Hello and welcome to this pre-recorded session of the Redburn Atlantic 2024 CEO conference, where it's our great pleasure to introduce Emma Walmsley, CEO of GSK. Emma, thank you very much for participating. Before we move into the discussion, maybe just a couple of words on where we stand now and where GSK is headed in the medium to long term.
Sure. Well, first of all, Simon, thank you so much for having me today. I'm sorry I can't be there in person, but looking forward to all of your questions. I mean, if we just take a snapshot of where we're at coming out of Q3, it'd be right to say that the transformation of GSK continues at full pace, now as a competitively performing, innovation-first, vaccines and specialty medicines pure Biopharma company. We just had Q3 2024 results. Overall, another positive quarter for GSK, and year to date, that puts us at 9% sales growth and 19% profit growth year to date. That matters because it's now the third year when we are delivering strong and, in fact, upgraded growth since the separation of Haleon, which is obviously one of the most important aspects of the transformation of the company.
I was pleased also to upgrade our medium and longer-term outlooks just earlier this year in February, which we remain very confident in. A key point to make is that this year's results are reflecting an accelerating momentum in our specialty medicines business, actually the biggest business in the company, and demonstrating a resilience that we've built into the portfolio with multiple engines of growth, obviously, therefore allowing us to digest some near-term vaccines pressure, which I'm sure we'll come on to. We've also, and this is always the question that matters in our sector, made considerable progress in our pipeline. I'm really pleased that we're now up to 12 positive phase III readouts so far this year. We're looking forward to, I hope, five major new product approvals planned for next year.
Absolutely critically in the last quarter, because we know it's been a question for investors, I was very pleased to be able to draw a line under the vast majority of the Zantac litigation, which, of course, allows us to fully focus on the future, which we are all very ambitious for.
Excellent. Excellent. With the perspective on that, let's move into a broader question on your perspectives on the overall journey since becoming CEO. It's been a busy time. A lot's gone. You've demerged Haleon, the Zantac case you mentioned, scaling up vaccines, specialty medicines, renewed efforts, and success in oncology and immunology. So what's your take on what's happened over your tenure so far?
First of all, I'm really pleased with the progress that we've made, and there's always more to do. We're full of ambition and energy for the journey ahead. I'm actually recording this in our new headquarters for GSK, and I have to say it is a completely different company than when I started. We've been on a major transformation journey, delivering, as I said, a step change in performance following real change, deep transformation in group structure, group strategy, capital allocation and capacity, and, of course, culture and the bench strength of the talent in the company. It's all been about much more of a focus on resourcing the key bigger assets and a strategic shift, as you said, towards vaccines and specialty medicines, these two key product areas.
Now, 2/3 of the company and a big shift in that shape, which allows us to drive leverage and improve profit growth as well, but also a much stronger focus on major markets, the ones that are driving the business. And, of course, most importantly in that, the US, which is more than half of the company now. R&D investment, and it is always about the pipeline, is up more than 50% during this tenure, and we expect that to continue to grow strongly as we invest in opportunities that secure the next chapters of growth. The balance sheet has been completely transformed. I think we peaked at nearly GBP 29 billion of debt.
Now we're post-Haleon and the operating performance of the company really in a much more sort of sector normal position, which, of course, has created wonderful capacity to invest not only in our organic pipeline, but the kinds of BD you've seen us doing and we'll continue to do. I think we've done 20 deals or so, these bolt-ons and tend to be earlier stages, but also some key assets that are coming through. And it's great to see some of those results like Ojjaara looking forward to more in the pipeline too. We are definitely a much more performance-based culture. As I said, double-digit growth in 2022 and 2023 and 2024. We're looking at 7%-9% top line with double-digit profit growth, 12+ phase III readouts so far this year.
Very excited, and I'm sure hopefully we'll come back to that to be seeing the move forward in oncology. Great momentum in that business. And we just announced and we'll be sharing publicly the overall survival benefit meeting statistically significant and clinically meaningful for DREAMM-7 in Blenrep, that new comeback in multiple myeloma. We have these five, hopefully, of product approvals, Blenrep being a really big one to focus on, but also in IL-5s, the Depemokimab and Nucala for COPD. We got a push back into antibiotics, which is really important when you look at the sort of global health security agenda with hopefully Gepotidacin being approved, and then, of course, on new five-fold meningitis vaccine. So all of these are demonstrations of the improved productivity in our pipeline.
