Novavax Inc Q4 FY2021 Earnings Call

Ladies and gentlemen, thank you for standing by, and welcome to the Novavax Fourth Quarter and Full Year 2021 Financial Results and Operational Highlights Conference Call. Please also be advised that today's conference call is being recorded. I would now like to hand the conference call over to your speaker today, Silvia Taylor. You may begin.

Good afternoon, and thank you all for joining us today to discuss our fourth quarter and full year 2021 operational highlights and financial results. A press release announcing our results is currently available on our website at novavax.com, and an audio archive of this conference call will be available on our website later today. Before we begin with prepared remarks, I need to remind you that we will be making forward-looking statements during this teleconference, which are based on our current expectations and beliefs. For example, statements relating to future financial or business performance, conditions or strategy including expectations regarding revenue, operating expenses, cash usage, clinical development of our vaccine candidates, timing of future regulatory filings, authorizations and actions, and other anticipated milestones are forward-looking statements. Novavax cautions that these forward-looking statements are subject to numerous assumptions, risks, and uncertainties which change over time, and actual results could differ materially from what is described in such statements. We encourage you to consult the risk factors discussed in our SEC filings for additional detail. Joining me today is Stan Erck, President and CEO, who will provide an overview of recent achievements, discuss regulatory updates and preview our upcoming strategic priorities; additionally, John Trizzino, Chief Commercial Officer and Chief Business Officer, will provide an update on the status of our global COVID-19 vaccine rollout, supply and manufacturing as well as address the broader market opportunity for our COVID-19 vaccine; Dr. Filip Dubovsky, Chief Medical Officer, will discuss recent clinical development across our pipeline; and Jim Kelly, Chief Financial Officer and Treasurer, will provide an overview of our financial results. Dr. Greg Glenn, President of Research and Development, will also be available for the Q&A section at the end of today's call. I would now like to hand the call over to Stan. Please turn to Slide 4. Stan?

Thanks, Silvia, and thanks, everyone, for joining us today as we discuss the substantial progress made by Novavax in 2021 and into the beginning of 2022. Through continued execution across all areas of our business, today, we have rapidly transitioned into a global commercial company, now delivering our COVID-19 vaccine throughout the world. Since making our first submission for our authorization in August of last year, we've delivered upon all of our commitments across our entire business, including, in regulatory, we have authorizations today from 12 regulatory agencies as well as emergency use listing from the World Health Organization, rapidly expanding access to our COVID-19 vaccine. We are authorized in 38 countries and have emergency use listing from the WHO representing the potential to reach over 170 total countries. Adding this all up, these markets represent 6 billion lives. In commercialization, we've initiated the commercial rollout of Nuvaxovid. We have shipped our vaccine to the European Union, Australia, Indonesia, and South Korea, and first doses of our vaccine have now been administered in all of these markets. Manufacturing capacity, we've achieved our target of annual capacity of more than 2 billion doses with the ability to meet the current and future global demand for our vaccine. And with respect to clinical data, we have built upon our robust body of clinical evidence and we have generated additional data to support expanded indications and policy recommendations that will drive utilization across our 3 core targets: primary vaccinations, boosters, and pediatric populations. These include new data we announced today demonstrating protection against all COVID-19 infection and durability of efficacy over 6 months, booster data demonstrating broad cross-reactivity against variants, and adolescent data demonstrating clinical efficacy against variants. With respect to COVID-19 variants, we also demonstrated our ability to rapidly respond to variants of COVID-19. We developed an Omicron-specific variant vaccine, and within weeks of initiating development, we began GMP manufacturing. This serves as an important proof of concept that we can evolve our vaccine as the pandemic evolves with new variants. With all of this momentum over the past 60 days, we are now delivering our protein-based vaccine to the world, and we expect this momentum will only accelerate. In 2022, we see significant opportunities for Nuvaxovid due to the ongoing urgent need for vaccines globally. These include a global vaccination rate of only 56%, clearly, we have not yet met the WHO goal of 70% global vaccination. Waning immunity over time after vaccination, the continued rise of variants, and pent-up demand for additional vaccine options, especially a protein-based option, all of these factors contribute to the urgency of bringing our vaccine to the market. With line of sight into all of these factors informing the need for our vaccine today, for the first time, we are providing financial guidance outlining our expectation to achieve full year 2022 total revenue of between $4 billion and $5 billion. With that, please turn to Slide 5, where we provide an overview of our regulatory progress to date. Through our focus on expediting our regulatory filings since the first submissions in August 2021, we've now gained authorizations in 38 countries. For our product, Nuvaxovid, we have received authorizations from all 27 member states of the European Union, Great Britain, Canada, Australia, Singapore, New Zealand, the United Arab Emirates, and, in partnership with SK Bioscience, we also received approval of our BLA in South Korea. For COVOVAX, which is our vaccine manufacturer and marketing bio partner in Serum Institute, we received authorizations from India, Indonesia, the Philippines, and Bangladesh. For both Nuvaxovid and COVOVAX, we've also received emergency use listing from the World Health Organization, representing the potential for our vaccine to reach more than 130 additional countries. In these geographies, Novavax is the first protein-based COVID-19 vaccine authorized for commercial use based on Phase III data, allowing us to bring to the market an important alternative based on a well-understood technology. With significant regulatory progress made to date, we expect to expand our regulatory authorizations through additional submissions, including making Nuvaxovid available in the United States where we have already filed our request for EUA in January. As Filip will discuss later on today's call, we are also executing upon a robust clinical development program to make our vaccine more widely available. And with that, I'll now hand it over to John to discuss our progress in delivering doses of our vaccine globally.

