Good morning, and welcome to Johnson and Johnson's Second Quarter 2021 Earnings Conference Call. All participants will be in listen only mode till the question and answer session of the conference. Call is being recorded. I would now like to turn the conference call over to Johnson and Johnson. You may begin.
Good morning. This is Chris D'Alorffes, Vice President of Investor Relations for Johnson and Johnson. Welcome to our company's review of business results for the Q2 and our updated financial outlook for 2021. Joining me on today's call is Joe Wolk, Executive Vice President, Chief Financial Officer. Also joining Joe and myself during the Q and A portion of the call will be Jennifer Talbert, Executive Vice President and Worldwide Chair, Pharmaceuticals Thibault Mongan, Executive Vice President and Worldwide Chair, Consumer Health and Ashley McEvoy, Executive Vice President And Worldwide Chair Medical Devices.
A few logistics before we get into the details. This review is being made available via webcast, accessible through the Investor Relations section of the Johnson and Johnson website at investor. Jandj.com, where you can also find additional materials, including today's presentation and associated schedules. Please note that today's presentation includes forward looking statements. We encourage you to review the cautionary statement included in today's presentation, which identifies certain risks and factors that may cause the company's actual results To differ materially from those projected, in particular, there is uncertainty about the duration and contemplated impact of the COVID-nineteen pandemic.
This means the results could change at any time and the contemplated impact of COVID-nineteen on the company's business results and outlook is a best estimate based on the information available as of today's date. A further description of these risks, uncertainties and other factors can be found in our SEC filings, including our 2020 Form 10 ks and subsequent Form 10 Qs, along with reconciliations of the non GAAP financial measures Utilized for today's discussion to the most comparable GAAP measures are also available at investor. Jandj.com. Several of the products and compounds discussed today are being developed in collaboration with strategic partners or licensed from other companies. This slide acknowledges those relationships.
Moving to today's agenda, I will review the 2nd quarter sales and P and L results for the corporation and the Three business segments. Joe will provide insights about our cash position and capital allocation deployment and will outline our updated guidance inclusive of the COVID-nineteen vaccine for 2021. Then we will begin the Q and A session with each of the segment leaders providing a Now let's move to the Q2 results. Worldwide sales were $23,300,000,000 for the Q2 of 2021, An increase of 27.1 percent versus the Q2 of 2020. Operational sales growth, which excludes the effect of translational currency, Increased 23% as currency had a positive impact of 4.1 points.
In the U. S, sales increased 24.9%. In regions outside the U. S, our reported growth was 29.5%. Operational sales growth outside the U.
S. Was 20.9% with currency positively impacting our reported OUS results by 8.6 points. Excluding the net impact of acquisitions and divestitures, Adjusted operational sales growth was 23.8 percent worldwide, 25.1 percent in the U. S. And 22.4 percent outside the U.
S. Turning now to earnings. For the quarter, net earnings were $6,300,000,000 And diluted earnings per share was $2.35 versus diluted earnings per share of $1.36 a year ago. Excluding after tax intangible asset amortization expense and special items for both periods, adjusted net earnings for the quarter were $6,600,000,000 and adjusted diluted earnings per share was $2.48 representing increases of 49% 48.5%, respectively, compared to the Q2 of 2020. On an operational basis, adjusted diluted earnings per share increased 44.9%.
I will now comment on business segment sales performance highlighting items that build upon the slides you have in front
of you.
Unless otherwise Stated percentages quoted represent the operational sales change in comparison to the Q2 of 2020 and therefore exclude the impact of currency translation. Beginning with Consumer Health. Worldwide Consumer Health sales totaled $3,700,000,000 and increased 9.2% With increases in the U. S. Of 12.4% and growth of 6.3% outside of the U.
S. Excluding the impact of divestitures, worldwide growth was 10%. Year to date adjusted operational growth was 3.3% And is more reflective of performance given the quarterly fluctuations of COVID-nineteen impacts. Over the counter medicines grew 8.9% globally, Driven by strong growth in ZYRTEC due to both the timing of and increased incidence in the allergy season. Digestive Health grew double digits driven by U.
S. Pepsiid New SKU stocking in the club channel, coupled with share growth and increased COVID-nineteen related healthcare professional recommendations For the hydration benefit offering ORSOL in the Asia Pacific region, the Skin Health Beauty franchise grew 12.9% globally With the U. S. Increasing 23% and OUS increasing 1.4%, Skin Health Beauty outside the U. S.
Was negatively impacted by approximately 300 basis points due to divestitures. Worldwide growth was driven by market recovery in key markets, increased U. S. Stocking for new products and comparisons to COVID-nineteen related destocking dynamics. Neutrogena and Avino delivered strong performance in the U.
S, primarily due to market recovery, new product innovation And higher stocking due to the Neutrogena rapid firming product launch, partially offset by competitive pressures. OGX and Maui growth was driven by share gains And market growth in hair care. Oral Care grew 2.5% globally due to strong OUS performance for Listerine, Reflecting accelerated category and increased demand from continued successful promotional campaigns, divestitures in the quarter negatively impacted results by 310 basis points. The Baby Care franchise grew by 5% as a result of market recovery And OUS strength in Johnson's and Aveeno Baby in e commerce. Wound Care delivered strong growth of 13.4% driven by U.
S. Market growth with increased consumer behaviors focused on preparedness and infection prevention and seasonal stocking versus Prior year COVID-nineteen destocking dynamics. Moving on to our Pharmaceutical segment. Worldwide Pharmaceutical Sales of $12,600,000,000 grew 13.6% with strength in both the U. S.
Increasing by 12.2% And OUS with sales increasing by 15.4%. Excluding the impact of divestitures, worldwide growth was 14.1%. Mobile sales in the quarter included $164,000,000 contribution from the COVID-nineteen vaccine. Additionally, as a reminder, for comparison purposes, Q2 of 2020 was negatively impacted by access related constraints Due to COVID-nineteen resulting in a decrease of roughly 300 basis points to 3.50 basis points in total across key brands. Our strong portfolio of products and commercial capabilities continues to enable us to deliver strong adjusted operational growth at above market levels.
Our immunology therapeutic area delivered global sales growth of 17%, driven by strong double digit performance of STELARA And TREMFYA offset by declines in REMICADE due to biosimilar competition. STELARA continue to show strength in all regions, Growing at 30.5 percent driven by increased market growth and share gains with U. S. Share increasing roughly 4 points in Crohn's disease And nearly 8 points in ulcerative colitis. TREMFYA was up 36.8% with strong double digit growth worldwide due to share gains, Continued global expansion into new markets and additional penetration into the psoriatic arthritis indication that was approved in 2020.
U. S. Share increased over 2 points in psoriasis and nearly 3 points in psoriatic arthritis in the quarter. Our oncology portfolio delivered another strong quarter with growth of 21.5%. DARZALEX Continued its exceptional performance trajectory growing 53.8 percent driven by share gains and increased Penetration of the subcutaneous formulation in the U.