Always more to do, but this was one of the really fundamental questions as well as capital allocation, strategy and structure, competitive performance commercially and operationally in the field, and R&D. And I think on all of those, we've delivered progress whilst also maintaining a continued sharp focus on operating margins and cash flow. And so overall, as we look ahead, we are very confident in our upgraded outlooks to 2026 and 2031. And remember, those don't yet include Blenrep. We're very confident in our investment choices to drive competitive growth in specialty and over time get back to growth in vaccines. And there's always more to do, but I have an absolutely fantastic leadership team alongside me, great bench strength in talent across the functions and operations. And we're all fired up for the opportunities and the journey ahead.
The ultimate measure of R&D success is product launches. 2025 is a busy year for GSK. You've touched on a few there, Blenrep, Depemokimab, Nucala in COPD, Gepotidacin, and the MenABCWY.
Yeah.
Yeah. Could you talk about the individual significance of those products, but also what that means more broadly for the renaissance of GSK R&D? Because it's a lot of products in a relatively short space of time across a lot of different areas and modalities. So how can we use that to think about the broader picture of GSK R&D?
Yeah. Well, first of all, I'd also invite everybody to join our Meet the Management, which is going on in the middle of December when Tony will sort of update on the path ahead and particularly to double-click on the next wave in oncology and respiratory immunology as well. But I think this is fundamentally the most important area to address. And it's wonderful to be making meaningful progress this year for key vaccines and medicines and positive momentum across all four of our core TAs. Because remember, from a product area, we were driving this big strategic shift to vaccines, but also specialty medicines. And within that, you have infectious diseases, HIV, of course, respiratory immunology, and this emerging much stronger business in oncology.
I think we have overall nearly 70, I think it's 67 vaccines and medicines in the pipeline, 18 in either phase III or registration, and the vast majority with either first or best in class potential. As you say, the ultimate measure is the quality of the launches. I remember when I started in this job saying, "Gosh, I've got, while we work on R&D, there are three things I really need to get approved and launched well." Those were Shingrix, two drug regimens in HIV, and Trelegy. By the way, happened to be our three largest assets, I think. Then we proved, I think it was highlighted as in the top 1% of launches in the last few decades with RSV, that even in head-to-head battles, we know how to launch new products competitively.
I think that's this huge credit to both Luke and Deborah to how we're bringing, as well as our supply chain teams, to how we're bringing these launches to market. Specifically, I'm going to start with Blenrep. By the way, the launches, and I would say these are approvals we're expecting to get next year. Most of their contribution is obviously going to be more in 2026 and beyond, but that matters because obviously people now always look beyond not only the year, but that five-year outlook to 2026, but what's going to happen in the next chapter. So these will be contributing to that growth. But these are five of the more than 12 that we're hoping we're going to be able to launch.
The key is that these are all, as we presented at the beginning of the year, assets that could be $2 billion or more, and we're looking to add to them, which again was why I invite people to join Tony and his team in December. The first is Blenrep. That's for multiple myeloma. And if it's approved, that is going to be a really fantastic result for multiple myeloma patients. We had DREAMM-7. We also have DREAMM-8, but DREAMM-7 showed an almost tripling of progression-free survival versus standard of care. And as I said, and we'll be sharing those details very shortly, we have stats that can clinically meaningful overall survival benefit. So we hope this can be a practice-changing medicine, hopefully with market re-entry in the second half of 2025. The next big one is going to be the move into IL-5s.
Sorry, the innovation in IL-5s has already got a great asset in Nucala, which I think has had 36 quarters of double-digit growth. So it's a wonderful asset for us, and we're looking to take that into COPD. COPD is the world's third leading cause of death. And if it's approved, this will be the first once-monthly biologic proven to reduce exacerbations across the full spectrum of COPD patients. And that's important when you look at the competitor context here because we have included the most difficult to treat patients, those with emphysema, which I think is about a third of the market. But the really big play for us is Depemokimab. It's going to be a launch with two indications in severe asthma and chronic rhinosinusitis with nasal polyps, if it's approved, of course. But the key here is the longer duration of dosing.
