In the US, COVID-19-related measures, including mask mandates and social distancing, have disrupted common patterns in the cough-cold and flu season over the past two years. As we head deep into the 2021/2022 season, new cultural norms - developed or accelerated over the course of the pandemic – have created a new cough, cold and flu environment that throws up new challenges for the consumer health industry.

Global Context – Pandemic-driven slump in sales

Over the past two years, demand for cold-cough and respiratory (CCR) products slumped, largely because of the COVID-19 pandemic. The mass adoption of masks, social distancing, coupled with the growing consumer interest in “wellness” behavior, has reduced the rate of common colds and flu in the general population. That translated to a significant drop in over the counter (OTC) sales of CCR products around-the-world.

In Q2 of 2021, IQVIA Consumer Health Global OTC Insights data showed that the CCR category saw a 13.6% drop in sales globally (see Exhibit 1). It is the only category that experienced significant declines over the 12 months. By contrast, the vitamins, minerals and supplements (VMS) category saw a 10.7% increase.

Exhibit 1: Global OTC sales by category MAT Q2 2021 (Source: IQVIA Consumer Health Global OTC Insights)

These trends were not unexpected, but they should be considered in the broader context. Sales of wellness products have been steadily increasing in recent years, and the pandemic accelerated the trend as consumers sought new products to protect themselves and their families. As a result, we anticipate the VMS category will continue to grow after the pandemic subsides – which could have a long-term impact on the CCR segment.

As we enter the second COVID-19 influenced cough-cold and flu season in the US, it is increasingly difficult to make confident assertions on what the season will look like. As this blog is published, the emergence of the Omicron variant has already led to the re-introduction of COVID restrictions in some countries, further mudding the waters for the rest of the season.

One indicator is to look at what’s happening in the Southern Hemisphere. Australia is currently at the tail end of its flu season, when cough-cold and flu incidences typically spike. While rates of fever and cough were higher than in 2020, they remained well below the five-year peak, despite a lower-than-average flu vaccination rate (see Exhibit 2). It is likely that the US and EU will see similar trends.

Exhibit 2: Levels of cough-cold and flu incidences in Australia in 2020, 2021 and 5 year average, along with levels of flu vaccines in 18-64 and 65+ age groups (Source: IQVIA Consumer Health/info.flutracking.net/reports-2/australia-reports/)

The known un-knowns impacting the US season

In the US, COVID-19-related measures, including mask mandates and social distancing, disrupted common patterns in the cough, cold and flu season over the past two years. But they also provided a simple path to follow when thinking about how the season would pan out - it was obvious incidence of coughs, colds and flu would fall.

The challenge for the 2021/2022 season is different. There are more unknowns than during the previous season, with variations across communities when it comes to restrictions, along with consumer behavior when it comes to avoiding large gatherings, not going into work when ill, better ventilation in schools and more. All could have an impact on illness levels over the season.

The rate of illness in the US adults will continue to be affected by remote work, and the use of social distancing in the office and in public. There is also greater pressure for people to stay home if they are sick and to wear masks in public. All these trends reduce the spread of illness, and ultimately sales of CCR products in the adult group.

However, among pediatric populations, the return to school and availability of pediatric COVID-19 vaccines for 5-12-year-olds will likely cause cough-cold and flu cases to begin to return to normal. While there is heightened awareness of sanitization in schools, the lowering of mask mandates and close quarters of the classroom are already having an impact.

FAN the trends

At IQVIA Consumer Health, we use the FAN database to track cough-cold and flu trends in the US. FAN uses real-time data from IQVIA’s longitudinal patient-level data warehouse, which includes more than 3.5 billion annual and 306 million unique patients, to track incidences of cough-cold and flu across the US in real-time. Manufacturers use the data to forecast overall product demand, and to determine how demand will fluctuate over time and among populations so they can align their media and market plans and in-store promotions to generate maximum returns.

Current FAN data shows that where COVID-19 related restrictions were eased, the incidence of cough-cold and flu symptoms have spiked, creating an artificial season that offers new sales opportunities (see Exhibit 3).

Exhibit 3 – As restrictions eased in spring, reported cough-cold and flu symptoms increased (Source: IQVIA Consumer Health FAN data)

The data found elevated rates of illness throughout Q2 and Q3, making it the biggest Q3 in FAN history (see Exhibit 4). While this was an artificial lift triggered by unique social factors, it is an interesting example of how manufacturers can benefit from aligning sales strategies to evolutions in current trends.

Exhibit 4: Levels of cough-cold and flu affected population highest in FAN history in Q3 2021 (Source: IQVIA Consumer Health FAN data)

A slow recovery

Looking ahead, we expect COVID-19 to keep demand low compared to previous years, and it might be time to acknowledge that we may never return to pre-pandemic years. The key now is to identify the new normal.

In 2021/2022 season, the biggest opportunity will be in Q1 for both adult and pediatric segments. Based on FAN data we expect +25% bump over a year ago, providing the best opportunities for sales. However, in Q4 the data is showing double-digit increases in affected population in the pediatric segment, which is looking like the biggest opportunity currently.

The data also indicates that an increase in demand is likely to occur in the April/May time frame, as adults grow weary of following sanitation and wellness regimes. The trend of seeing a spring-time bump in illnesses has been growing for a while with some years now showing more rates of illness in spring than in fall.

This spring-time bump represents an opportunity for manufacturers to increase promotion of cough-cold products in March and April. Few cough-cold and flu product manufacturers are currently talking to consumers at this time, which is creating an unmet need for product information that savvy manufacturers can fill.

With overall demand depressed, monitoring trends at a local level can help manufacturers adapt their sales strategies throughout the year, to take advantage of emerging trends. Integrating local data into market strategies makes it easier to maximize the impact of media dollars, and to pivot that spend in response to hotspots. When market strategies use data to adapt fast, they can drive more sales, even when demand overall is weak.

To learn more about these trends, listen to our recent webinar, US Cough, Cold and Flu 2021/22 - Navigating the Unknown.

For more information on IQVIA Consumer Health’s US FAN services contact Chip Schiable