S. And EU. DARZALEX continues to grow share across all lines of therapy With nearly 4 points of share growth in Line 1 in the U. S. This quarter, ERLEADA also continued its global momentum With growth of 73.7 percent in the quarter, driven by market share, which increased by nearly 2 points across indications And penetration gains, especially in the metastatic indication.
IMBRUVICA grew 12.5% globally Due to volume gains driven by our market leading share, it was partially offset by modest share losses in the U. S. To novel oral competition And a market that remains slightly depressed due to temporary COVID-nineteen impacts on new patient starts. In neuroscience, our paliperidone long Acting portfolio had strong double digit growth of 10.6%, driven by market and share growth due to increased new patient starts and strong persistency. Cardiovascular, Metabolism, Other declined 7.3% this quarter, driven by continued biosimilar competition for Procrit And competitive pressures in INVOKANA, which was partially offset by growth of 1.8% in XARELTO due to continued demand strength.
Lastly, our pulmonary hypertension portfolio achieved growth of 8.7% with OPSUMIC growth of 11.9% And OBTRAVI growth of 9.8%, both driven by market penetration and share gains. I'll now turn your attention to the Medical Devices segment. Worldwide Medical Devices sales of $7,000,000,000 grew 57.2% with the U. S. Increasing 77.2% And OUS increasing 41.9 percent, primarily due to the recovery of procedures from COVID-nineteen restrictions That occurred in the Q2 of 2020 coupled with the success of recently launched products and commercial activities across the business.
Selling days had a minor positive impact on growth this quarter. We expect the full year impact from selling days excluding the impact of the 53rd week In 2020 to be minimal. Given the extent of the procedure disruption from COVID-nineteen in 2020, I thought it may be helpful to provide context for our current quarter performance versus the Q2 of 2019. Worldwide Medical Devices grew about 7% versus Q2 twenty nineteen with 8 of our $11,000,000,000 platforms Showing growth versus 2019. The pace of market recovery in knees, spine and vision surgical Has been slower than the other markets in which we compete as these procedures are perceived to be more deferrable by patients.
Geographically, both the U. S. And Asia Pacific markets surpassed Q2 2019, while EMEA and Latin America markets have been slower to recover and Q2 results remained at or below 2019 levels. Looking at results for each of our platforms. Interventional Solutions delivered another strong quarter with worldwide growth of 71.3% and strong double digit growth versus the Q2 of 2019.
Electrophysiology reinforced our global market share leadership position growing 74.4% Driven by recovery in the market coupled with our market expansion activities, the strength of our broad based portfolio and new products. Worldwide Orthopedics delivered 48.6 percent growth versus the prior year, driven primarily by market recovery and success of newer product launches. Worldwide Trauma delivered growth of 24.8%, reflecting market recovery, strength of our comprehensive portfolio And success of newer product introductions. This quarter, we expanded our market leading portfolio of products with the launch of a next generation Variable angle clavicle plate system designed to enhance plate to bone fit on a broad range of patients And simplify implant selection for the surgeon. And we launched an advanced tibial nailing system designed to provide a more stable implant solution And create efficiency within the healthcare system by streamlining instrumentation across our portfolio.
Worldwide hips Screw 68.1 percent this quarter driven by market recovery, our continued leadership position in the anterior approach, Demand for the Actus Stem aided by our other enabling technologies such as Velas hip navigation and innovative commercial programs Focused on expanding coverage and access for hip fracture patients in parts of Europe and Latin America. Knees returned to growth this quarter increasing 94.6% globally, primarily due to market recovery. Results reflect continued COVID-nineteen challenges and the related impact on procedures in markets like India, Japan and Australia And other dynamics including faster recovery trends in primary knee procedures compared to revisions. This quarter, we began commercialization of our Velas Robotic Assisted Solution for total knee procedures in the U. S.
We believe this launch along with our differentiated Velas digital solutions and Attune Knee platform including the second half twenty twenty one launch Of the Tuned cementless fixed bearing knee with a Fixium 3 d printed technology will enhance our portfolio and competitiveness as procedures continue to recover. Spine returned to worldwide growth this quarter increasing 51.7%, reflecting market recovery and positive impact from recently launched products Symphony, Conduit and Fibrograft as well as strategic partnerships which further enhance our offerings such as the XPAC Expandable Cage. Advanced Surgery grew 44.3% versus prior year. In addition to the positive impact of procedure recovery, Biothersurgery delivered sales growth of 48% and positive share momentum driven by new products and commercial strategies to expand market penetration and adoption. Endicutters and Energy both grew around 40% globally, primarily due to procedure recovery, new product introductions In China, Tier 2 and 3 hospital market expansion activities, partially offset by competitive pressure in the U.
S. We also achieved a significant milestone within the quarter with our Monarch Robotic platform surpassing 100 customers and 8,000 procedures. General surgery grew 67.8% globally with wound closure growing 50.1% globally driven by recovery in the markets, Continued strength of our market leading suture portfolio, including our Plus Sutures and STRATAFIX Barb Suture family And a change in channel inventory levels in the U. S. Contributing about 6 points to global growth.
Global general surgery sales We're positively impacted by 23 points due to a prior year unfavorable pricing adjustment in the U. S. We communicated last year. Worldwide vision grew 66% this quarter, primarily driven by market recovery. U.
S. Contact lens growth of 73.6% reflects The strength of our market leading Acuvue portfolio, commercial initiatives such as our Prioritize Your Eyes campaign Launch to raise awareness around the importance of routine screenings, new products including early success from Acuvue Multifocal And an inventory build contributing about 5 points. Growth outside the U. S. Of 43.1% reflects market recovery And strength of AccuView, one day and recent Asia Pacific AccuView, Define Fresh beauty launch.
Well Surgical Vision delivered growth of 115.8 percent driven by market recovery and positive momentum related to new products like Techniscience, Technosynergy, which both launched this year in the U. S. Market and Veritas, our next generation phacoemulsification device. Now regarding our consolidated statement of earnings for the Q2 of 2021, please direct your attention to the box section of the schedule. You will see we have provided our earnings adjusted to exclude intangible amortization expense and special items.
As reported this morning, our adjusted EPS Of $2.48 reflects a reported increase of 48.5% and an operational increase of 44.9%. I'd like to now highlight a few noteworthy items that have changed on the statement of earnings compared to the same quarter last year. Cost of products sold improved by 3.40 basis points, primarily driven by the recovery in medical device from prior year COVID-nineteen related inventory impacts And fixed cost deleveraging. Selling, marketing and administrative margins improved 110 basis points Due to the recovery of medical device sales from the prior year's negative COVID-nineteen impact, we continue to invest in research and development at competitive levels, Investing 14.6 percent of sales this quarter, the $3,400,000,000 investment was a 25% increase versus the prior year due to portfolio progression. The other income and expense line showed net income of $488,000,000 in the Q2 of 2021 compared to net expense of $24,000,000 in the Q2 of 2020, primarily due to reduced litigation related items, partially offset by lower unrealized gains on securities.