It's six monthly, and that is really, we believe, going to open up the biologics market in asthma and keep people out of hospital. And then so those are, I would say, the ones, the most important ones to focus on. And then, as I said, Gepotidacin, that's bringing us back into innovation in antibiotics. Therefore, the treatment of uncomplicated UTI is an incredibly frequent disease that so many women can suffer from, but where resistance is really the key question here and how we build that business over time along with some other innovation in complicated UTIs. That's been accepted for priority review by the U.S. FDA, but I would be cautious on build there because obviously good sort of governance and stewardship around antibiotics is something we take into account. And then MenABCWY vaccines that could lead to a simplified meningitis immunization schedule.
Obviously, depending on the context we operate in, but more people being vaccinated for an absolutely horrible disease that kills one in 10 people who contract it within 24, 48 hours, and one in five has life-changing injuries. These are really exciting innovations to move forward. We're already setting our next wave of sustainable growth beyond 2031 and bring that into sharp focus. Again, more on that in December.
Perfect. That's really helpful. Now, on specialty medicines, with some of the launches you've just talked about, the future looks very bright, but so does the present. The performance of specialty medicines has been very strong. How should we think about the near-term momentum going forward for specialty into 2025 and beyond?
With a lot of positivity, it's our biggest business. It's growing, I think, year to date at 20% with double-digit growth in all three of the TAs. In fact, oncology is sort of nearly doubling, but obviously off a smaller base. We'll give guidance, obviously, the year-end results for 2025, but I think we're all very excited about the momentum in this business. It would be fair to say this is where there is probably a larger disconnect in terms of our confidence and the evidence, frankly, that we think underpins it and what the market sees. I mean, the first area to go would be HIV.
Our ViiV business has consistently led the way in innovation, and we've continually, frankly, upgraded the outlooks of this business with fantastic performance of two drug regimens with Dovato and, of course, the pioneering work in long-acting, which has continued to go well. In both of these fields, I think it's important to note that the entire sector has since followed the leadership that we demonstrated despite some early skepticism, I would say. This we really believe is the future of this field. We have consistently, and we intend to consistently lead the way to hopefully ending this epidemic with the particular focus on patient insights. That's really helpful in the way we run our HIV business through ViiV, which is a very dedicated expert team that has nothing else to focus on apart from not leaving any patients behind.
Our belief is that, and by the way, helped by others coming into the field. This is something that's really important to understand is what is in our best interest is to grow the long-acting share of the total market. So others investing into it is a good thing. And we think actually that by the end of the decade, considering where everyone else is focusing too, that long-acting is going to be the largest class of medicines, particularly if, which is our intent, we can move into six-monthly solutions by the end of the decade, then this can really be the largest class of medicines in HIV. So very excited about what's coming there and the priority there being the largest market, which is treatments. In respiratory immunology, as I said, Nucala is just having stellar growth. We want to add with COPD, Depemokimab.
We'd like to get to an approval by the end of 2025. That's going to be the first and only IL-5 with twice yearly dosing. And actually, Benlysta has also had continued double-digit sales growth as the leaders in Lupus. And I was really pleased we just did a deal on a T-cell engager out of China, which we think could be very exciting in Lupus and potentially beyond that to add to that. And then in oncology, we've now in nine months crossed the GBP 1 billion franchise. Remembering we had zero sales in 2018, wonderful, wonderful momentum with Ojjaara, but also Jemperli. So actually, it's been really great to see the momentum there in women's cancers and also in heme-onc, which obviously very excited to add to with Blenrep.
