"Norm Erosion" Looks Like This

What Happens When the Levee Breaks?

The?Wall Street Journal?this morning is the first to report that the?Trump Administration is Weighing Major Cuts to Funding for Domestic HIV Prevention.

"The cuts [in HIV prevention] could affect drugmakers like Gilead Sciences and ViiV Healthcare, which sell HIV/AIDS medicines. Gilead stock dropped nearly 3% in after-hours trading, following The Wall Street Journal's report on the administration discussions.

Gilead has asked the FDA to approve the company's next-generation prevention treatment, called lenacapavir, which patients could take twice a year. Morgan Stanley estimates the drug's sales could surpass $6 billion a year by 2030, with most of the revenue from commercial health insurers [in the United States]."

I wouldn’t bet on it.

Assuming stability is one of the ways ruins get made.?

To the big forecast miss ahead for drugs to prevent HIV (more Blue Spoon thinking here:?Is HIV Prevention and Treatment "Gender-Affirming Care"?), I would add we’re about to see an?epidemic of commercial withering across the board?in healthcare generally, and specifically for any?system of markets?whose revenue depends on successfully rotating around “vaccine” as its orbit.?

And not just demand for flu (human or bird) or Covid vaccines, but cancer, HPV, shingles, RSV, malaria, tuberculosis…..all of it, the entire unfolding and infinitely-expanding galaxy of faith and forecasts in the humanity-saving potential of agentic-AI for drug development and scientific achievement to prevent the spread of disease, is now lost in space somewhere. Or it’s stuck in low-Earth orbit. Or it’s just failing to launch altogether.

This is a big economic system that includes essentially all of retail pharmacy worldwide and huge swaths of the pharmaceutical industry as its keystones.

For the Poster Children of the Problem:?

• Moderna losing 93 percent of its market value since its peak in 2021.?It doesn’t help the Moderna rebuild that its?$590 million contract?to develop a bird flu vaccine is getting reevaluated by HHS, its leader saying last month that the better approach for tackling the bird flu bedeviling U.S. poultry farms is to?let the virus rip.?Instead of culling birds when the infection is discovered, farmers “should consider maybe the possibility of letting it run through the flock so that we can identify the birds, and preserve the birds, that are immune to it,” Kennedy said recently on?Fox News.?Meanwhile over at the NIH, the new management team is advising people to remove all references to mRNA vaccine technology from their grant applications, saying "It’s still unclear whether mRNA vaccine grants will be canceled". And about a half-dozen states are targeting mRNA specifically with legislation dismantling the technology's 'storyline of value', led by Florida (summary here by Amy Baxter at PharmaVoice )
• The structural collapse at Walgreens.?When you think about the ‘vaccine market’, it helps to understand it at a system level, more as?a set of markets?interacting and interoperating as a single economic unit: the drug market + the retail pharmacy market + the telehealth market, each needing the other for commercial success. Walgreens went from a “$100 billion health giant to private-equity salvage project” in around 10 years. (More Blue Spoon thinking here:?‘Structural Collapse at Walgreens’).
• The wasteland called “digital health”.?A few years ago, Dave Chase, Health Rosetta-discovering archaeologist wrote a piece in?Forbes?that still holds true today, probably even more so:?Why 98% of Digital Health Startups Are Zombies And What They Can Do About It. “The common view is that 98% of digital health startups are the walking dead right now. These startups received angel funding but they are operating on fumes and clearly aren't on a path to profitability and/or Series A funding. My takeaway: There is no lack of elegant-looking software. If that’s all it took to succeed, I wouldn’t be writing this piece. The recurring issue for these struggling startups is they lack a creative business model and often are missing a clever go-to-market strategy.”

Here’s how?The England Journal of Medicine?framed the market outlook for “vaccines” (The Vaccine-Hesitant Moment):

Twelve years ago, a meeting of public health experts was convened to reflect on why there was such low uptake of the influenza A (H1N1) vaccine, which was hurriedly developed in response to the pandemic alert issued by the World Health Organization (WHO). The title of the meeting report was “A Crisis of Public Confidence in Vaccines,” and it heralded a warning: “The lack of public confidence in vaccines risks undermining the political will necessary to rapidly respond to a more severe influenza pandemic in the future.”

Keeping in mind this was written long before the world got really weird.

Markets are like complex cellular organisms; when they fall ill, there can be multiple causes that are hard to sort out.?Which is why they can’t be ‘fixed” with the Standard Linear Model of thought.?But they can be transcended with a biological orientation, systems thinking used to position a Modern Strategy Story, one that works with a different lens to see and sustain “value” for shareholders, for businesses, for patients and for the Wealth of Nations who can reorganize themselves around the ‘production of affordable health’ as the basis for economic competition. (Dig deeper here:?How to Crack the Mad Riddle of Healthcare).

For the?pharmaceutical-as-healthcare market,?your options are this: get comfortable leading big system change (i.e., profit from disorder), or try staying comfortable sitting on the mental furniture of the past (i.e., hope the disorder doesn't disintegrate your business).

Leading. The Pack.

How business leaders talk about the Trump administration in private has been markedly different than what they are game to say in public. The dissonance was on full display here this week.

Early on Tuesday, dozens of corporate executives and others assembled at a Yale CEO Caucus not far from the White House just as news emerged that the Trump administration planned to potentially double tariffs on steel and aluminum from Canada. Those in the room responded with a mix of groans and shocked laughter.

“There was universal revulsion against the Trump economic policies,” said Jeffrey Sonnenfeld, a professor at the Yale School of Management, who organized the invite-only summit that included corporate bosses such as JPMorgan Chase’s Jamie Dimon , billionaire Michael Dell and Pfizer’s Albert Bourla . “They’re also especially horrified about Canada.”

That sentiment wasn’t apparent hours later, when many of the same chief executives from the Yale event attended a question-and-answer session with President Trump at the Business Roundtable . There, the exchange was largely cordial and executives didn’t ask the president any pointed questions about his tariff strategy, according to people familiar with the event.

— CEOs Don’t Plan to Openly Question Trump. Ask Again If the Market Crashes 20%.,?via?Wall Street Journal, March 12, 2025

No one ever gets credit for fixing problems that don’t occur.?

But the problem waiting for a market crash to happen is that, well, by the time it happens, the trillion-dollar damage is already done. And then “fixing” the mess is impossible.

At least not with “normal” rules of engagement, anyway. And certainly not by using hope as a strategy.

/ jgs

John G. Singer is Executive Director of?Blue Spoon, the global leader in positioning strategy at a system level. Blue Spoon specializes in constructing new industry ecosystems.