What a moment. Despite the significant logistical hurdles, COVID-19 vaccinations have begun in earnest across the globe. For the supplement industry, after a year of searching for footing in the shifting terrain of the pandemic—replete with conspiracy theories and eager consumers seeking any help to stay healthy—COVID-19 vaccines add a new navigational hazard. How does an industry that has long presented itself as an alternative—or even in opposition to—mainstream medicine respond to these new vaccines?
The vaccine rollout stands as a moment imbued with consequence. Industry experts recognize that economic and philosophical motives are at play and are poised to clash in unpredictable ways in the marketplace, where natural health consumers have longstanding suspicions about vaccines.
A tradition of oppositional thought
The natural products industry is no stranger to strong opinions that run counter to conventional wisdom. Food as medicine, nutritional ingredients as drug alternatives: even these are still disruptive concepts to many. Suspicion of vaccines is another item on this list, and it echoes other deeply rooted concerns about modern public health policy, including mercury in dental fillings and fluoride in the water supply. The core natural products community holds a constellation of these beliefs, so many of which fall into buckets of “us versus them” or “health freedom versus government mandate.” Is it any surprise that aspects of COVID-19, including vaccines, fall easily into these buckets as well?
But in the current climate, some health freedom advocates’ beliefs about COVID-19 risk drawing the same critical scrutiny—and online frenzy—as every other conspiracy theory. Psychologists and security experts alike specifically point to misinformation around COVID-19 vaccines as the No. 2 sinkhole for truth, right after claims of election fraud. Supplement makers are just beginning to understand the ways that the vaccines can both fuel and hamstring their futures, and healthcare practitioners are now confronting ever-louder voices around vaccinations, both for and against.
It’s messy. The COVID-19 vaccines will both illuminate and complicate the supplement message. What better time to parse some data and try to make sense of this unique moment, a moment with murky but serious ramifications for both supplement sales and the future credibility of the industry.
Capturing the moment with data
To repeat—current research is a snapshot. Time, and opinion, moves fast these days, and sentiments are sure to be scrambled yet again. At the very front end of this vaccination process, where does America stand?
The Kaiser Family Foundation launched a vaccine monitor to track public acceptance of COVID-19 vaccines longitudinally over time. In September, 63% of respondents were likely to take a COVID-19 vaccine. In December, that number bumped up to 71%. The increase holds across racial and ethnic groups, and even across political affiliation. The takeaway? Most of the mainstream wants the vaccine in numbers that grow with each week of forced isolation and fear of contagion.
Nutrition Business Journal ran its own microsurvey of 1,000 U.S. consumers, of which 473 self-identified as natural shoppers. This gives the natural products industry insight into potential discrepancies between “mainstream” and “core” perspectives in some rudimentary fashion.
NBJ data shows that, if the vaccine were available to everyone today, 62% of the general population would take it compared to 70% of natural shoppers. This runs counter to the theory that the natural consumer is disinclined to vaccinations, a theory further challenged by the “never” responses to taking the vaccine. That response lands at 11% in the general population versus only 5% for natural shoppers. A more expected data point: natural shoppers have greater concerns about the long-term safety of the vaccines (65% vs. 55% in the general population), with a full 35% “very concerned” about that safety.
NBJ also asked about changes in supplement usage during the pandemic, and here the natural shopper did deliver—70% increased their intake during the pandemic, compared to 54% in the general population. If natural shoppers are more likely to have upped their ante due to COVID-19, this raises questions about how best to attribute the sales increases of 2020. New consumers to the category or increased compliance amongst the converted? New consumers or a flight to premium products? All of the above, of course, but to what degrees?
Jim Emme is the CEO at NOW Health Group, a company well informed about both the natural and mass market. “Our industry has been presented with a huge new group of consumers,” he says, “a group so large that no single marketing campaign would have likely gained at the levels COVID-19 brought forward to all of us.”
But will they stick around? “There’s a lot of talk about what the ‘new normal’ will look like,” says Emme. “Our view is that many consumers will use their newfound knowledge of supplements to prepare for the next novel virus, even though none of us can predict how or when that may occur.”
Here’s the real kicker. NBJ asked: “If you got the vaccine today, would you alter your supplement usage?” More than half of natural shoppers plan to increase their supplement usage after vaccination, compared to only 33% in the general population. Is this a strategy to boost health during the vaccination process? Or early signs of a true new normal with a higher baseline post-pandemic? Either way, almost no one—just 5% of respondents—plans to decrease their supplement usage. Few, it seems, are viewing the COVID-19 vaccines as a panacea.