There have been some other, I would say, high-risk, high-return areas we've been investing in, but with a very disciplined capital allocation. And you can imagine we're very thoughtful about gating extremely aggressively any work in TIGIT. The one to watch here next after Blenrep, and you'll hear more from Tony on that in December, is our portfolio of ADCs, which we are very ambitious for. Remembering Blenrep is our first foray into ADCs. So I think it would be fair to say that while, as you know, at Q3, we put a note of caution out for vaccines in the near term, we remain very confident in the medium and longer term there for all sorts of obvious reasons. But the momentum in our specialty business and the pipeline that's coming through, we feel very, and frankly, the returns in that business, we feel very positive about.
We did also flag, obviously, environmentally the things that we're expecting from IRA, which is worth picking up in the notes, so those will be some dilutive to growth impacts, but the fundamentals are very good.
Great. Thanks for that. Now, let's stick with vaccines and Arexvy. I mean, as you say, the launch was phenomenal, far exceeding our forecasts and expectations on the.
Ours, actually.
But with the mere strength of the launch and the tricky comp that creates U.S. recommendations, the revaccination frequency, it has created a degree of uncertainty in investors' minds, which was very acute at Q3. How do you see the outlook and potential for Arexvy in the U.S., but also, and I think this gets overlooked a lot, in markets outside the U.S.?
Great point.
Where you're yet to launch, and what does that mean for the launch strategy in terms of pricing and uptake as this is no longer likely to be an annual vaccination?
Yeah. So first of all, this is an extraordinary vaccine. And I think the industry has been trying to work for like 50 years, as I said, to try and develop an RSV vaccine. We were the first at GSK with very high efficacy, more than 90% protection for those that represent 90% of hospitalization in a disease that is a meaningful burden for, I would say, normal seasons for hospitalization and, in fact, death. And now we have a very effective, both from an efficacy and a cost-effectiveness solution for that. A launch which I think surprised everybody because it was a new vaccine, and that's the thing that we've all got to remember. It is a new vaccine in the foothills of its journey in terms of its contribution to global health, frankly.
We started to see the pressure here in June with, I would say, what was a surprise revised ACIP recommendation, and this is really important, tighter guidelines for the 60-74-year-old age group, sort of the biggest ones. That has increased some complexity, I'd say, in terms of the HCP and pharmacy distribution. As you referred to, we had the prioritization, a huge surge in COVID infections in August, and we had the prioritization of the COVID vaccine. Actually, the third thing that was, I would say, unexpected, and it would be normal it was unexpected, is we had an exceptionally low level of RSV infections so far this year. It can be linked to all sorts of things, perhaps COVID coming out earlier. We've seen what's happened in the weather environment.
But anyway, I think there's only been two extremely low seasons in the last 15 years of RSV, and one of them was during COVID when no one went out. So it's unusually low. So all of those things impacted us as we saw through Q3 and will continue to through Q4, which is why you saw us lowering our expectations for vaccines this year and, importantly, setting conservative expectations for vaccines as a whole next year. And I think that's the right thing to do. Obviously, we're also going into a new administration, and we want to see how all of those organizations and decisions are going to be made. But we are very confident in this vaccine overall and its data. We're looking forward to bringing transparency, continued transparency, I should say, as always on the benefit risk.
I would underline once again that despite this, we remain extremely confident not only in those double upgraded outlooks for this year, but also the upgraded outlook for 2026 and beyond, i.e., the strength of the full portfolio and having multiple engines of growth secures that. Now, I would also say, and this is important because we're early doors, that there's no change to our ambitions on the medium and long term for this asset, which we've said we expect could reach more than GBP 3 billion of peak year sales because of the strong burden of disease. I think it's 64 million people in the richer countries impacted by RSV and over 30,000 deaths in a, if I can say, a normal season. So we have very strong benefit risk equations. We still have a leading market share.
We have not even scratched the surface of the international opportunity, as you alluded to. And don't forget, Shingrix is nearly 60% international business now. So we're very, very low there. And we do believe, and this is an assumption that's important to take into account, that there will be revaccination. Now, we've had very strong data for two years, good data for three years, but there is waning from, if you look at the total cohort, over 80% to less than 50% efficacy. At three, we will have data at some point next year on four. So our assumption, considering the trajectory and also, frankly, the data from the other key vaccine in the field, we think it is a reasonable assumption to say that within five years, revaccination will be recommended.