Regarding taxes in the quarter, on a GAAP basis, our effective tax rate declined from 8% in the Q2 of 2020 To 5.8% in the Q2 of 2021, primarily driven by a one time tax benefit the company recognized in the Q2 In the Q2 of 2020, the company recorded additional tax benefits related to the transitional provisions of Swiss tax reform, which benefited the 2020 tax rate. Excluding special items, the effective tax rate was 14.8% Versus 16.7% in the same period last year. I encourage you to review our 10 Q for additional details on specific tax matters. Let's now look at adjusted income before tax by segment. In the Q2 of 2021, our adjusted income before tax for the enterprise As a percentage of sales increased from 29.1% to 33.4%.
The following are the main drivers of change to the adjusted income before tax by segment. Medical Devices margin improved from 1.2% to 28.6 percent driven primarily by overall expense leveraging resulting from the COVID-nineteen related sales recovery. Consumer Health margins improved by 3.80 basis points, primarily driven by supply chain efficiencies, including the benefit from our SKU rationalization program, partially offset by increased investments in brand marketing expenses. Pharmaceutical margins decreased by 4.50 basis points, primarily driven by increased research and development investment inclusive of the COVID-nineteen vaccine net costs and general portfolio progression. Moving to important developments.
Here is a slide summarizing notable developments occurring in the 2nd quarter. I'll highlight a few starting with our Pharmaceutical business. We continue to make positive progress advancing our strong pipeline of innovative medicines and therapies. As we've shared previously, we are rigorous in focusing on differentiated, transformational medical innovation. In the quarter, we announced our decision not To continue a collaboration and license agreement for cuzituzumab, an investigational therapeutic antibody that targets CD70.
The decision is based upon Janssen's review of all available data and in consideration of the evolving standard of care for the treatment of AML. We received EU approval for PONVORI in relapsing multiple sclerosis and also U. S. Approval of Rybovant For the treatment of patients with locally advanced or metastatic non small cell lung cancer with epidermal growth factor receptor exon20 insertion mutations. In addition, we completed our EU filing for silpa cel, a BCMA CAR T for the treatment of multiple myeloma.
We anticipate U. S. Approval for our BCMA CAR T later this year, which will represent a 3rd NME approval this year. Within our medical device portfolio, we continue to make meaningful advancements in our innovation pipeline, launching 17 major first country launches in the first half of twenty twenty one, including 8 products this quarter. As noted earlier, we received FDA approval and launched Technisynergy and Technisynergy Toric 2 intraocular lenses in the U.
S. These are next generation presbyopia correcting lenses and deliver the widest range of continuous vision and the best near vision among leading PC IOLs. Finally, within the surgery business, the Nseal X1 curve jaw tissue sealer launched in the U. S, Expanding the Ethicon Advanced Bipolar Energy Portfolio. That concludes the sales, P and L and pipeline highlights for Johnson and Johnson's 2nd quarter.
I'm now pleased to turn the call over to Joe Wolk. Thank you, Chris.
Good morning and thanks to all of you for joining us today to discuss our strong first half of twenty twenty one, specifically the high growth we experienced in the second quarter and our updated outlook for the balance of the year. I hope everyone is having a safe, healthy and enjoyable summer. As Chris referenced, Johnson and Johnson's businesses remain leaders or are better positioned within the markets in which they compete. While the pandemic makes it difficult to reliably gauge what results will be in any given quarter, you likely noticed That all three segments beat your expectations. We continue to be poised for further growth and value creation, not just in 2021, but more importantly for 2022 and beyond.
Over the past 18 months, Our people have been a driving force behind our success and guided by our credo, they have demonstrated resilience and agility, while remaining committed to ensuring our life saving medicines and products reach patients and consumers around the world. Thanks to the efforts of our 136,000 colleagues across the world, Johnson and Johnson continues to make significant strides towards our mission of improving human health And well-being of everyone everywhere. Foundational to any healthy business is a focus And commitment to broader stakeholders stewardship. We are proud to share the progress we are making in a transparent and accountable manner. A few weeks ago, we held our annual ESG Investor Update following the publication of our 2020 Health for Humanity report and our 2025 goals.
Through these goals, we aim to deliver even greater long term value to our broad set of stakeholders. I hope you had the opportunity to view this webcast. If you have not, the replay is still available on the Johnson and Johnson website. Let's get into the results with an update on our cash position. We continue to generate strong free cash flow With approximately $8,000,000,000 year to date, we ended the 2nd quarter with approximately $25,000,000,000 of cash and marketable securities And approximately $33,000,000,000 of debt, resulting in $8,000,000,000 of net debt.
Our financial position and balance sheet remains strong. As we enter the back half of the year, we are well positioned to continue to deploy capital in a strategic value creating way that will benefit stakeholders over the long term. Our dividend remains a key priority and during the quarter we distributed $2,800,000,000 to shareholders. Regarding M and A, we continually evaluate strategic opportunities that have the potential to further enhance our business, while also driving better health outcomes for patients and consumers. Since Chris covered highlights from our Q2 performance And our worldwide shares will provide sector specific commentary to open the Q and A session.
I will now move directly to providing the update to our full year 2021 guidance, which reflects our strong year to date performance. For clarity, I will first comment on our core business revenue and then remark on our anticipated COVID-nineteen vaccine revenue, which is now included in our enterprise guidance. For full year 2021, we continue to expect our base business defined as excluding our COVID-nineteen vaccine to remain strong. Based on this confidence, we are increasing and tightening our adjusted operational sales range to 9.5% to 10.5%. This adjusted operational sales growth is on a constant currency basis consistent with how we manage our business performance.
We are maintaining our estimate for the net impact of Acquisitions and divestitures of approximately 50 basis points, which accounts for previously completed divestitures in medical devices, Consumer Health as well as within other oncology and pharmaceuticals, resulting in an operational sales range Of 9.0 percent to 10.0 percent or $90,000,000,000 to $90,800,000,000 For a midpoint of 9.5 percent or $90,400,000,000 While we don't predict currency movements, Utilizing the euro spot rate relative to the U. S. Dollar as of last week at 1.18 and in consideration of other currency movements, There is no change from our previous estimates resulting in favorable currency impact of $1,300,000,000 or a year over year increase of 150 basis points. This results in estimated reported sales in the range of $91,300,000,000 to $92,100,000,000 an increase of 10.5% to 11.5% We're 11% at the midpoint versus 2020. Now a few words on the expected contribution of our COVID-nineteen vaccine to our updated full year 2021 guidance.
Our goal has always been to bring forth our scientific capabilities and resources to develop a safe and efficacious vaccine that would complement other measures to end the global pandemic. We are proud to have been part of the unprecedented collaboration in the healthcare industry that has led to a number of authorized vaccines in the marketplace. Chris shared earlier that we recorded vaccine revenue in the quarter. Specifically, our COVID-nineteen Seam contributed $164,000,000 in revenue in the Q2, bringing the year to date total to $264,000,000 At this point, Revenue from the first half of the year was provisionally recorded at $5 per dose, given that volumes during the pandemic period were uncertain. Currently, we expect the ultimate final not for profit price could be as much as $8 per dose.