Thank you, Stan. Novavax continues to build a body of evidence to enhance our highly competitive Nuvaxovid product profile, which demonstrates high levels of efficacy and a reassuring safety profile. Beginning with our positive Phase III data, we have built upon our clinical package with new data from boosting studies, pediatric populations and today with data demonstrating our vaccine's ability to protect against infection and its strong durability over time. Taken together, our product profile results in a differentiated vaccine that will help achieve global health policy goals and at the same time, allow us to satisfy existing and future demand globally. As we look to expand access to our vaccine, we've already begun to see supportive policy recommendations for Nuvaxovid, which is a testament to the robust clinical data package we've generated to date. Ministries of health and national immunization technical advisory groups across the European Union, at the World Health Organization, and in Canada, Australia, and Singapore have published their recommendations for Nuvaxovid as a 2-dose primary series. And in some national policy recommendation bodies have recommendations allowing heterologous vaccination and boosting. With regulatory authorizations and policy recommendations in hand, we've mobilized our global manufacturing and supply network to execute on the rollout of our first commercial product, Nuvaxovid. Since December of last year, we've begun shipping doses around the world, including 9 million doses to Indonesia, 6 million to Australia, 2 million to South Korea, and 27 million doses that have already been delivered through our European distribution center. Shipments are already arriving in individual EU countries, and we expect shipments to continue to additional countries in the EU will quickly follow these initial deliveries. As already reported, an additional 42 million dose order commitment is in place for the second quarter, resulting in 69 million total doses for Europe in the first half of 2022. In all of these markets, vaccinations with Nuvaxovid have begun. For the COVAX Facility, we are collaborating closely with Gavi and our global partners to optimize supply quantities and delivery schedules. And together, we are committed to achieving our shared goal of equitable access. Now with regulatory authorization in 38 countries and a WHO EUL, our vaccine has the potential to access more than 170 countries around the globe. This global access is supported by bilateral supply agreements already in process of being shipped. License partners, Serum Institute, SK Bio, and Takeda, all manufacturing, we expect additional approvals in the U.S. and others with immediate product availability. And through our partnership with Serum Institute, we have already shipped 9 million doses to Indonesia in support of our commitment to equitable access. In the U.S., we further solidified our partnership by extending our funding agreement through 2023. With this latest modification to our agreement, our $1.8 billion of allotted funding will support additional booster and adolescent booster studies for our vaccine, reflecting the U.S. government's ongoing investment to support expansions of our label. We are appreciative of the ongoing support from the U.S. government, and in the future, we see an opportunity to pursue procurement agreements to supply doses to the U.S. We are frequently engaged with health ministers, public health authorities and KOLs around the globe, and it is clear that there is a strong demand for an effective protein-based alternative that is safe, effective, and refrigerator stable to allow for ease of transport and on-site storage. In addition, as doses of our vaccine are being received across the globe, we believe consumer choice will play an increasingly important role in driving demand. Through Nuvaxovid's reassuring tolerability and safety profile, we are confident that utilization of our vaccine can support preferences over time, building additional demand now and into the future. Please turn to Slide 6. As we execute on the commercial rollout of Nuvaxovid, we have readied our global manufacturing infrastructure with sites around the world consistently producing vaccine at commercial scale. Through our partnership with Serum Institute as well as our Novavax-owned facilities and other manufacturing partnerships, we have significant bioreactor capacity for antigen production and achieved large-scale production of our Matrix-M adjuvant, together supporting our over 2 billion doses of annual capacity. Now please turn to Slide 9 -- please turn to Slide 7. In evaluating the global market demand for Nuvaxovid, data today demonstrates continued need for primary vaccination, boosters, and for the pediatric market. There is still a need to increase vaccination rates globally. In fact, data from the CDC show a persistent increase in the mortality rate for the unvaccinated over recent months reiterating the urgent need to deliver our vaccine globally. These data show that mortality rates are lower for those that receive a booster dose. Also, boosting is necessary to increase protection versus those that have only received the primary series, especially as variants of COVID-19 continue to emerge. We believe this presents an additional opportunity for Nuvaxovid to support the fight against the ongoing pandemic. Please turn to Slide 8, where we provide an overview of the market opportunity across primary, booster, and pediatric indications as well as global opportunities to ensure equitable access to vaccine. For primary vaccination, we believe that Nuvaxovid can serve as a desirable alternative for those that remain hesitant and those that want additional vaccine options. We also expect that waning immunity and the continued emergence of variant strains will drive ongoing demand for booster and annual revaccination, and we believe our vaccine is ideally positioned to support this need through its demonstrated ability to produce robust immune responses against variants. In the pediatric populations, we see continued need for a differentiated vaccine option. We are encouraged by the positive results from our pediatric expansion in our PREVENT-19 Phase III trial announced earlier this month, which demonstrated our vaccine's vast potential to serve as an alternative for pediatric populations. And finally, on a global scale, we see significant gaps in vaccine access, which we believe Nuvaxovid can address through its favorable distribution and storage profile.