So in that sense, that is an important contributor to our assumption, as well as further penetration in the U.S. I think we've still got 80% of those for whom the vaccine could be recommended not vaccinated yet. So just needs to settle down. We have been conservative in the outlooks that we've put specifically for vaccines, and we will continue to engage with the data and all the public health authorities and internationally for a product that, frankly, is one of the best returns on investment any payer can consider.
Right. No, that's all very clear. And moving on to Shingrix, which is a little later in its life cycle. How would you characterize the performance and outlook in the U.S., in China, where at the periphery there appear to be a few macro issues and in other international markets? And then going on beyond that, Shingrix has been very, very successful in its role for Shingrix shingles prevention. But there is the wildcard of alzheimer's and dementia prevention. How do you think about that as a longer-term upside option on Shingrix?
Yeah. Well, it's not included in where we are, but I completely agree with you. And it's hard not to when you have, frankly, a vaccine that protects us. And one in three of us will suffer from shingles, okay, if we reach 80. So this is an excruciatingly painful experience that can have all sorts of other knock-on effects. And we have protection of 80% for already 11 years. So this is an exceptionally high-performing vaccine without any reasonable competitor threat. And specifically, and then I'll come back to your questions on the operating performance, there is headline data from more than one source that suggests that Shingrix is associated with, after three years, a 27% reduced risk of developing dementia versus a competitor zoster vaccine or a 24% reduced risk versus a comparison pneumovaccine, i.e., using other vaccines as comparators.
So you kind of reduce that effect a bit. Now, it's still very early days, and we are looking at a range of approaches in partnership with a few expert bodies, which I think Tony will be able to communicate on by the end of the year in terms of how we want to pursue any further studies here. And if the science bears out and we're able to demonstrate any kind of causality, frankly, it would be an extraordinarily widely available prevention option that could have a big impact in an era where this is one of the single biggest burdens of disease for society. So why wouldn't you? Now, but that's, I would say, upside. We did, I think, just sort of GBP 3.5 billion of Shingrix last year. And we've said that we think there is a peak year sales of GBP 4 billion plus.
There's no change in that. Now, the growth, to be clear, is going to come from outside the U.S. The U.S. will continue to decline, and I'll explain why, although it will continue to be a very material contributor to the scale of Shingrix. I think the important thing about China is when the growth is ex-U.S., and this is one of the reasons why we also noted some caution for vaccines going into next year, the biggest contributor, and we have a great, exciting deal with Zhifei, a key partner, a Chinese partner that has the track record of partnering to build a multibillion vaccine with Merck, of course.
But we've built that partnership, and we had a pretty aggressive trajectory with them, which we would want to mark a lot more caution on right now because of the macro environment in China, which nobody is immune to in any industry, frankly, at the moment. So that's a little bit of a note of caution in China, although it doesn't take away in any way from our ambitions with this partner and for this vaccine. But I was in France yesterday, and frankly, visiting the factory that makes Shingrix and talking to our country head in France, where we've just been excited to get the national immunization program approved. And there are plenty of other opportunities for international growth in European countries like Italy and Spain. We've got more opportunities in Japan.
But I think this has to do, therefore, with a slightly slower China than originally anticipated and, of course, the U.S. dynamic. And the reason the U.S. goes down is not because we don't see plenty of opportunities to increase penetration. We're at 39% now. There's no reason why you couldn't get up to 50%, 60% over time. It's just it takes longer because these are harder to reach people. And obviously, there's no revacs with this, at least yet. We do start people at 50. So it may be, but again, we don't bank on that way down the line we start to see that. But the key point is we're moving from penetrating new cohorts at 7% a year to maybe 3%- 5%. So that you'll just get new 50-year-olds coming through, and some of those will be super enthusiastic, but it's harder to reach.
But a fantastic vaccine, still room to grow internationally and some optionality for the future, but we'll mark a caution on that. And we'll continue to be, I mean, the great thing about a vaccines business, and this is where obviously we're being cautious about RSV and Shingrix in the current environment in the near term with the reminder they're just part of the portfolio, but we are really looking forward to adding to those with hopefully mRNA and then pneumococcal and really confident for the sort of medium and longer-term contribution of our vaccines portfolio alongside specialty.