Within the industry, UNPA ran its own survey of members. Collectively, this in-the-know group expresses more resistance to vaccination than NBJ found among consumers: only 56% expressed immediate interest in the vaccine, with 28% taking a wait-and-see approach and 16% opting out. This is another surprising result, given the practical benefit of inoculating the workforce: reduced risk and volatility, plus operations at a level that fully seize the production opportunities presented by COVID-19.
Or maybe they know too much. Allergic-reaction concerns around the novel mRNA technology of the Pfizer and Moderna vaccines is causing some to delay. Given the checkered history of mRNA drug development, other concerns center around the technology’s genetic mechanism of action. While the molecules introduced by the mRNA vaccines prime immune response in ways that the body’s own enzymes eliminate within days, it’s still a novel approach with a vague ring of genetic manipulation.
It’s safe to say two things in parsing this data. First, COVID-19 complicates the traditional market drivers associated with supplements, as fatigue builds and the hunger to return to some semblance of public life infects all manner of consumers, including the natural-first consumers. Second, consumers new to the supplement market may place greater faith in conventional medicine and grant less philosophical weight to vaccine suspicions. Said plainly, philosophy and history (historic assumptions about consumers, anyway) are weaker drivers in the new consumer equation.
Capturing the moment with sentiment
Experts across the many constituencies that connect into supplements—brands, suppliers, practitioners, consumer advocates—have a lot to say about the COVID-19 vaccines.
“There are many people who would choose not to get vaccinated, even well before the COVID-19 virus struck last year,” says Emme. “Others do not trust the rapid rollout of the FDA approvals for the various versions of the vaccines. We believe there are a significant number of consumers who will choose not to get the vaccine, for a variety of reasons, many of whom will turn to dietary supplements to support their desire to stay healthy.”
UNPA received a healthy dose of feedback from its member survey, and opinions differ. Some see COVID-19 as the first of many pandemics to come, with vaccines (and the protections of the vaccine courts) as another iteration of the pharma treadmill to chase profits. Some see COVID-19 as the natural expression of a planet in disharmony, with a biosphere whose immune system is so far out of whack that zoonotic diseases arise as a likely new norm. Still others see no problem with the AstraZeneca vaccine, which is still on the horizon but presents a more traditional approach and a longer track record of safety.
“A lot of people are fatigued by this,” says Dr. Mark Pedersen, director of customer innovation at Capstone Nutrition, a leading contract manufacturer in the industry. “They’ve increased their levels of all the usual suspects, like vitamins C and D, but the vaccine presents a more permanent solution. They’d rather spend their money on leisure and plane tickets than immune products.”
Experts predict that air travel will ultimately require proof of vaccination, with Quantas leading the charge in Australia. This is a natural evolution of the vaccination certifications required by school systems, but the extension of such strict requirements to by most businesses is unlikely, especially in the natural products marketplace.
Scott Steinford, CEO at Health Wright Products, another leading contract manufacturer, says COVID-19 and the vaccines force employers to look for balance between meeting high demand and offering employees choice. “There was concern among my staff that we would require vaccination, but we won’t. It’s voluntary but advised, and we won’t ask them either way.”
No one understands the nuances of patient persuasion like a health practitioner. Dr. Joe Pizzorno, Chairman of the Board at the Institute for Functional Medicine (IFM), calls the chatter around vaccines “loud on both sides.” Patients are looking for guidance, and doctors are looking for data. “The big challenge here is the extremes,” says Pizzorno. “The anti-vaccine group is opposed for everybody, and the medical apologists think vaccines are great for everybody. The in-between is not that simple. There are populations where vaccines are contraindicated, and other populations where it’s a good idea.” IFM has a special committee diving into the issue now, with official recommendations expected in February.
Of course, sentiment around the COVID-19 vaccines lives squarely inside the larger story around vaccinations, where plus or minus 40 shots before adulthood is a common protocol. Stacking vaccines for efficiency continues to raise suspicion as a cause of fast-onset autism, and consumers are increasingly confused about all the surrounding noise online.
Gretchen DuBeau is the executive and legal director at the Alliance for Natural Health USA (ANH-USA), a politically active nonprofit that represents consumers and practitioners in the natural health community. ANH-USA played a key role in the GMO labeling movement. “My membership is more vocal than usual about these vaccines,” says DuBeau. “We advocate for free access to information, and there’s not enough information to make informed decisions here. The end points for safety and efficacy aren’t complete. The vaccines haven’t been tested on immuno-deficient patients and pregnant women. It’s an enormous experiment.”
