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VPAS: Achievement so far on objectives for patients

The UK has a voluntary agreement that was struck by the government and NHS England (now referred to
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The UK has a voluntary agreement that was struck by the government and NHS England (now referred to as NHSE&I) with the Association of the British Pharmaceutical Industry (ABPI) in 2018, which governs pricing for branded medicines and offers commitments on access. The full deal is set out in the 2019 Voluntary Scheme for Branded Medicines Pricing and Access (VPAS). The deal is just the latest in the long history of voluntary agreements reached in the UK. With the current deal two years into the five-year agreement, Leela Barham takes stock on each objective, starting with the first objective that relates to patients (spoiler alert: not much).

The VPAS dedicates Chapter 3 of the agreement to the mechanisms to deliver on the objectives for patients. These objectives are to:

  • simplify, streamline and improve access, pricing and uptake arrangements for cost effective medicines; and
  • deliver faster adoption of the most clinically and cost effective medicines with the aim of improving patient outcomes.

The ways that the VPAS sees these being delivered are via a number of different areas of activity.

Enhanced horizon scanning

The NHS already has mechanisms to find out what’s coming down the pipeline. So the VPAS sought to ‘enhance’ these activities.

The VPAS talks about a shared ambition for complete and accurate information about the products coming soon. This specifically includes the clinical, financial and service planning information. UK PharmaScan is the tool used.

The VPAS committed NHSE&I, ABPI, and the National Institute for Health and Care Excellence (NICE) and others to work together to establish an approach for regular review of horizon scanning.

Whilst the Scheme set out to agree ‘success factors’, subsequently renamed metrics, there isn’t yet a published metric that covers enhanced horizon scanning. A potential metric has been discussed by the DHSC and the ABPI – a draft metric related to proportion of new TAs with PharmaScan presence two years in advance – but that hasn’t made it to the first metrics tracker report set out July 2020.

What you can tell from public sources is that UK PharmaScan website has been overhauled to help improve usability and navigation and has also added a section to its website about VPAS. A joint horizon scanning platform, with the Accelerated Access Collaborative, was reported to be in train in June 2019 meeting minutes from the Collaborative. Operational review meeting minutes also suggest that the working group on this had to stop work due to COVID-19 and needs to restart. So not much progress on the substance of improving horizon scanning, at least on the basis of public information.

Improving engagement and evolving commercial flexibilities

The VPAS recognises that there already was engagement between the NHS and industry and other bodies, so improving these was the aim. Name-checked are ambitions to improve multi-agency learning, early company engagement with the NHS and more proactive case management.

What this translates to at an industry level is using the pre-existing forums such as the Life Sciences Council (LSC), the NICE Implementation Collaboration (NIC) and the Accelerated Access Collaborative (AAC).

“Partly as a reflection of the COVID-19 pandemic, the Commercial Framework remains draft. That rationale is wearing thin though… It should really be a formality for NHSE&I to publish a final version and would at least signal a commitment to delivering on one of the most objective deliverables committed to in the VPAS”

It’s tricky to find out about the work of the LSC. At the time of writing the LSC webpage held nothing further than the name. Operational review meeting minutes instead focus on PAMP (the Patient Access to Medicines Partnership), which the BIA describe as an expert sub-group of the LSC. PAMP met in July 2019 according to the BIA. There doesn’t appear to be any public website from the government that explains PAMP or provides any records of who they are, or what they’re working on. The government has been asked in Parliament for more on PAMP. A 11 March 2020 response suggests that there will be a summary of the PAMP discussions ‘in due course.’

Tricky too to find out about the current work of the NIC. What is available is from when the work initially started, back in 2013.

It’s much easier to find out about the work of the AAC. Much of their work is supported by a new team working within NHSE&I. The original Collaborative was set up in 2018 and with a refresh of its work completed in 2019, it’s now described by government as the umbrella organisation for UK health innovation.

The AAC website outlines how, from April 2019 to December 2019, the Collaborative has provided access for over 400,000 patients to 26 late stage innovations. These 26 innovations are varied but do include some medicines; PCSK9 inhibitors and cladribine as two examples. The Collaborative is also able to demonstrate uptake trends in some areas too with a dashboard; a snapshot is available from the Collaboratives website but it seems that the full web platform isn’t publicly available (or at least, not easily found).

The AAC board includes industry, with Haseeb Ahmad, current president of the ABPI. The board has met three times since the start of VPAS. So it is clear that there is regular engagement between industry and others on the board of AAC, delivering on part of the VPAS commitment.