Right. No, that's very clear. You touched on China there. Perhaps you could just give us your thoughts and perspectives on the Chinese market at the moment. There's a sense in some investors' minds that it's maybe not quite as attractive as it was. Is that just the law of large numbers? Or to what extent are things like macroeconomic pressures and funding pressures, the anti-corruption drive, how's all that coming together more broadly when you think about China as an opportunity?
Yeah. Well, first of all, I'm very happy with where we are in China broadly. But for some of the, I mean, obviously, GSK has had a painful history and missed some opportunity, but as a result of that. But for where we stand today in the geopolitical environment we stand today and with the growth profile of the company, it's still a relatively small business for us. So in the sense of exposure, we are in a strong position in terms of the mapping of our supply chain and a lack of exposure in that sense. We see genuine opportunity for material growth contribution, particularly in our vaccines business, but you're also seeing some of our specialty medicines get very interesting and specific accelerated approvals.
I mean, whether that's what Blenrep might be able to do, but I'm also particularly excited about the opportunity for Hep B there, where there's a big burden of disease. And that's a very interesting asset that's coming through. And then this partnership with Zhifei, we are delighted to have been able to do that. And frankly, that's why I don't want to put any pressure on that. We will take our time to be a long-term partner with China in China for the future. I think the other sort of double-click on China that is very important for us at the moment and where it's all opportunities and business development.
And you've seen us, whether it is the two ADCs we've picked up or the recent T-cell engager, but we think we've done extremely disciplined capital allocation for potentially very high returns because you are seeing some great leaps forward in the innovation in China and opportunity for deals ex-China where an international partner is probably best placed to deliver results. So we're very engaged. And I see the risks that you outline as well managed, and it's helpful to not be overexposed, but I see a lot of opportunity.
I think you make a really interesting point on the business development angle because for some pharma companies, China is simply a market to exploit, whereas you and a small number of others are thinking about China as an opportunity to develop their and globalize their innovation. How does that change the sort of quality of the relationship with the authorities over there? I'm guessing that's something that they're hugely supportive of.
I think the quality of relationships with the authorities matters in every country in the world, whether it's China or the U.S. or our home country in the U.K. You are in the market for the market, but also in the market from the market. There are countries where our industry is fundamentally seen as deeply strategic and a core of, you go so far to say, a security, not least after what's happened in the last few years, and where people want to invest structurally in building a capability when we can offer a constructive partnership for execution. That's always worth exploring. You do have to, I mean, at the same time, we screen very aggressively, as you would expect for due diligence, to make sure we're setting up supply chains. That's true for every country we're in, really thoughtfully for an evolving global environment.
The subjective relationship with authority is a nice segue into another important market, which is the U.S. We're a few weeks after the presidential election. It's very early, of course. But what are your early thoughts on how you see the U.S. environment changing? I think we've now got pretty much the full slate of nominations for the relevant positions. How do you see things evolving under the Trump presidency for the pharma industry and for GSK?
First of all, we've worked with the Trump administration very successfully before, and we plan to do so again, focused consistently on bringing differentiated, needed scale innovation to American patients who are waiting and to continue to support the access agenda as ambitiously as we can. Frankly, as GSK has a great track record of doing. Let's start with the U.S. is incredibly important for us, and it's even more important now than it was when we started the transformation journey for GSK. I think we're at 52 or 3% of our sales in the first nine months of this year. It's incredibly important because it's also a place where huge numbers of our people, our deeply talented people are based. It's a very significant investment area of our R&D operations and our manufacturing footprint.
We're really heavily invested in local manufacturing, which is important in the current context. I think we announced just this month or last month another $800 million investment in one of our U.S. sites in Pennsylvania, which is the largest U.S. investment to date. And fundamentally, I am going to make no argument, in fact, the opposite with the vision of making America healthy again. I mean, literally, the purpose that GSK has defined for itself is to combine science, technology, and talent, all of which are in great supply in the U.S. to get ahead of disease together. And obviously, we will see the nomination go through for RFK, and there will be some uncertainty and lots of commentary on priorities, and I'm sure that will continue for some time. But we stay focused on our priorities.
