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Fewer routine doctor visits, procedures and screenings for cancer and other diseases during the pandemic hit pharmaceutical companies hard in the first quarter, slowing sales of everything from vaccines to diabetes therapies and oncology drugs.

Merck & Co. reported fewer new patients starting treatment with its blockbuster cancer drug Keytruda and getting vaccinated for HPV and pneumococcal disease. Sales of Amgen Inc.’s top arthritis drug Enbrel declined as fewer patients were diagnosed and started treatment. And Bristol-Myers Squibb Co. saw revenue drop for a key cancer drug and other products administered in health-care settings. The shares of all three declined on Thursday.

Drugmakers jolted by the same pressures last year had expected business to rebound as 2020 wore on and lockdowns were eased, especially for lifesaving medications. Yet many recently faced renewed disruption from another surge in Covid-19 cases as the new year opened.

“The pandemic suppressed demand for all health care other than Covid over the last year, even in chronic disease where you think people will get cancer infusions or get an HbA1c test for diabetes," Eli Lilly & Co. Chief Executive Office David Ricks, whose company reported declines in sales of drugs including insulin in the most recent quarter, said in an interview. “Those procedures haven’t even returned to pre-pandemic levels yet."

The latest results from pharmaceutical companies speak to two warring realities that Covid-19 created in the health-care industry. Even amid warnings that infections could overwhelm medical capacity, routine kinds of care have gone underutilized, especially if they require treatment in person.

It remains to be seen how other companies, including coronavirus vaccine-makers, fare amid these trends, including Pfizer Inc., which will report first-quarter earnings on May 4.

Drug companies, meanwhile, say they’re seeing signs of that changing. They now project a return to normalcy in the second half of this year, as vaccines are more widely distributed, especially in the profitable U.S. market.

Vaccine Rollout

“With a strong rollout of the Covid vaccines, we expect patients will be more comfortable to seek care in a timely manner," said Frank Clyburn, Merck’s president of human health, on the company’s first-quarter conference call early Thursday. “In fact, we are encouraged by the recovery trends we saw as we exited the first quarter, with March wellness visits in the United States tracking above pre-pandemic levels."

Read more: Missed Doctor Visits Have Created Covid’s Shadow Health Crisis

Merck also said on Thursday that a focus on the Covid-19 vaccine rollout had hampered its own vaccine sales, as coronavirus vaccine recipients aren’t supposed to receive other shots around the same time.

And the pandemic’s disruptive effects could drag out for Merck and other vaccine manufacturers, which “may be underestimating the potential for Covid booster doses impacting other vaccines," said Bloomberg Intelligence analyst Sam Fazeli.

Back to School

Another uncertainty is when Covid-19 vaccines will become available for young people, which could continue to slow vaccine sales through another back-to-school season, a key time. It’s also not clear whether or how social distancing precautions, which have thinned out waiting rooms at medical facilities, will endure as the months go on.

And around the world, where access to Covid-19 vaccines has been highly inequitable, disruptions to routine medical care could be lengthy.

“Outside of the U.S. it’s probably delayed," Lilly’s Ricks said. “Europe is projecting more like a fall to ‘return to more normal’ based on the vaccine schedule. And then Japan, which is our other major market, is even slower. We’ll still talking about endemic effect on health-care consumption as we exit this year and enter next year in parts of the world."

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