The final not for profit price will until the end of the year when we know precisely all the variables that go into the calculation, namely the net cost incurred as well as volumes produced during the pandemic period. Given the firm contracts we have in place, Pending advance purchase agreements, we expect to recognize vaccine sales of approximately $2,500,000,000 in 2021 with more than half of that revenue likely to occur in the Q4. Regarding vaccine manufacturing, we continue to expand our global network to include 10 manufacturing sites for various stages of production. On July 2, the European Medicines Agency's Committee for Medicinal Products for Human Use approved an expansion of our facility in the Netherlands, increasing our capacity to produce active drug substance. The FDA also released 5 batches of drug substance manufactured at the Emergent Biosolutions Bayview facility Under the emergency use authorization and we continue to work with health authorities on the approval of additional drug substance manufactured at Emergent.
Now I do appreciate that many of you are understandably looking beyond 2021 to 2022. It is simply too early to provide specific information on a 2022 outlook for our COVID-nineteen vaccine, given the uncertainty on the need for boosters and new variants. But as recent published clinical data indicates, our vaccine appears to have durability for at least 8 months and is effective against the recent Delta variant and other highly prevalent viral variants. At this time, I'd caution you to wait to include future projections in your models for our business. The COVID-nineteen vaccine market will continue to evolve and we look forward to sharing additional details As more data become available, including the role our vaccine will play for you to forecast future years.
Given this and what I already provided on our base business, our new updated guidance expectations are reflected on this slide, reflecting an enterprise total revenue of $94,200,000,000 at the midpoint. Moving to other items of the P and L. We are now expecting our operating margins to be nearly a 200 basis point improvement over last year, Slightly less than our prior guidance as we continue to invest for the long term. We are increasing our other income estimate To a range of $800,000,000 to $900,000,000 This increase is primarily attributable to increased investment returns related to our employee benefit programs. As a reminder, pension service costs are recorded in operating expenses, while any investment performance related to our employee benefit programs are recorded in other income and expense.
Moving to interest expense. Based on our year to date experience, we are lowering our estimate to a range of $100,000,000 to 200,000,000 Finally, we are lowering our effective tax rate estimate to a range of 16.0% to 17.0% based on certain one time benefits realized in the first half of the year. The result of these updates translate to increasing our earnings guidance. We are also tightening the guidance range. The new adjusted operational per share guidance range is 18.4% to 19.6% were $9.50 to $9.60 with a midpoint of 19% or $9.55 per share.
While not predicting currency movements, but to provide some direction on the impact of currency fluctuations on our reported adjusted EPS, We expect a slight change from what we communicated on the Q1 earnings call. Currency will now impact EPS by 1.2% 0 dollars to $9.70 or a midpoint of $9.65 increasing 20.2%. Consistent with what we shared before given the not for profit nature of the vaccine, there is no significant EPS contribution in 2021 And therefore, the EPS guidance I provided is inclusive of the vaccine revenue. I am now pleased and want to thank our worldwide chairs, Jennifer Calvert, Thibault Mongan and Ashley McEvoy for their participation in the Q and A portion of our call today. I know this audience values having these leaders on earnings calls from time to time.
So before we jump into the Q and A portion of the call, I'd like to ask Jennifer, Thibault and Ashley, each to provide a brief business segment update and qualitative outlook for the remainder of 2021. Jennifer, let's start with the Pharmaceutical segment.
Well, thank you, Joe, and hello, everyone. It's a pleasure to be here with you today. I'd like to start by thanking my Janssen colleagues around the world for their relentless focus on delivering for patients. As a result, I'm Proud to share that our Pharmaceuticals sector had another strong quarter of above market growth. As you heard from Chris, our Pharmaceuticals business delivered 12 Our base business, excluding the COVID-nineteen vaccine, demonstrated robust growth at 12.6%.
This is our 3rd consecutive quarter with sales exceeding $12,000,000,000 and our growth was broadly based across geographic regions and our therapeutic areas. We continue to maximize the value of our industry leading portfolio, delivering double digit growth for 9 key brands, including our oncology medicines DARZALEX, IMBRUVICA and ERLEADA our immunology medicines, TREMFYA and STELARA Our pulmonary hypertension medicines, OPSUMIT and NEPTRAVI and INVEGA SUSTENNA and TRINZA in our neuroscience portfolio. Our leading commercial and market access capabilities enabled increased market penetration and share gains across our key promoted brands. And as we shared in our transparency report this year, our growth continues to come from volume gains and not price. This is a strong indication that our life changing medicines are reaching more patients each day worldwide.
It's important to note we continue to be a trough investor in research and development. This investment fuels our pipeline and builds the foundation for our long term growth. During the Q2, we continued to deliver on our pipeline of transformational medicines. I'll highlight just a few of the key milestones and achievements. First, in May, the FDA approved amavantumab, now known as Rybrivant.
This is the 1st bispecific antibody approved for the treatment of non small cell lung cancer characterized by EGFR exon 20 insertion mutations. This is our first approved treatment for lung cancer, which we hope will be an important area for us going forward. This is our 2nd NME approval of this year. PONVORI Orpanezimod was our 1st 2021 NME approval, and this was by the FDA in March for the treatment of adults with relapsing forms of multiple sclerosis. In the Q2, it was also approved by the European Commission and Health Canada.
We also advanced Our BCMA CAR T cell therapy program, Cilta cel, for patients with multiple myeloma. In the second quarter, the U. S. FDA granted our BCMA CAR T priority review. A marketing authorization was filed with the European Medicines Agency And submission was made to the Brazilian Health Regulatory Agency.
We anticipate FDA approval of cilta cel as our 3rd NME approval later this year. In addition, our subcutaneous form of DARZALEX continues to benefit an increasing number of patients. In the second quarter, The European Commission approved DARZALEX for 2 additional patient populations as combination therapy for the treatment of adults with newly diagnosed Systemic light chain amyloidosis, which is the 1st and only approved therapy for this rare and life threatening blood disorder And as combination therapy for adults with pretreated multiple myeloma. Additionally, subsequent to the quarter, the FDA approved DARZALEX FAST In combination with pomalidomide and dexamethasone for the treatment of patients with multiple myeloma after first or subsequent relapse, Our 6th indication specific to our subcutaneous form of DARZALEX. I'm proud of our pharmaceutical results in the second order and feel confident in our ability to make 2021 our 10th consecutive year of above market growth.
Our outlook for the rest of the year remains strong. Before I close, I'd like to invite you to join us for our Pharmaceuticals business review on November 18. We look forward to sharing a comprehensive overview of our business, Our robust pipeline and our long term growth outlook. We'll cover our key therapeutic areas, including oncology and immunology, which are always areas of high interest, And we'll delve deeper into some of our newer areas, including our retina and gene therapy pipeline and the details behind the breadth of our antibody program that came through our acquisition of Momenta last year. I hope you'll be able to join us.
So again, it's a pleasure to have this opportunity to connect with you today. Thibault, I'll now turn it over to
you. All right. Thank you, Jennifer, and good morning to all of you on the call. I would like to start by congratulating my consumer health colleagues for their continued focus on flawlessly executing against our strategy. Last year, this focus on execution across our broad based portfolio delivered solid results, Growing 3% operationally.