I think whether you're preventing disease before it starts or intervening earlier to change its trajectory, that is better for budgets. That's better for patients. That's better for burdened hospital systems. We will seek to partner very carefully with the agencies that fall under HHS, whether it's FDA, CDC, let's see with CMS and ACIP. Obviously, the double-click that people are very focused on at the moment is the questions that have been raised on vaccine safety and mandates. I would also point you to the immediate statements around not being anti-vaccines and that vaccines wouldn't be taken away from people. I think a request for transparency and trust around the benefit-risk data is a really good thing because regardless of the administration, there is some hesitancy in a post-COVID world. Let's run towards that with transparency.
I think GSK is very, very well placed to do that with the assets we have, the track record we have around benefit-risk. I'm really looking forward to engaging alongside the industry, but with incoming administration and the new policymakers, particularly in how we ensure there are opportunities in the global context that we've just been talking about. How do we make sure that the U.S. remains the best place in the world to develop innovation and bring it to Americans who need it and export it around the world? I think let's not overreact and do our job.
That's very helpful. And I think, yes, last week's overreaction within the markets does seem to have calmed down a little bit now. There were slightly more sober views this week, which is a great thing. Now, of course, another country slightly close to home that's undergone a change of government recently is the U.K. Given that's where GSK is headquartered, have you seen much impact there? Do you expect much change from the new Labour government?
I think the first thing to say in slight contrast to the U.S., the U.K. is a very small part of our business. I think it's in a very low single digit to 3% of the global business. It's a very important country to us because we are listed here as well as in the U.S. I will let you comment on how you think the capital markets environment in the U.K. may or may not evolve. Even more than that, we have a very significant R&D presence here. The U.K. is recognized worldwide as being very R&D capable. We have a big sector presence here, obviously, as an industry in both small and medium and large cap. We have some of the greatest academic institutions in the world. At GSK, we also have a pretty cross-country manufacturing presence as well.
So we're a big employer here. And what we actually discover, develop, and make here are really at the cutting edge of innovative specialty medicines, actually. We don't do any of our vaccines work there. So this is a specialty medicines country where we export. I think GSK alone exports more than Scottish whiskey does from the U.K. So I'm not sure that's the right comparison. But anyway, so I would say in all of that context, of course, we engage as one of the U.K.'s biggest companies, very enthusiastically with governments, including this new one. Personally, I am hugely supportive of the health secretary's long-term reform plan for the NHS, the focus on prevention, of course, right at the heart of what we do, the focus on digitization, the focus on community to relieve burdened hospital systems.
I'm very excited, and this is us alongside others in the industry really trying to partner constructively on this, but we read the commitment to improve the clinical trial environment, not only so we can innovate more effectively investing here, but frankly, so that British patients get access. This is really key to new medicines earlier than they have been to a fair recognition of value, so those are the other aspects that we continue to look at.
That's very helpful. Thank you. You touched on it in your earlier comments about Zantac. That's clearly been a long-standing distraction and irritation for GSK and indeed for us over the last few years, but it's now pretty much resolved. You were very clear that Zantac never affected your capital allocation decisions, but now it's out of the way. Can you just remind and refresh us on what those capital allocation priorities are for GSK?
Yeah, I mean, they are completely consistent and unchanged, but I can't help but just say it has been great to essentially draw a line under that litigation, removing the vast majority of the exposure. And frankly, the real issue here is the potential material future risk for the company. And we've seen examples in the industry when these things just go on and on. And while the settlements were agreed with zero admission of liability and you have to hold your nose, we strongly believe that that was in the best interest not only of the company, but also of shareholders. We've had very positive feedback on that. Now, on the capital allocation framework, it's quite simple. The number one priority is, as you would expect, to invest for growth and sustained profitable growth for the company.