Thank you, John. Please turn to Slide 9. John outlined the three major areas where we see an opportunity for a vaccine to have an additional impact. We're gathering clinical data to support both label expansion as well as policy recommendations. Let's go to Slide 10 and talk about primary vaccination. As John described, we continue to seek emergency authorization in additional territories for primary vaccination. In parallel, we are reading data from our Phase III studies to perceive approvals. We expect to file our BLA in the second half of this year. We're also gathering additional data for our vaccine can be used to allow for better use. Today, I will give a couple of examples. One from our BLA data set from our U.K. Phase III study and another study we recently launched in South Africa. Please turn to Slide 11. The design of the U.K. Phase III study included 15,000 participants who have received vaccine and have received placebo. The primary endpoint was PCR-confirmed mild, moderate, or severe disease beginning 7 days after the second dose. Please turn to Slide 12. This slide describes the emergence of variants during the conduct of the study. The cases for the primary efficacy evaluation were collected over 3 months during a time window from the 10th of November to the 24th of January, as marked in the green box. You can see that the majority of patients were caused by the alpha variant, which emerged during the conduct of the study. Now let's go to Slide 13. Here we see the primary efficacy data that was used to obtain approval for emergency use authorization. The data was collected over that 3-month period, which represents a median of 55 days surveillance. There were 10 cases in the vaccine group, and 96 cases in the placebo group with the resultant efficacy of approximately 90%. All the severe cases occurred in the placebo group due to low case count, this was not specifically significant. So let's move on to Slide 14. The data I will present today represent the BLA MAA data, the efficacy endpoints were collected over a 6-month time period and marked in the green box on the slide. The alpha variant continues to be the predominant variant during the efficacy collection window. Now let's go to Slide 15 and look at some data. Here, we have displayed high-level safety data. The safety profile is very consistent with previous studies. The event rates are low and balanced between vaccine and placebo group, serious, severe, and adverse event, the special interest occurred at very low frequencies. Let's move to Slide 16. Here we have the placebo efficacy data collected over the 6-month surveillance period, which represents a median of approximately 100 days of surveillance. There were 24 cases in the vaccine group and 134 cases in the placebo group, which yielded a vaccine efficacy of 82.7% with a lower bound greater than 73%. This is consistent with the known decay of antibody for this vaccine and for all other COVID vaccines. Importantly, in this expanded data set, we had an adequate number of cases to statistically demonstrate vaccine efficacy against severe disease. We saw a vaccine efficacy of 100% with a lower bound confidence interval above 0. Now let's turn to Slide 17. This is a graphic representation of the protection. The vaccine group is in blue, while the placebo group is in gray. The vaccine group and placebo group diverged on day 0, which was the day the second dose of vaccine was administered, indicating that efficacy can be observed early in the primary vaccination schedule. Now let's go to Slide 18. The data on this slide represents our first evaluation of protection against infection. Infection is designed and defined as either still converting to the N protein or being PCR positive, thus capturing both symptomatic and asymptomatic cases. This analysis included a collected through the extended data set. Overall, there were 36 cases in the vaccine group and 195 cases in the placebo group, which yielded a vaccine efficacy of 82.5% with a tight lower bound of 75%. Okay, let's jump to Slide 19 for a quick summary. I presented data from the extended data cut that will be used to support the BLA MAA or from our U.K. Phase III study. The top line safety continues to be reassuring, clinical efficacy was maintained with the expected diminution as immune responses waned, vaccine efficacy against severe disease was preserved with no severe cases throughout the expense related period. The vaccine demonstrated protection from infection which recapitulates what we saw in our nonhuman primate studies. And this has potential implications for transmission as well as for promotion of long-term COVID sequalae. If you're not infected, you can trust in the virus or long COVID.