Reading between the lines, maybe there’s now less need for the other forums? So maybe progress is best seen in light of the quality of engagement that is happening via the AAC rather than bemoaning the absence of engagement by the LSC and the NIC.

For companies, improving engagement translates to a single point of contact with both NHSE&I and NICE and for an unspecified number of companies picked for relationship management. The aim is for more consistency and clarity of advice given to companies. Both agencies were to together develop and deliver a joined-up approach for earlier engagement and case management.

When it comes to engagement at the company level it’s not clear what’s happening from public sources; NHSE&I have stated, as reported in operational review meeting notes, that there is a commercial medicines triage function established. NHSE&I also view engagement as positive. NICE is also reported to have set up a Commercial and Managed Access function. It is clear though that deals are being done. Since VPAS began NHSE has been publicising ‘smart deals.’

The smart deals include an agreement providing access to MS treatments Orkambi, Symkevi and Kalydeco, an agreement on another MS treatment, ocrelizumab, a programme to eliminate Hepatitis C, deals on low-cost versions of adalimumab, CAR-T therapies, pembrolizumab for lung cancer and the first treatment for spinal muscular atrophy, nusinersen.

Whilst it is unclear if the aims to improve engagement are being delivered upon from the perspective of companies, it is clear that there is much engagement that is resulting in agreements that deliver access and are acceptable to both the company and NHSE&I. To know if engagement has improved an option is to ask companies involved in deals, pre and post the VPAS. Perhaps something like this is in the minds of the stakeholders who signed up to the agreement?

NHSE&I Commercial Framework still draft

Another commitment in the deal was for NHSE&I to produce a new Commercial Framework. But this would only be for the best value propositions to support patient access to cost-effective medicines.

A consultation on a draft of the framework was undertaken from 1 November 2019 and closed on the 10 January 2020. No doubt partly a reflection of the COVID-19 pandemic, the framework remains draft. That rationale is wearing thin though; especially if you take the view that little was likely to change in response to consultation on what amounted to a re-statement of principles agreed in VPAS and the desirability of leaving some flexibility. Flexibility can be useful to both companies and NHSE&I. Uncertainty and its management features too in the framework. It should really be a formality for NHSE&I to publish a final version and would at least signal a commitment to delivering on one of the most objective deliverables committed to in the VPAS.

More NICE appraisals and managing uncertainty

The VPAS made a commitment to more and speedier NICE appraisals. Under the VPAS, NICE has to appraise all New Active Substances (NAS) and significant extensions to marketing authorisations. In recognition that this might take some time to deliver, a commitment was made for meeting this aim by April 2020.

It is unambiguous that NICE has been doing many more appraisals over time; in 2014/15 NICE published 30 appraisals and by 2019/20 they published 53 albeit lower than the peak year of 2017/18 when 77 were published, according to NICE’s statistics. But we need to dig a little deeper to find out if NICE is publishing appraisals for all NAS. We can infer that perhaps NICE isn’t yet achieving this at least up to March 2020.

Using data from the metrics that DHSC have published allows a comparison between price applications for NAS (so in essence, the number of these being launched in the UK) with the number of appraisals (Figure 1). It should be taken with a pinch of salt though; it’s not clear if this matches in terms of time periods as NICE appraisals may be published with a lag compared to when the NAS was launched.

Figure 1: Price applications for New Active Substances and STAs published for New Active Substances

Source: Data from the DHSC. (July 2020). 2019 Voluntary Scheme Operational Review Metrics, July 2020.

Speed relates to the desire to do appraisals outside of oncology as fast as in oncology, as long as there is sufficient evidence for a rigorous NICE appraisal to be run. Speed is one of the metrics that the DHSC has explored and on a 12-month rolling average basis NICE has not been hitting the target during the VPAS, be that for the first output, or for the final output (Figure 2 and 3 respectively).

Figure 2: 12 month rolling average for time for first output in NICE appraisals in oncology and non-oncology, 2014 Q1 to 2020 Q1

Source: Data from the DHSC. (July 2020). 2019 Voluntary Scheme Operational Review Metrics, July 2020.

Figure 3: 12 month rolling average for time for final output in NICE appraisals in oncology and non-oncology, 2014 Q1 to 2020 Q1

Source: Data from the DHSC. (July 2020). 2019 Voluntary Scheme Operational Review Metrics, July 2020.

Of course, COVID-19 should be considered when looking at NICE’s work; they have not only had the deal with the challenges of staff sickness and working remotely but also the workload of having to produce COVID-19 clinical guidelines rapidly. That NICE has done so much and so quickly should be seen as a success, even if it’s not yet hitting the goals in the VPAS.