ANH-USA collects its vaccine content at vaxinsider.com, where recent posts have focused on syncytin-1, a protein used to form the placenta that some fear is triggered by COVID-19 vaccines, and PEGs, polyethylene glycols used as excipients in drug applications that some believe trigger allergic response and anaphylaxis. “We’ve worked in this area for 25 years,” says DuBeau. “I’ve witnessed the vaccine injuries, the unnecessary deaths and autoimmune disease. The biggest problem with the new vaccines is that we don’t know what we don’t know, and we likely won’t know for a long time.”
The market impact of vaccines
One question for the supplement industry goes beyond efficacy and into economics. If COVID-19 spurred supplements to record sales levels, are vaccines poised to pierce that bubble? Said another way, if the pandemic goes away, do the sales go too?
“It’s clear that the impact of dietary supplements on COVID-19, and vice versa, is significant,” says Steinford. “More folks are taking supplements now than ever before in our industry’s history.” In fact, NBJ estimates a record year of sales in 2020, with growth spiking to 12.1% and sales passing $54 billion. A consumer survey from Trust Transparency Center, where Steinford serves as founder, pegs the big three winners from COVID-19 as vitamin D (+10%), multis (+5%), and omegas (almost 5%). Insiders would add botanicals to that list, including essential oils and elderberry as such a particularly big winner that adulteration concerns are on the rise.
“I believe there will be a difference in the 2021 marketplace,” says Steinford. “Sales will slow, but not reset. We’ve earned a degree of respect, and it’s our responsibility now to build upon that. I would argue that supplements are playing a bigger role in this environment than drugs.” This speaks to the industry’s effort to assess the “COVID-19 bump”—sales attributable to the pandemic alone. It’s a challenge that’s top-of-mind for investors in the space. (See Normalizing the COVID-19 bump on page 18.)
“Customers are just starting to push their orders out,” says Pedersen. “The industry built up so much inventory in the supply chain, with purchases up to a year in advance. There are warehouses full of product, so I see companies hedging their bets a little bit.” If pressed, Pedersen believes the vaccines could tamp down demand but still leave sales dramatically escalated after a year that saw 30-50% growth in some categories. “It’s inventory management now,” says Pedersen. “Before, it was sky’s the limit.”
“The subject of vaccines has been a factor in our operational planning for 2021,” says Emme, “and although the views are mixed within our team, the forecast from our customers is that they see no significant slowdown in demand for most of this year.” The new normal has legs. “We believe there will be a slowing down at some point, but not anytime soon since the distribution of the vaccines is currently falling behind the original schedule communicated by the White House and the CDC.”
Emme speaks of March and April 2020 as levels of demand that the industry might never see again, but the heady climate of consumers hungry for health products shows few signs of abating much in 2021. “We are making major investments in manufacturing capacity to meet these supply challenges, not just for this year, but for many years to come,” he says. Both Steinford and Pedersen speak of significant capital investments made in 2020 as well.
The COVID-19 bump’s longevity remains unclear, and likely will remain that way for another 12-18 months. What’s also unclear, but worthy of a survey, is a timeline on a possible return to some normalized public life. NBJ asked those 1,000 consumers when that day might come, and consensus opinion says it’ll be awhile. A full 69% expect another six months of restrictions and uncertainty, 43% stretch it to nine months, and 22% kick it past a year.
During this transitional phase, confusion is likely to grow, both inside and outside the industry, around the true power of these vaccines. Studies are ongoing to assess infectivity after vaccination, so public health officials want the population wearing masks and distancing even after their shots. The vaccines appear effective and safe at keeping people alive and out of hospitals, but the big question remains—will enough people comply to create that purposeful, manageable bridge to herd immunity?
India and China on the rise
While the geopolitics around China are growing more volatile and adversarial, with many supplement experts quietly pleased to see some righting of the trade imbalances and predatory behaviors that have festered for decades, COVID-19 works in the opposite direction. China and India are likely to come out of the pandemic playing an even more dominant role in the dietary supplement supply chain.
“Except for packaging, they managed this crisis perfectly,” says Pedersen. China moved much of its plastics industry into hand sanitizers during the height of the pandemic, which created six-month delays in the supply chain for bottles and lids. Anything petroleum-based that’s not stock white can still require up to a year lead time.