Thank you, Filip. Please turn to Slide 29. This afternoon, we announced our financial results for the fourth quarter and full year 2021. I'll begin with an overview of the full year 2021 total revenue performance and our year-end cash position and then my commentary will focus primarily on our fourth quarter results. For the full year 2021, Novavax recorded total revenue of $1.1 billion, a milestone for the company. This $1.1 billion reflects 141% growth in total revenue year-over-year and consists of $949 million of grants revenue and $198 million of royalty and other revenue. Grants revenue has been an important source of capital to fund our Nuvaxovid clinical program and the scale-up of our commercial manufacturing capabilities. During 2021, we recorded grants revenue of $811 million and $135 million from the U.S. government and CEPI, respectively. Under the U.S. government agreements, we have $800 million of funding remaining, and we expect to recognize the majority of this amount during 2022. For 2022, we do not expect to recognize a material amount of grant revenue from CEPI as we've completed the activities funded under this agreement. We ended 2021 with $1.5 billion in cash and received an additional $350 million milestone payment from Gavi in the first quarter of 2022. This means Novavax is well capitalized as we launch Nuvaxovid globally. Please turn to Slide 30. Turning to our fourth quarter 2021 results, Novavax recorded total revenue of $222 million compared to $280 million in the fourth quarter of 2020. Fourth quarter 2021 royalties and other revenue grew to $127 million compared to $20 million in the prior year and reflect the additional royalties from our license partners on their sales to South Korea and Indonesia. Fourth quarter 2021 grants revenue of $95 million compares to $259 million in the prior year. The decline in grants revenue resulted from the completion of the manufacturing scale-up activity funded by CEPI earlier in 2021. We recorded total operating expenses of $1 billion in the fourth quarter of 2021, including $963 million for R&D. This reflects a significant increase to R&D expenses as compared to both the same quarter prior year and the third quarter of 2021. This increase was primarily the result of the accelerated recognition of embedded lease expenses tied to our contract manufacturing agreements and the expensing of Nuvaxovid prelaunch inventory that in the future will be capitalized to the balance sheet. Neither of these items impact cash flow in the period, and by expensing these manufacturing costs in 2021, we expect lower cost of goods sold expense in future periods. We will revisit the concept of less-than-full cost COGS on our first quarter call. When seeking to understand the operational run rate for R&D costs during 2021, we believe our Q1 to Q3 R&D expense run rate is a better starting point for estimating future R&D cost trends. We expect our full year 2022 R&D expenses to be lower than 2021, and a significant portion of 2022 R&D costs will continue to be funded by the U.S. government. We recorded general and administrative expenses of $84 million in the fourth quarter of 2021 as compared to $61 million in the fourth quarter of 2020. This increase in G&A was the result of our support of the Nuvaxovid launch, and we expect G&A to continue to grow into 2022 as we further enhance our commercial capabilities to bring Nuvaxovid to markets around the world. And finally, for the fourth quarter of 2021, we recorded a net loss of $846 million as compared to a net loss of $178 million in the fourth quarter of 2020.