And this year, we continue to demonstrate a strong level of performance. The strategy we set a couple of years ago for the consumer health segment to be focused on personal health with science based professionally endorsed brands and advancing our digital capabilities continues to strengthen our ability to meet the needs of our consumers and customers worldwide, resulting in strong quarterly results and solid year to date performance. Our consumer health sector grew 9.2 percent operationally in the quarter and 2.7% on a year to date basis. Our adjusted operational growth for acquisitions and divestitures was 10% in the quarter and 3.3% on a year to date basis. And as Chris stated in his remarks, These year to date results are a better representation of our performance given the fluctuations we see in the market due to COVID-nineteen dynamics And seasonality overall.
We saw strong year to date performance for brands in our 2 strongholds such as Ziatek, Pepcid and Nicorette in OTC Avino, Neutrogena and OGX in Skin Health. In our specialty areas, brands like Listerine, Avino Baby and Band Aid also contributed nicely And from a geographic perspective, we are encouraged to see that we grew across all regions in the quarter. Now if we look into the future, even if we will continue to see variability in categories depending on seasonality and local market conditions, We are confident that our strategy is working. We have the right portfolio to continue to deliver solid results, Well balanced both in terms of categories we compete in and in terms of geographic presence. And lastly, we have been able to achieve our solid sales results while simultaneously improving our margin profile.
Our efforts on end to end profitability improvement, including Full year optimization and network improvements have delivered to plan. Our year to date adjusted IBT is approximately 27% Another 250 basis point improvement over last year. We have made great strides in increasing our profitability to become a leader within our peer set. And we will continue to look for opportunities to improve our margin profile, while at the same time investing to grow the top line, Launching new products, and Chris referenced some of them in his remarks, and managing through anticipated higher commodity and distribution costs in the back half of 2021. So in a nutshell, Consumer Health delivered a strong quarter and a solid first half.
Our strategy is working, And we are confident in our ability to continue to deliver profitable growth in line with the categories and market in which we compete. And now let me hand over to Ashley McEvoy. Ashley?
Thank you. Thank you, Tivo, and good morning. Thanks for joining. Let me just begin with across J and J, how privileged we feel to work in healthcare because we recognize that what we do matters, especially now. We're united by our purpose profoundly changed the trajectory of health for humanity, and we are propelled by our medtech aspiration to reimagine the future of health Today in 3 ways.
1 is innovating across the continuum of patient care. 2 is prioritizing and modernizing health. And 3 is promoting health equity and wellness. We continue to see strong evidence that our focus and actions to impact Humid Health and improve our competitiveness is working. This quarter, MedTech delivered sales of $7,000,000,000 representing adjusted operational growth of 50 9% versus 2020, and as Chris mentioned, up 7% versus 2019, bringing our first Half of 2021 revenue performance to just over 5% compared to 2019.
Our sales market recovery and our positive competitive momentum. 8 of our $11,000,000,000 medtech platforms grew Versus the Q2 2019 and quarter 1 2021 share trends show that we have maintained or gained share in 10 of these platforms. We have an exciting pipeline and we've achieved some truly amazing results in the first half of this year, which position us well to continue our growth momentum. We've launched 17 major products in the first half of twenty twenty one. This is the highest number of first half of the year launches in 5 years for our business.
These include products which will strengthen our core like TECNIS synergy, our most advanced premier intraocular lens in surgical vision And the Enseal X1 curved tissue sealer, a next generation advanced energy solution in our surgery franchise. We continue to focus on significant global health concerns, including Myopia Management, where we plan to have a portfolio of solutions for patients. And we are progressing all things digital with solutions covering the entire paradigm of care, including open and Laparoscopic procedures, orthopedics and Illuminal Interventional and Vision. Our Monarch platform achieved a significant milestone reaching over 100 customers and enabling over 8,000 bronchoscopies, which is life changing and potentially life saving in the detection and treatment of lung cancer. Velas, our robotic assisted solution for total knee procedures launched in the United States and received regulatory approval in Australia this month.
We are extremely pleased With the early customer engagement and feedback confirming the differentiation of this next generation solution. And OTAVA, our soft tissue digital surgery offering continues to progress its key development milestones. We also recognize that the digitization of healthcare is happening and rapidly accelerating technology like this, making it possible to deliver new ways of care. An example of this is from our innovative team in China, who developed a virtual solution powered by artificial intelligence and machine learning to more effectively train and Expand the number of highly skilled electrophysiologists and provide broader access to high quality care. Learning curves went from novice to experts From a year to 4 months.
In the 1st 4 months of launch, 150 newly trained physicians delivered care to 7,500 patients. It's no surprise our electrophysiology business in China is so strong. And we continue to leverage science to influence industry trends And positively impact patient outcomes and human health. Just this month, the UK modified their NICE guidelines to recommend the use of Plus Sutures as a standard of care, Giving the evidence supporting their role in reducing surgical site infections and our necessary cost to the healthcare system. Okay.
Regarding the pandemic, we are seeing light at the end of the COVID-nineteen tunnel, but this remains, as we all know, a very fluid situation. The pace of continued recovery will depend on multiple factors, including the speed at which global populations are vaccinated, Healthcare capacity and the ability to manage through surges as well as the rate at which patients seek treatment. In closing, I'd like to emphasize that our strong quarter 2 results and continuing momentum can be attributed to our purpose driven Globally diverse team, which embody a winning spirit every day. Their resilience, agility and creativity have taken us to the next level in our business, Build stronger relationships with our customers and patients and defined a clear vision of our future. Thank you, and I look forward to your questions.
Great. Thank you, Jennifer. Thanks, Thibault, and thanks, Ashley. Let's now move to the Q and A portion of the webcast. Rob, can you please provide instructions for those online wishing to Good question.
Yes. Thank
Your First question comes from Louise Chen with Cantor Fitzgerald.
My question is about the global surge in COVID. There has been a surge despite high rates of vaccinations in many places in
the world. So just curious
how you think this could impact your business in the second half twenty twenty one if it continues to get worse? Thank you.
Yes. Thanks for the question, Louise. I think it's probably best maybe that you hear from both Ashley and Jennifer on this specific perspective. So, Ashley?
Yes. Louise, I would say,
listen, we're encouraged by, quite frankly, several things. The ability that hospitals can manage through capacity and surges and labor, As well as obviously the vaccination efforts around the world. And just a patient, there's a significant backlog of care. If I look at the UK, My goodness, there's like 5,000,000 patients waiting for medical interventions, 400,000 of those folks waiting for surgery for the past 12 months. But as we know, it's not going to be linear.
We do know hospital systems in the United States are starting to delay care right now. So I think Quarter to quarter, it will improve, but it will never be a linear line.
Yes. I can add in. On the pharma side, most of our Core categories are pretty much back to the pre COVID level, the exception on that actually being CLL. But we're really seeing strength coming back, for example, in the United States and in Europe. And we do anticipate some Modest ups and downs, but I think our team really did an extraordinary job last year of partnering with health care systems and physicians and patients To make sure that they could get on and stay on the therapies that they need.
