
Manager’s Report
Annual Report and Financial Statements 2024 • Polar Capital Global Healthcare Trust plc 17
US politics: What does a Republican trifecta mean
for healthcare?
In early November it was confirmed that Donald Trump will be
the next US President. With the Republicans retaining control
of the House of Representatives and also flipping the Senate
from being Democratic, the trifecta is complete. Heading into
the election, there was a school of thought that healthcare
was not a key priority for the Republicans, with the focus
more likely to be on the economy, taxes, immigration and the
climate. This may yet turn out to be the case, but when Trump
announced that Robert F Kennedy, Jr (“RFK Jr”) is his nominee
to run the Department of Health and Human Services (HHS),
he introduced a greater level of uncertainty for healthcare
investors given some of RFK Jr’s public comments on vaccines,
especially COVID-19 vaccines, fluoride in water and the
association between HIV and AIDS. Ahead of RFK Jr’s potential
confirmation, far from guaranteed given the controversy
surrounding the nomination, it is maybe worth discussing the
key topics of access to care and drug pricing.
On the subject of access to care and insurance, Trump’s
views on the Affordable Care Act (ACA) have been
somewhat ambiguous, with comments ranging from the
ACA being a “disaster” that needs repealing and replacing
only to then backtrack by saying that he is “not running to
terminate” the ACA but wanted to make it “better” and
“less expensive”. Regardless, there is a potential risk that the
new administration allows the Federal subsidies that provide
financial assistance to millions of Americans to sunset at the
end of 2025, a scenario that would create a headwind for
the healthcare insurance companies exposed to Medicaid and
the exchanges. A second derivative of that scenario would be
less patient volumes running through the healthcare system,
potentially putting modest pressure on healthcare facilities
and providers. On the subject of drug pricing, things become
even more opaque given the Republicans’ lack of public
commentary. Maybe they will look to stall the 2022 Inflation
reduction Act (IRA), which introduced measures aimed at
reducing the cost of prescription drugs for US seniors, or
perhaps the Trump Administration will look to negotiate even
bigger price discounts? Regardless of the eventual outcome,
a Republican trifecta and Trump’s surprising nominee to
run the HHS, has introduced a greater level of near-term
uncertainty, near-term uncertainty that could yield interesting
medium-term investment opportunities.
Positioning and process
The Company began the financial year with significant
exposure to healthcare facilities, biotechnology and healthcare
supplies alongside a modest positive tilt towards managed
care. The biggest underweight was in the pharmaceuticals
sector, with smaller underweights in healthcare distributors,
healthcare services and life sciences tools and services.
As the year progressed, the sustainability of high levels of
utilisation that characterised much of 2023 and the start
of 2024 became a concern, plus valuations appeared to be
rather stretched, especially for facilities stocks. As such, the
overweight positions in healthcare facilities and medical devices
(i.e. healthcare supplies and equipment) were reduced, having
had an elevated exposure for the first half of the financial
year. Nonetheless, we maintained a positive stance on these
sectors, especially supplies, focussing on companies with
reasonable valuations that are either in the middle of a new
product cycle or whose sales growth and earning power are
under-appreciated by the market. We would also note that
medical technology companies are perhaps the ones further
ahead in their adoption of AI, although we would also caveat
that there remain reimbursement barriers that could slow the
monetisation of new AI applications.
Throughout the financial year, the Company was consistently
underweight versus the benchmark in pharmaceuticals and
overweight in biotechnology. Variations in the magnitude of
the difference versus the benchmark were mostly driven by
stock specifics, with innovation and new product cycles central
to the decision-making process. As a collective, pharmaceutical
companies tend to have mature revenue and earnings growth
profiles but there have been significant breakthroughs in areas
such as obesity, Alzheimer’s disease and respiratory disorders
like COPD (smoker’s cough) and RSV (respiratory syncytial virus)
that are changing the investment landscape for some. Not only
do these breakthroughs meet high unmet medical needs, but
they offer significant commercial opportunities that could drive
very attractive revenue and earnings growth.
As a reminder, the Company has exposure to this theme
through holdings in companies like Eli Lilly, Sanofi, SOBI and
Zealand Pharma (a biotechnology company).
Also, the Company adopted a less negative stance on life
sciences tools and services, an industry that has faced several
challenges in recent years, from customers reducing inventories
for bioprocessing consumables and primary packaging
components, depressed emerging biotechnology funding,
muted replacement cycles for equipment, a more cautious
approach to R&D (research and development) from larger
biopharmaceutical companies and a slump in Chinese demand.
Looking ahead, the industry’s end-market fundamentals
remain intact and exposure to the subsector has increased on
a view that the tide will eventually turn. Thanks to the stimulus
measures announced by the Chinese government, there could
be a rebound in demand for life science equipment in China.
Moreover, there are signs that early-stage biotechnology
funding is improving which should benefit outsourcing
companies such as Contract Research Organisations and
Contract Development and Manufacturing Organisations.
Finally, commentaries from various sources suggest customer
inventory destocking is ending and that a new replacement
cycle for basic life science instrumentations is emerging.