Thanks, Jim. We're pleased to report those results of a highly productive fourth quarter, reflecting our rapid transition into a global commercial organization. With significant results achieved to date and our expectation of achieving $4 billion to $5 billion of total revenue in this year alone, I'd like to end today's call by providing an overview of our strategic areas of focus for the remainder of '22. On the commercial front, through '22, we will distribute doses globally to our customers to meet our revenue targets. On the regulatory and manufacturing front, we expect to gain additional authorizations where we have already filed, including in the U.S. We will pursue full approval of our vaccine, including filing our BLA in the second half of '22. We'll add additional manufacturing sites to our filings and will manufacture doses to supply all of our current as well as additional demand for 2022. And finally, we will develop -- we will advance clinical development of other vaccine candidates in our pipeline, including continuing clinical development to expand the use of Nuvaxovid into additional indications such as boosters and into the pediatric population as well as continuing the development of our Omicron vaccine and will advance our COVID influenza combination vaccine, which is a key component of our pipeline. We expect to announce data in April and to initiate a Phase II trial that will also include a NanoFlu stand-alone arm, bringing us one step closer to pursuing licensure of our product. Thanks for your attention. I will now turn it over to the operator for Q&A.

[Operator Instructions]. Our first question today comes from Roger Song from Jefferies.

Congrats for all the progress. So the first question from me is regarding the sales guidance or revenue guidance. I think that's very nice. You provided $4 billion to $5 billion overall guidance. Could you provide any comments around the breakdown between the product sales like APA or versus the royalty and grant and other revenues?

Yes, I'll take it. This is Stan. And the vast majority is related to product sales. And of that, the vast majority of that is related to Nuvaxovid product sales. And so we book Nuvaxovid product sales as product has shifted into the hands of our customers. On our partner sales such as Serum, we booked the portion of the sales that is revenue related to us through royalties. And so it's virtually all product-related sales with the exception of the government grants that Jim mentioned, would be largely expanded in 2022 and on the order of magnitude of about $600 million to $800 million, in that range.

Of the $800 million, we expect more than half will occur in 2022.

Yes. Okay. So it's product-related revenue.

Go ahead, sorry. Hello?

Next question? Yes. Sorry, did I miss something?

Yes. No -- yes, that's great. And then regarding the COVID vaccine data in April this year, so just -- can you just provide some kind of your expectation and what is the go-no-go decision point to move forward into the Phase II?