So our outlook for the rest of the year really remains strong for our sector regardless Of what happens with emerging variants and any continued blips as it relates to COVID.
Yes. I'd also add, Louise, that I think we've got to really tip our cap to the Healthcare administrators, health professionals across the globe, we're in a much better position to handle a pandemic than we were of March of last year. And so certainly that would have, I would say, a favorable impact on whatever unfavorable events may occur. So We really need to recognize just the great resiliency and agility that those individuals have shown as well.
Thibaut, do you want to share a little bit about consumer and the momentum you see there and maybe a couple of the category dynamics as well? No.
We see strong momentum across Our broad based portfolio, as I told you earlier this morning, our categories will continue to be impacted by Market level conditions, seasonality. Having said that, we have proven over the past 18 months that our broad based portfolio In terms of both categories and geographies, allows us to weather whatever external conditions happen, and we expect Continued momentum into back half of the year.
Great. Terrific. Thanks, Louise. Appreciate the question. Rob, next question, please.
Your next question comes from the line of Larry Biegelsen with Wells Fargo. Please proceed with your question.
Good morning. Thanks for taking the question.
Ashley, just a finer point
on the quarter over quarter improvement in devices you mentioned. Do you expect continued acceleration relative to 2019 in Q3 and Q4. And Joe, could you just help us think about the operational ex COVID vaccine sales and EPS cadence in the second half given the easier comp in Q3 and the extra week in Q4 2020. Thanks for taking the questions.
Sure. Thanks for the question, Larry. I think what you heard is in quarter 2, we were up about 7% relative to 2019. And that was pretty broad based. And I say all 3 out of 4 of our franchises posted growth versus 2019.
Orthopaedics was down about a Point, we were up in the United States about a point, down about 3 points in orthopedics in OUS In quarter 2, really due to some of the slower moving countries like Japan and India and of kind of opening up in COVID. When I think about quarter 3 and quarter 4, I do expect continued momentum. You'll recall last year, we were down about 3% In quarter 3 versus 2019, and we were down about 1.5% in quarter 4 2020 versus 2019. So I do expect Continued progress. I expect orthopedics to go positive.
I expect vision to accelerate given a lot of the new product launches. As we've discussed, we think the category is going to be high double digit and we expect to be more in the high single digit at the end of this year versus 2019. Yes.
And Larry, with respect to your question on guidance overall, I think I almost have to mirror a little bit what Ashley had said. The comparables We're going to be most pronounced for the Q2. There'll be a little bit of benefit as we look into the 3rd Q4. As you know, we don't provide guidance by quarter. But I'm really looking at the underlying strength of each of our businesses, improved share in the markets in which we lead and for those that which we don't lead.
In addition to the what you heard from all 3 of our segment leaders, just an improved cadence of innovation, new approvals, New offerings that offer better health care solutions. So that's how we're thinking about it. From an EPS We are challenging our teams to continue to invest. We think when we have 10% top line growth and EPS growth that will approach 20%. We think that's very healthy to take it up today on top of what we delivered in January, which surprised the upside as well.
We want to make sure that we don't only deliver strong results in the current quarter or the next two quarters, but really in the middle and back half of this decade as well. We think we're very well positioned to do that.
Great. Thanks, Larry. Appreciate the question. Rob, next question, please.
Your next question comes from the line of Chris Schott with JPMorgan. Please proceed with
your question. Great. Thanks so much for the questions. I guess my question is just on the core revenue growth guidance. I think you've raised it twice this year.
And I was just looking for a little bit more color of what's driving the upside versus your expectations. So is this more device Versus pharma or consumer, is it share gain versus overall market growth? Are there geographies that are standing out? I'm just trying to get a sense of like really is it Would have been the real upsides versus your initial expectations. Now if I can just slip a second quick one in.
I think you mentioned the pharma margins We're impacted by increased investments in 2Q. I guess, should we be thinking about that as a onetime event with the COVID vaccine expenses, etcetera? Or are we entering kind of a sustained period of R and D ramp here where we could see some of those margins under pressure? Thank you.
Yes. So, Chris, let me take a stab at that and maybe Jennifer, you can chime in with anything that I might have missed. But with respect to the revenue guidance, Chris, I would Say, coming into the year, just like every other company and probably every other industry, we remained a little bit cautious with respect to how the recovery Would unfold, would there be new variants. And so we took what I thought was a very responsible and prudent approach to our expectations at the beginning of the year. That being said, I don't want to undermine just the operational performance that each of the teams are executing upon As we go throughout this year, what we did learn and it really is a credit to the leaders that you've heard from today and their teams just how important it is Reaching out to customers during the last 18 months, not only to find out what the status of COVID-nineteen was and how it was impacting the businesses, But also how Johnson and Johnson could help them in the recovery.
And I think that is having some, I'll call it, a goodwill factor with respect To how we're approaching our business today. With respect to operating margins in R and D, I would say that the COVID investment for the vaccine specifically is a small part of it. What we're seeing and really what we all take Great pride in is there's not one big outlying expense item or investment item in the quarter or even year to date with respect to milestones. It's really just the maturity of the portfolio. Again, a It's really just the maturity of the portfolio, again, across all three segments that really positions us well.
So last Sure. You might recall, we increased our R and D investment by $800,000,000 above 2019 levels. Even with all the questions uncertainty and even though maybe competitors pulled back a little bit, we know the only right answer was to invest for the long term. We're actually at a pace this year through 6 months, about $1,300,000,000 above last year's level on a 6 month comparator. So, we feel very well positioned.
And again, with How I answered Larry earlier on the EPS accretion. We kind of think we're hitting the mark across all aspects. I don't know, Jennifer, if there's anything else you want to add? So what
I'd add in, we really focus on being a transformational medical innovator, and we know that we do disproportionately invest in R and D Versus the other areas of our business. If you take a look at the strength of our pipeline as well as the continued progression, we are seeing more assets Transitioning into those later stages of development that require additional costs. And as Joe had indicated earlier, the beauty right now of the Strength that we have for the business is it's allowing us to invest for those future waves of innovation. So we feel real good about the level of investment for R and D in
the Pharm Group.
And just so nobody has a takeaway, we're only investing in pharmaceuticals. We're investing in digital surgery capabilities that Ashley mentioned, we're investing in the consumer space, connecting with the consumer in more digital enabled ways. So it's really across the board.
Yes, Chris, and I would just add, I guess, on the Medical Device side, Ashley alluded to the amount of innovation we've seen in the quarter. So think some of the strength you're seeing on the top line is clearly the result of the focus on bringing strong innovation to market. We're well poised over a 2 year Carry to deliver nearly 40, what we would call, major new product launches, which is significant increase from where we've been. I think you're seeing that coupled With the recovery in the MD results and then clearly in pharm, double digit growth year to date, strong above market performance. So, I think Those investments are paying off and focus on innovation will be a core focus of ours.
Thanks for the question, Chris. Rob, next question, please.