“China cleaned up,” says Pedersen. “They knew this was coming early, and just waited for us to place orders. It will be hard to take that supply chain back domestically, because they’re so good at it.” China and India kept Americans in drugs and supplement ingredients largely without interruption, and they did it with very little price volatility, something that stands out as an underreported story for COVID
“China ramped up quickly,” says Steinford. “There were vitamin C concerns that never materialized. I didn’t even hear of severe price fluctuations. China acted fairly responsibly here.” The unstated subtext here, of course, is “this time.”
What is the real opportunity for supplements?
One last question, and perhaps the most important one. As an industry, did supplements seize the moment to educate these new consumers and add credibility to the category on the world stage?
“While the industry did move to educate consumers in the best way possible,” says Emme, “our view is that we, as an industry, have fallen short of successfully getting our message across. Things were moving way faster than we could respond to at the beginning of the pandemic. We just didn’t know which products would be in high demand in support of immunity.”
It’s to be expected that consumer education loses some emphasis during a global emergency, so how about now, with the emergency slowly fading in the rearview mirror? “This is the opportunity for the industry to proactively assist in the healthcare marketplace,” says Steinford. “It’s in our best interest to continue to support the science and show the positive impact of what we provide. We’ve always known the benefit here, but now some of those questions and challenges are being put aside.” Anecdotal evidence of doctors—even the nation’s favorite, Dr. Anthony Fauci—recommending supplements, in the absence of any viable therapy to fight against COVID-19, abounds.
Which brings this story to long-haul post-COVID-19; this is maybe the lasting opportunity that arises from the frenzy of 2020. There is a growing body of evidence that problems can linger for months after acute infection—China reports symptoms in 76% of patients six months after hospitalization, including sleep difficulty and chronic fatigue. These are patients without a clear protocol of care in conventional medical settings, and conventional modes of caregiving are struggling to find the disease names and drug solutions that might apply. Would it come as any surprise if this group grows dramatically in number, and ends up in practitioners’ offices looking for alternatives? Naturopaths and practitioners of eastern medicines, particularly TCM and Ayurveda, are already fielding the calls.
The industry has an opportunity to speak to—and speak for—this constituency. The wave of new consumer interest in 2020 could come from within the industry itself, and not from prominent public figures with big megaphones, like Donald Trump. “More scientific information has come out indicating that supplements, such as zinc and vitamin D, can help support immune health in regard to COVID-19,” says Emme, “yet most of it didn’t come from our industry. As an industry, we can build on this science and take the opportunity to lead in educating consumers and medical personnel about the benefits of supplements in supporting the health goals of consumers.”
As the pandemic dug itself in for the long haul, FDA and FTC dug their heels in too: They issued dozens of warning letters around immunity claims and COVID-19 treatments perceived to threaten public safety. A new administration and new leadership at FTC raise questions about an even more vigorous enforcement posture to come. The frustration around communicating what is known to be true about immunity and supplements is real. It has also likely held back an even more rapid adoption of supplements, with even higher levels of sales.
“One of our biggest challenges is sharing good information with the public,” says DuBeau. “FDA and FTC are going after supplement companies, but also doctors. We’re forced to pull natural medicine information off websites. We’re banned from talking about andrographis here, and Thailand just approved it to prevent and treat COVID.” Many would argue that the regulatory structure showed its age yet again, as credible science was effectively de-fanged at the very moment it was most needed.
At press time, the nightly news is chock full of headlines about a healthcare system on the brink, hospitals at capacity, front-liners exhausted and exasperated by the wave of illness they see every day. The COVID-19 vaccines can help with this, but they can’t make us healthy. “It’s an attitude,” says Pizzorno. “We are seeing more and more pandemics because our population’s immune system is fundamentally damaged by environmental toxins and lifestyle decisions that make us less healthy.” America is impaired. The world is bearing the highest burden of chronic disease ever seen in human history. “If we took better care of ourselves, we could get our immune systems as resilient as possible,” says Pizzorno. And all of this would be a lot less bad.
“I’d like to offer a silver lining,” says DuBeau. “Many people will choose to be vaccinated, and many others will opt for andrographis and quercetin. But both groups will continue to focus on health, and that’s a good thing. That helps improve comorbidities. While COVID-19 is tragic, it really shined a light on what actually helps here.”
This article was featured in the Nutrition Business Journal Guest Editor Issue. The guest editor was United Natural Products Alliance President Loren Israelsen.