Yes. So we go into this trial, knowing some things already. We know how the response to our flu vaccination was and including in a Phase III immunogenicity trial, we know from preclinical studies what we wanted to show was that by putting the COVID and the NanoFlu vaccine together is neither one suppressed the immune response to the other. And in animals, we found that we need to confirm that in humans, but we're pretty confident that those data will be available to us. And then we took a pretty broad range of vaccine arms so that we could come to a conclusion on what dose level we want between flu and COVID in various arms. And that will be really key because it's a more complicated vaccine. And there, we want to make sure we've got the right dose. So that's the point of the Phase I/II trial. I think it will give us information to go into a Phase II trial that will confirm the dose selection, and that will be later this year.

Great. Maybe just one last one from me is recently your competitor Sanofi and GSK, they provided some positive data for their protein-based vaccine. And maybe just curious your thoughts around how this will impact your commercial adoption for Novavax vaccine?

Yes. I don't think it has much impact on us right now. I mean it's hard for us to tell about a competitive product when we haven't seen the data, and we don't know the timing of when they're going to file or enter into the marketplace. So we're pretty confident based upon what little we've seen that our combination of efficacy data and safety data and the fact that we're in the market will give us a good head start on any potential competition.

Our next question comes from Charles Duncan from Cantor Fitzgerald.

Stan and team, congrats on executing well during a challenging environment throughout '21. Also, thanks for the sales guidance. I did want to ask you a little bit more detail about that. In terms of -- you said that it was primarily driven by actual sales of Nuvaxovid, could you give us some color on the timing? Is this a quarterly build? Or would you anticipate bulk of the sales in the first half of this year and then it to be relatively stable over the course of the year?

Well, we're not -- I'm sorry, Charles, but we're not giving quarterly guidance. And so we've come up with -- we've got these APAs that are in place. We have manufacturing schedules, which will support them. And it's the timing of our customers and when they want their shipments will determine the quarterly pace of these. And of course, there's going to be a fairly quick out the door because we've already announced that we've shipped 27 million doses to Europe. And, Jim, I note that we've shipped 27 million doses to Europe in January for further distribution to our customers. So a lot's gone out the door. We've got -- as John also noted, we have a 42 million dose order just from Europe in the second quarter. But as far as further definition of doses and doses by quarter, we're not able to provide that guidance right now.

Okay. That's cool. We're okay with that. Regarding the guidance, though, is it dependent on U.S. approval? It doesn't seem like it would be, but is there perhaps the $4 million versus $5 million -- or billion dependent on approval and use in the United States?

I think the U.S. represents upside potential for us.

Okay. And then relative to the BLA, you mentioned the BLA in Europe and then potential for BLA filing here in the United States. Can you give us a little bit of color on what additional work needs to be done to support a BLA filing here in the U.S.? And are you signaling that we should forget about an emergency use authorization and really focus on BLA?

No is the answer to the last question, but I'll let Filip step in and maybe provide some opinion on BLA.

Sure. I think, just to reiterate, we're going full blast for our EUA. We're in contact with the FDA periodically to make sure all the questions are answered. So looking forward to moving forward with that. And as you know, we don't control the pace they review the filing, we're looking forward to a successful of our packet in the near future. The clinical data that's required for the BLA and the MAA are very similar. What they're really looking for is longer-term safety and it's a long-term safety of the product. The U.S. is different from some territories, including Europe, in that from time to time, they want a lot block-consistency study. So that's an additional small study we would have to conduct to support the U.S. BLA as opposed to the MAAs. Now all that being said, a condition for us to get the MAAs are well, we had the successful EUAs first before we move on to the planned licensure. And that's the path we're going to be following in the U.S. as well.

Okay. That's super. Last quick question is on safety since you brought it up. So I guess I'm wondering if you've seen any outsized incidence of myocarditis in patients -- or in people who have been vaccinated? And does that change over time as you track them over time, any incidents?