Your next question comes from the line of Bob Hopkins with Bank of America. Please proceed with your question.
Okay. Thank you very much. Just a quick one for me. For MedTech, thank you for giving that 7% number versus 2019. I was just curious, is that a reported number or is that a Number that adjusts for currency.
And then one other thing I'd love a quick comment on is on the COVID type questions. Just curious, especially on the device side, Ashley, is there kind of a major geography right now where increasing levels of hospitalization Have you particularly concerned or are we not quite at that stage yet?
I guess, first real quick, Bob, the 7% is an adjusted ops growth number Just for consistency, as you understand underlying organic.
Yes. And Bob, just again, thanks for the question. Again, We've had the benefit to learn from like how this virus manifests around the world, starting with China. Asia is A region that is above 2019 in terms of procedure volume, clearly really driven by China. We've seen that Japan is in lockdown.
We know that Australia went back to lockdowns recently. We know India is digging out. So some of those other countries are going to be slower to recover. EMEA, we've been which has been at a slower pace than the United States. We actually see A lot of acceleration happening right now in EMEA with the vast distribution and uptake of vaccinations and quite frankly, The backlog of patients that really need to be cared for.
As I mentioned, I share a little bit of the waiting list data in the UK. And the U. S. In quarter 2 has had significant recovery versus the Q1. I look at data like in January, we were down, Medical procedures were down about 6% in January versus 2019.
And in May, that went positive to up about 3%. But as I mentioned, it's going to be not a vertical line, given the recent surges that are happening in systems in the U. S, like Florida, like Michigan and the Midwest. So again, I think our systems are unbelievably equipped to manage through this, have huge respect and admiration For a lot of our customers who are managing COVID as well as non COVID patients.
Thanks, Bob. Appreciate the question. Rob, next question, please.
The next question is from the line of Josh Jennings with Cowen. Please proceed with your question.
Hi, good morning. Thanks for taking the questions. Joe, I was hoping to just as we're thinking about 2022 and you are encouraging the Street to exclude COVID vaccine revenues From our forecast, I was hoping to just help better understand the COVID-nineteen vaccine margin impact in 2021 It seems to be margin dilutive with how we should be thinking about the core businesses margin and then that for a baseline for our 2022 forecast.
Yes. Josh, I would say at this point, it's really a minimal in terms of both the segment as well as certainly Johnson and Johnson's margin profile. Thus far through 6 months, it's been dilutive again to a minimal amount. We expect that dilution to kind of reverse itself In the second half of this year, but again being a not for profit, there's no material impact on EPS despite the $2,500,000,000 revenue estimate that we've provided earlier today.
Thanks, Josh. Appreciate the question. Rob, next question please.
Next question is from the line of Terence Flynn with Goldman Sachs. Please proceed with your question.
Great. Thanks so much for taking the questions. I guess the first one is just on the duration Protection with the vaccines. I mean, Joe, you touched on this a little bit, but maybe just what's your perspective on how often a booster might be required here? And then can you remind us of timing of your 2 dose Phase 3 trial?
And then Jennifer, would love any more details you could provide on the DARZALEX sub Q conversion and the IMBRUVICA competitor dynamics that you mentioned. Thank you.
Yes. So Terence, thanks for the questions. I would say in terms of the Booster, whether it's needed or not, I think we should really defer to health officials around the world as to what that call will be. We do like the durability of at least 8 months for our vaccine. We think that's better than some of the Other vaccines that are out there, not to disparage them in any manner whatsoever, but health officials still have not made any type of Decisions on when or if a booster will be needed.
So we'll just defer to them when more data is collected.
Perfect. So then as it relates to DARZALEX, starting off with DARZALEX, you saw the very strong results that we had in the quarter, Also, the significance of the additional indications that continue to come through and our 6th indication specifically for the DARZALEX FAST PRO Application. As we take a look, so far across the business, already 60% of our DARZALEX business is in the subcutaneous form. And that's whether we look at the United States or whether we look outside the U. S.
And so very, very rapid adoption As well as expanded into additional patient populations for DARZALEX. So we're very, very confident in the uptake, and this is really Providing significant benefits from patients going from multiple hour infusions down to a 3 to 5 minute injection. So a lot of good things to come on Darzalex, as it relates to IMBRUVICA, we're seeing very strong growth for IMBRUVICA outside the United States. Right now, 22% growth in the quarter. As we take a look at IMBRUVICA overall, we had double digit growth, But obviously, less than that in the U.
S. In the U. S, we're still a bit impacted. The patient volumes and new patient starts Are still down a little bit in CLL due to COVID. For these patient populations, there can be more of a watchful waiting period or sometimes treatment with older therapies.
And so we did see a slower growth rate, particularly in the U. S. In the quarter. But we do anticipate that to rebound as we move forward and more people get vaccinated. As it relates to the competitive dynamics, IMBRUVICA remains the number one prescribed treatment in CLL And relapsed refractory MCL and also Waldenstrom.
So it's the number one BTKI wherever they're prescribed. It's also the only agent that's got demonstrated overall survival in first line CLL and a safety profile that's supported by over 5 years of follow-up and clinical experience. So we believe we've got a great profile that stands up competitively with IMBRUVICA And we'll continue to be able to deliver great growth
for us going forward. And Terence, with respect to your question on the 2 dose Next question is from the line
of Matt Miksic with Credit Suisse.
Next question is from the line of Matt Miksic with Credit Suisse. Please proceed with your question.
Hey, thanks so much for taking our question. Just one Just a quick follow-up. I know that there were some questions early on sort of the tone of the market and COVID and trends for the back half of the year. But just to Verify specifically for Ashley, the Q3, for those businesses that are In the past, the Medevise businesses that have been sort of seasonally off, down slightly flattish from Q2 to Q3, Is that the pattern when you talk about improving momentum, I mean, is that the pattern we should see sort of a normal seasonal pattern? Or Is the momentum you're describing something that would actually take this some of those businesses up sequentially?
And I have one follow-up, if I could.
Yes, Matt, I think thank you for the question. I would tell you that what we've experienced is maybe some bookends like Our electrical physiology business, our AFib, the treating cardiac ablation has kind of recovered very expeditiously and That team right now is just really working on refilling the patient funnel. At the other book end, I would say would be cataract surgeries, which are procedure volumes are still below 2019, so we would expect that one to significantly accelerate On a balance to go. So it really depends by procedure. They really are meeting the bell curve, if you will.
And again, as I kind of come back to what's going to affect the pace, it's really the pace of vaccinations, pace of Hospitals being able to match the capacity and keep a highly engaged healthy workforce and manage through some of the surges that we're seeing right now in the U. S. And And then just really patient sentiment. There's been a lot of investment that J and J has been doing to reassure patients to go seek medical care. And I think we've seen a lot of the facts and data and publications on the impact on non COVID patients who haven't seek care.
So we expect To continue, we don't expect, again, a perfect linear line. I keep saying that because we learn every week. We take 4 steps forward and maybe a step back. Thank you.
And then just one on Vision, if I could. You mentioned the approval of Synergy in the U. S. I know it's been out. This is the Crysvopia correcting IOL has been out for a while in Europe.