That's investing in the pipeline and in new product launches and the kind of BD you've seen us doing. Just to emphasize, that's the sort of thing we want to do more of, nothing different from that in our core areas. It would be right to say a strong focus on innovation. Because of the amount that we're continuing to digest and what's available in our specialty medicines would be core to that. And within that, obviously, the two highest sort of growth areas of respiratory immunology and oncology, but we continue to keep our eyes out for all sorts of opportunities. So that is the first priority. And then alongside that, and we are extremely thoughtful about this in the current context, coupling that with attractive shareholder returns. So it's been great to get back to a progressive dividend.
You saw that year-on-year increase in the dividend that was announced for our Q3 delivery. Also, when other aspects have been satisfied, looking at excess cash returns to shareholders. All of that has to be underpinned and is by a strong balance sheet with strong investment-grade credit rating. When we look back over where we've come from, I'm extremely proud of the progress and the capacity that we've been able to generate there. Absolutely clear capital allocation priorities and no change to that.
One of the questions that we've had from a number of investors really since Q3 has been on the subject of buybacks. It's not been something GSK has done for a long time, but the valuation certainly to our mind is somewhat extreme on the low side. So is it now notwithstanding the growth priorities, is it something that is seen as a more interesting option at these levels than previously?
I think it would be fair to say that whenever we look at the allocation of capital, we consider what the alternative options would be. So that's including whether we're looking at inorganic options, BDs. We would naturally compare that with alternatives. And again, no change at all to that being part of the consideration set as we really continue to focus not only on the prospects for the company, but on the importance of demonstrating shareholder returns.
That's very clear. That's very clear. Now, in the last couple of remaining minutes, I just wanted to go back to respiratory, and you've talked about Nucala and COPD, which has got best-in-class breadth, Depemokimab mAb, best-in-class dosing frequency, and the efficacy data we've seen so far looks really good, so just broadly, with those two assets, how big do you think injectables could become within this space? Because the penetration is still relatively low, but if we sort of think back to sort of 20 years ago with rheumatoid arthritis, the same was said about the TNFs. They were going to be very small specialist severe disease, and they're now enormous, so how long or sort of how deep do you think injectables can go within the space?
We think this is a really important point, Simon. Fundamentally, we've said we think our IL-5s can be a $4 billion peak year sales business. That is in large part because we think the biologic penetration and Luke presented some quite detailed studies on this earlier in the year. There's no reason why it shouldn't in asthma get to, by the early 2030s, get up to 60% like you've seen in some other spaces, and it's probably half that at the moment. Really big opportunity. Within that, we couldn't be more excited than for the launch of Depemokimab. We'll launch with two indications, as I mentioned earlier, but we've got four in phase three development.
That is a total transformation in the way GSK does R&D in terms of working to do things concurrently and build bigger assets faster with some shift in risk appetite there. I think you've got, yeah, a third of potential asthma patients on biologics now. Going to the asthma conference and respiratory conference in Vienna earlier and just listening earlier this year and just listening to the HCPs and their enthusiasm for long-acting, just practically for patients, is amazingly exciting. I think we've got some internal research that said that for asthmatic, 87% of patients would be interested in a six-monthly dosing option. Because we just have to think it's twice a year. The SWIFT-1 and SWIFT-2 data showed that you get more than 50% reduction in exacerbations, but critically, over 70% reduction in exacerbations that cause hospitalization or an emergency room visit.
So if you just start with that, and that's what people are afraid of for themselves or for their kids, because that's when these things become life-threatening, it's a very big deal. Now, of course, Depemokimab will take some business from Nucala, but I think our study said about 25% from there and the rest sort of more equally across the range. But what's more exciting is how it can grow the biologics market. It will take some time, so we shouldn't get ahead of ourselves in the pace there. But we are really excited with where biologics could go and then, of course, how we can add to that. And again, more from Tony on that in December on how we think about COPD and biologics and starting with Nucala.
Perfect. The clock has beaten us. That's a great place to stop. Emma, thank you for a fascinating discussion. I think we've gone through the investment case on GSK and the story very thoroughly and certainly makes me feel very positive about our buy recommendation on GSK. So thank you very much for your time participating.
Wonderful to see you, Simon. Thank you very much.
Thank you. And thank you to all of you for listening. Thanks very much.
Bye.