Yes. So we, of course, take all safety very seriously. And we've previously announced that in any safety database as large as ours, you expect to see cases in the vaccine and placebo group. What I can tell you is like those rates of myocarditis are balanced between the vaccine and placebo group. Additionally, you know that our safety has been adjudicated by close to a dozen regulators globally and if you scrutinize our label, you'll see that we don't have myocarditis that had a drug reaction in any of our labels. Now all that being said, as acknowledged that ours is a relatively small database, only roughly 60,000 individuals. So as we start selling millions and millions of doses, we'll get a much better ability to understand if there's any risk for myocarditis or not.

Okay. Very good. That's helpful. Congrats on the progress last year and into this year.

Our next question comes from Georgi Yordanov from Cowen & Company.

Congratulations on all the progress for me as well. Just a clarification on the guidance. Is there an expected timeline in the countries that have signed the APAs we need to accept doses by? And again, related to the $4 billion to $5 billion, do you expect the majority of the currently signed APAs to be satisfied this year? And then as a follow-up, our estimates suggest that you could generate $2 billion to $3 billion in cash flows in the next, let's say, 12 to 18 months. How do you plan to utilize this cash? What are your thoughts on potential BD opportunities or share buybacks?

Georgi, John Trizzino here. So yes, the APAs are behind and backing up all of the expectation for our revenue guidance this year. There -- so we don't typically reveal any kind of detail timing obligations. But we're, as we've talked about in the presentation, shipping across the board to all of the APAs. And so I think the timing of all the shipments is in line and we feel real confident about what the APAs are that are supporting the revenue recognition. As far as BD opportunities are concerned, I think I'll probably pass it back to Stan mostly for that, but I think it's probably an expectation that we would be utilizing our cash in an effective way. But Stan?

Well, thanks. Thanks For ducking that one, John. So yes, we do expect to generate cash, and the cash will be used for investing in our internal projects like the combination of NanoFlu and other respiratory parts of our franchise. Part of it will be used to explore BD opportunities. And I think that's where our focus will be -- I doubt that our focus on stock buyback in the next 12 months.

That's great. And then just a quick follow-up. Given that there could potentially be a significant booster market this fall, maybe could you just talk about how do you see yourself prepared to participate in it? Some of your competitors have indicated plans to develop bivalent boosters, is that something in the plans? And would you be able to generate data to get authorization ahead of the fall? Or given the strong data you've already generated, do you believe the stand-alone vaccine will be sufficient?

Dr. Dubovsky?

Thank you. It's a good question. And we're obviously building our database both for homologous boosting, including looking at multiple rounds of boosting the Phase II in U.S. Australia that's now vaccinated people with upper 4 doses and the studies we're planning for heterologous boosting also envision at 3 or 4 doses in boosting on top of heterologous vaccination. So it isn't -- it really isn't clear to us if a buydown will be required. It is clear to us that an Omicron-specific vaccine will be required. But we're going to be prepared for both. So the initial study design calls for looking at Omicron compared to the original prototype. But how we insert the bivalent product into that study or a subsequent study or alternate study, we're deciding on right now. I guess I should say you know that our dose -- our antigen level is very, very low in our vaccine. And there's not a problem for us to include ultra additional antigens. You can see that from our flu product, which the amount of range we have is much, much higher than what we have in the COVID vaccine. So it's not a specific technology limitation for us to have a polyvalent vaccine, including bivalent vaccine.

[Operator Instructions]. Our next question comes from Mayank Mamtani from B. Riley Securities.

Congrats on a productive quarter and year, and thanks for providing a helpful outlook. And let me also pass on, thanks for the revenue guidance there. So -- but first question, causing some confusion on the fourth quarter numbers, maybe I can ask Jim. So two parts on revenue and cost recognition methodology here. So as you've recognized stockpile doses on P&L, and maybe going forward on balance sheet, could you just clarify, do we still assume manufacturing about 2 billion doses this year? And more importantly, it would be helpful to understand the OpEx rate. I know you said 1Q to 3Q to be a better proxy, but obviously, people are interested in learning about your cash flow generation this year. So OpEx is an important part of the equation. And then I have a follow-up on revenue guidance.