Just wondering if you can tell us what that has done for the European business, what the response has been And how you're thinking about that mapping over to the U. S? Thanks.
Sure. We've seen really strong performance Of the TECNIS synergy in EMEA, we are growing market share in EMEA and vision surgery. And that market had a lot of available Premium intraocular lenses, we're pleased to bring that technology to the United States. We just launched in quarter 2. There's been very good pickup.
It's also complemented, As Chris was mentioning, with kind of our first innovation in the phacoemulsifier, the VERITAS, so the combination of those two With really our first advancement in monofocals in the Technez IHANCE, which just launched earlier in quarter 1, The combination of those three innovations, I expect should improve our current run rate of revenue performance in the U. S. Surgical Vision. And as you heard in quarter 2, we did grow revenue versus 2019 in OUS. And so I expect that, that should have the U.
S. Start to pick up more in the back half
of the year.
Thanks, Hansley. Appreciate it. Matt, thanks for the question. Rob, next question, please.
The next question comes from the line of Joanne Wuensch with Citi. Please proceed with your question.
Good morning and thank you for taking the question. 2 of them. 1, could you sort of give us a
little bit of update
and color on the orthotaxy Adoption, you did provide some statistics on Monarch, but anything else that you can sort of add in that bucket? And then my second question is, I might be reading the tea leaves a little bit here, but you sounded maybe just a little bit stronger on the idea or concept of M and A. Am I interpreting that correctly? Yes. Thanks, Joanne.
I'll start and then I'll turn to my colleagues to talk a bit about M and A and some of the other businesses as well. I would say we're very encouraged. We've had about 750 on hand demonstrations with our Velas knee digital surgery offering. We've done about 100 cases to date. What we keep hearing from customers who have been giving us really positive feedback on A couple of things, the value of the system's smaller footprint, the images interoperative capabilities and really the ease of integration For surgeons and OR teams, the workflows, reducing the heavy physical and financial burdens of the currently available marketplace offering.
It's new. We just got approval also in Australia. So we're going to start to do cases in Australia. And I would say very encouraging. We have Several different commercial models that we're assessing and we're seeing hospitals take really multiple archetypes, so stay tuned on that.
And then I think you had a second question, Joanne, on M and A. And I would just say, for a medtech Point of view, you've seen we've invested over $10,000,000,000 of capital in M and A really behind getting into I Health, getting more significant into digital surgery And then really starting to invest in, I'll call it, standard of care changing technologies like NuWave and ablation. For liver ablation was the first indication. Right now, we are under clinical trial to partner that technology with our Endoluminal Monarch Technology for Lung Cancer, the Treatment of Tumors, Bleeding Tumor Cells. We're also in first in human in oncolytic viruses and drug delivery using Monarch, as well as starting to get a stronger foothold in the fast Growing area of stroke, our stroke business was up over 30% in Q2 relative to 2019.
So again, a procedure that Was less affected in the COVID environment that we continue to bolt down to. But I'll turn to my colleagues to talk a little bit about M and
Yes. One of the things that helps us be really successful here is that we're truly agnostic to the source of innovation. So The win is having something that's really transformational and being able to get it to patients. It's not where it originated from. And so as a result, About 50% of our products come internally, 50% externally.
So for example, late last This year, we brought in bermekimab. We made the acquisition of Momenta. We brought in Teris as a drug delivery device For bladder, gene therapy for geographic atrophy and age related macular degeneration from HUMIRA. And so we really do work Very, very assertively to find the best technologies in our key areas of focus. And many times, that's coming from our internal labs.
Many times, it's also coming externally. So our strategy and interest there remains the same in making sure that we've got The best innovation for patients going forward. I feel like we're doing a really good job on that front.
And in Consumer Health, I would say that we have a very strong portfolio of iconic brands that we continue to develop very quickly. Mostly, we continuously scan the market For opportunities to find either new go to market models or close gaps in our portfolio. But If you look at the acquisitions we have made over the past couple of years, we are really pleased with their performance. All of them, whether it's in self care Of Skin Health are performing well, and that's very encouraging for the future.
And Joanne, I'll just say you're going to force me to review the transcripts in maybe more detail than I usually do. I didn't think our language Change much. We always remain pretty aggressive when it comes to rigorous portfolio management, making sure that we're making the most of this, the scientific expertise, the The commercial capabilities that we have and we just got to find deals that really fit the financial construct in a disciplined way. So whether it's in medtech, Pharmaceuticals are consumer. We look across the board really monthly, if not more often, at opportunities that may fit nicely within the Johnson and Johnson business.
Thanks, Joanne. Appreciate the question. Operator, last question, please.
Yes. That question will be coming from the line of Jayson Bedford with Raymond James.
Good morning and thanks for squeezing me in. 2 unrelated questions that require, I think, Quick answers. I'll ask both upfront. I guess, first, on the potential knock on impact of the vaccine, I appreciate the not for profit nature Of the product. But do you expect to see a halo effect, meaning do you think the vaccine will help pull through or benefit other areas
of the
portfolio? And Then my second question maybe for Thibault. At 28%, how much further can consumer margins So and then any further commentary on the inflationary pressures that you alluded to in the commentary? Thanks.
So I'll jump in on the vaccine question first. So really, we're really proud of what we've been able to do in bringing forward And we see this as really the start of what will become a vibrant vaccine business for Johnson and Johnson. So You were talking about the halo effect or a knock on effect. We believe the good that we're doing in the world and that we will continue to be doing on the COVID Seeing, it's a great start. And in our pipeline right now, we've got a number of vaccines in development that we hope to have positive results coming from, Including an RSV vaccine, an HIV vaccine, one for prevention of sepsis and others that we're looking at.
So we hope this to be a start of what will become a very vibrant vaccine business for us over time.
Yes. And to your question on consumer, as I Ted, we have seen the first half and we continue to expect in the it's a back half of the year pressure in parts of our For you in terms of commodity inflation and distribution cost, we are prepared to absorb those. And in terms of margin improvement, we are committed to continuously improve our margin profile. But as I said, it's going to be a mix of continued search for efficiencies, but also investments In our business, whether it's brand building activities or new innovation program. Great.
Thanks, Jason.
Appreciate the question, and thanks to everyone for your questions and your continued interest. Apologies to those we couldn't get to because of But don't hesitate to reach out to the Investor Relations team as needed. I'll now turn the call back to Joe for some brief closing remarks.
Great. Thank you, Chris, and thank you really everyone for joining today's call to discuss our 2nd quarter results and updated outlook. We are incredibly proud of the relentless focus each of our J and J Ali's apply to really meet patient and consumer needs around the globe, resulting in a strong financial performance this quarter across the enterprise, While simultaneously investing for a very strong future, I'm very confident in our outlook for the rest of 2021. Our business is performing even beyond the mathematical year on year comps. And hopefully, that's your takeaway today.
So thank you for your time and bye for
now. Thank you. This concludes today's Johnson and Johnson Second Quarter 2021 Earnings Conference Call. You may now disconnect.