bossier LA 33.7% 6 Harnett NC 29.0% 16 Canyon ID 31.1% 26 Terrebonne LA 32.7% 36 Miami OH 33.7% 7 Lee AL 29.3% 17 Anderson SC 31.1% 27 Spartanburg SC 32.7% 37 Kootenai ID 33.9% 8 Tuscaloosa AL 29.3% 18 Morgan AL 31.2% 28 Rowan NC 32.7% 38 Weld CO 34.0% 9 Matanuska-Susitna AK29.3% 19 Kings CA 31.3% 29 Randolph NC 32.9% 39 Jefferson MO 34.2% 10 Calhoun AL 29.4% 20 Pueblo CO 31.6% 30 Tangipahoa LA 33.0% 40 Sebastian AR 34.2% Source: JHU, CDC, State Health Departments, Census. September 29, 2021. 5 lowest vaccination states compared to the US average State ND MS WY WV ID USA Total population 51% 50% 48% 48% 47% 65% 18-64 population 57% 55% 53% 50% 56% 72% 18+ population 63% 61% 60% 57% 63% 77% 65+ population 87% 84% 83% 80% 86% 93% Source: OWID, CDC, JPMAM. September 29, 2021. 2 EYE ON THE MARKET • MICHAEL CEMBALEST • J.P. MORGAN Coronavirus Vaccination vs infection, mortality, hospitalization and 2020 Trump voting share US county infections vs vaccinations US county deaths vs vaccinations Cumulative infections per mm since July 2021 Cumulative deaths per mm since July 2021 100,000 1,600 90,000 1,400 80,000 1,200 70,000 1,000 60,000 50,000 800 40,000 600 30,000 400 20,000 200 10,000 0 0 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Average fully vaccinated people as % of state population since July 2021 Average fully vaccinated people as % of state population since July 2021 Source: JHU, CDC, State Health Departments, Census. September 29, 2021. Source: JHU, CDC, State Health Departments, Census. September 29, 2021. US state hospitalizations vs vaccinations Trump share of 2020 vote and vaccination by county Average hospitalization rate per mm since July 2021 Fully vaccinated people as a % of county population 600 90% R² = 0.39 80% 500 FL 70% 400 AL 60% MS GA AR NV LA TXKY 50% 300 TN MO OKSC WV 40% WY IN ID NCAZ 200 MTKS 30% AKOH HI OR ND DE WA IA CA DC UT SD NE VA NM IL WIPA CO MD 20% NY 100 MI MN NJ RI ME CT NH MA 10% VT 0 0% 30% 40% 50% 60% 70% 0% 20% 40% 60% 80% 100% Average fully vaccinated people as % of state population since July 2021 % of county population who voted for Trump Source: OWID, HHS, IMF, JPMAM. September 29, 2021. Source: Harvard Dataverse, CDC, State Health Depts, JPMAM. September 27, 2021. 3 EYE ON THE MARKET • MICHAEL CEMBALEST • J.P. MORGAN Coronavirus “A pandemic of the unvaccinated” Note: Given higher vaccination rates among older age groups as well as higher probabilities of hospitalization once infected with COVID, it is important to pay attention to age-stratified infection and hospitalization rates when comparing vaccination status, as Seattle/King County has reported in the charts below. The following page goes into more detail on the importance of age-adjusting COVID data. Seattle: age adjusted infections Seattle: age adjusted hospitalizations Daily infections, # per mm, smoothing = 7 days Current hospitalizations, # per mm, smoothing = 7 days 120 1,000 Not fully vaccinated Not fully vaccinated 900 Overall Overall 100 800 Fully vaccinated Fully vaccinated 700 80 600 500 60 400 40 300 200 20 100 0 0 Jan '21 Mar '21 May '21 Jul '21 Sep '21 Jan '21 Mar '21 May '21 Jul '21 Sep '21 Source: Washington Department of Health. September 22, 2021. Source: Washington Department of Health. September 22, 2021. The below table shows the multiple of hospitalization and death risk for unvaccinated people compared to vaccinated people. The rates are population-adjusted and reflect state estimates of breakthrough hospitalizations and deaths since vaccination began in January 2021. The table reports data on states who provided at least two months of records to the New York Times.