Well, thanks for the question. And of course, certainly anticipated a great deal of interest in our -- the shape of our business as we commercialize Nuvaxovid. When providing guidance on the R&D trend, what we're sharing with you is the R&D trends whereby we are capitalizing the inventory, meaning that the vast majority of our R&D is clinical activity and then, of course, the manufacturing in support of clinical. And that's very different from what you saw in the fourth quarter where there was a significant prelaunch inventory that in subsequent periods would find its way onto our balance sheet. The shape of R&D when you compare 2022 to 2021 full year is we expect 2022 to be lower. So hopefully, that alone is helpful. We will provide additional cost structure guidance beginning next quarter. And so I'm not going to be able to provide any more details on that today. I will reinforce that we have built up our manufacturing capability to produce up to 2 billion doses in the year.

Okay. Great Okay. And then the second question, maybe for John, in terms of the quality control process that is happening in the original country, India, where the vaccines are coming from, and then they get to the particular country, there's a local quality control process and then subsequently, there's revenue recognition. So can you clarify -- different countries have different timing and processes. Can you just clarify what would be the expectation for U.S., for instance? And then how does this all come together for a statement you put out in third quarter filing of potentially recognizing $7.2 billion in APAs at some point across these different quarters, initial quarters?

To clarify, I think what you're referencing is a disclosure around performance obligations of $7.2 billion. Is that correct?

That's correct.

Okay. When you see our KOL, it will say $8 billion, right? And it's everything from the outstanding amounts under operation work speed, our order book of APAs, milestones, and adjuvant commitments from our license partners. So there's a number of different items in there. And so as you can tell, it's above our guidance range of $4 billion to $5 billion. And therefore, you'd expect that we'd meet those obligations in this year into next.

Great. And then just a quick follow-up for Fil on the NanoFlu COVID combo next study. Would that include a bivalent or an Omicron-specific construct, this study you're planning for? And then on the -- great to see the 6-month durability data, some cases in the Delta wave. Are you able to put in context what we may have seen from the currently very effective EUA-approved vaccine at that time period, maybe in a comparable way because it looks like most of the data was in the Alpha wave?

Yes. So let me take you this separately. Right now, our plans are to not use Omicron in our combination in the Phase II study. Now some of that will depend on what happens as the pandemic evolves. We'll have that vaccine in hand, and it certainly wouldn't be a problem to include the Omicron into the quadrivalent study. What we're looking for is more of a proof of concept. And by including the prototype strain in there, we can do a direct in logic comparison back to the Phase III studies that were associated with protection, both in the U.K. and the U.S. Now as far as -- I think we wanting me to speculate on what the durable protection would be like as alternate strains emerge. And as you know, we don't have any data on that other the immunogenicity data I shared with you, which show that we have an immune response which does recognize Delta as well as Omicron as well as a host of other variants. Now if you remember back to the Atlas and efficacy data, that although we didn't have a lot of cases, that had a good estimate of efficacy against Delta, which is 82% and the lower bound of roughly 75%. And I think that's consistent with what the other sponsors have shown in their studies against Delta.

And ladies and gentlemen, with that, we'll conclude the question-and-answer session. I'd like to turn the conference call back over to Stan for any closing remarks.

Thank you. I think that people who have been following us for some time will recognize that this has been a very transformational quarter for us. We're a revenue-generating company. We've got obligations to support that revenue generation and report on that. We're very excited by this. We've now got a manufacturing process that's been approved by virtually the world. We've got regularity to our shipping. We've got good cadence, and we're looking forward to every quarter talking with you more. Thanks for your attention. I will now turn it over to the operator for Q&A.

Ladies and gentlemen, with that, we'll conclude today's conference call. We do thank you for attending. You may now disconnect your lines.