The VPAS also committed to NICE scoping and initiating a review of the methods of Technology Appraisal. The VPAS also said that industry and other stakeholders would be active participants in the review, inputting on the scope, participating in working discussions and giving views on the recommendations. A first consultation on this closed on the 18 December 2020. In an effort to limit the impact of such a review, the VPAS stated that any future changes would need to be consistent with improving the health gain achieving by spending on new innovation medicines. It’s too soon to know where this is at since no changes have been concretely identified and predicting the impact will be difficult in any case. NICE is due to publish their plans on 4 February 2020.

The VPAS also included a commitment to a review of the process and methods for the Highly Specialised Technologies programme as well. So far, details of this haven’t come out (or if they have, there are not easily found). NICE board papers from May 2020 do note that the review is ongoing but major changes aren’t likely; rather NICE is aiming for more clarity on the criteria to do a HST, according to their website.

The VPAS also includes a commitment for NICE to clarify its approach to managing uncertainty including briefing committees on the types of uncertainties and ensure committee discussions focus on those areas of uncertainty that have the biggest impact on cost-effectiveness estimates. Uncertainty is a big part of the NICE methods review so progress is being made on this.

Combination pricing

The prices of treatments given in combinations is seen by some, as evidenced by a recent Blood Cancer Alliance report, as a reason why some treatments can’t be recommended by NICE and can’t then be easily accessed by patients.

The VPAS doesn’t make reference to combination pricing explicitly but does acknowledge the challenge in bringing combination branded therapies to market. The VPAS suggests that the DHSC and NHSE&I will support ABPI efforts to help find solutions. Nothing was found on the ABPI website to indicate progress with the ABPI efforts.

Increasing transparency

Visibility of tenders was to be improved as well as the transparency of commercial arrangements agreed between companies and the NHS across the devolved nations.

There already exists a NHS England eTendering service and there is also a tender tool specifically for drugs and pharmaceutical supplies, SELECTT. These are tools available only to registered users and hence it’s hard to know, from outside, whether visibility have been improved for tenders.

Similarly, with the full details of smart deals only known to the companies and NHSE&I, it’s hard to know if the devolved nations are able to access the full details, but you can imagine that this is pretty easily done internally.

Promoting uptake

Arguably the most important of all is a commitment to promoting uptake. This included the intention to invest in the data infrastructure in the NHS in England namechecking e-prescribing as well as improving the Innovation Scorecard. The Innovation Scorecard reports on use of NICE approved medicines in the NHS in England. It also discusses taking a more proactive approach to supporting, understanding and promoting the uptake of the most clinically and cost effective products in England.

The Innovation Scorecard gets regularly updated, with the latest version published on 8 October 2020. It’s not clear what – if anything – has changed in line with the VPAS intentions. It’s even harder to know what has transpired in relation to the commitment for a proactive approach to supporting, understanding and promoting the uptake of the most clinically and cost effective products. Mostly because it’s hard to know what products this relates to and disentangling the impact of VPAS from what was always being done in any case.

A measurable objective is set out to reach the upper quartile of uptake in comparison to comparator countries for five highest health gain categories. A timetable was set out too; to do reach this target during the course of the first half of the VPAS, by June 2021. That means that there is just less than six months left to hit that. No public source has found what the five highest health gain categories are, nor how to measure uptake, and which countries will be considered appropriate comparators.

VPAS operational review meeting minutes show that discussions have been had on reaching the upper quartile of uptake in comparison to comparator countries for five highest health gain categories, but have been difficult. Whilst it is premature to berate NHSE&I for a lack of progress since the target date hasn’t passed yet, it’s looking like it could well be missed.

Product launches

One of the published metrics for the VPAS that is relevant to access is product launches. The DHSC’s metrics data from July 2020 has found that applications for prices for new products and NAS shows a decline in new product launches but stability in NAS (Figure 4). The trouble is that this alone isn’t enough to tell us whether patients in the UK have a chance to access all the new treatments that are launched, just those launched in the UK. This leaves an important question unanswered; are there new treatments that have not been launched in the UK?

Figure 4: Applications for prices for new product launches and New Active Substances

Source: Data from the DHSC. (July 2020). 2019 Voluntary Scheme Operational Review Metrics, July 2020.

We can also look at DHSC metric data to help explore if there are NAS that aren’t coming to the UK. Their metric data includes terminated Single Technology Appraisals (STAs) and that shows that there was one NAS in 2019 and one in quarter 1 of 2020 where the STA was terminated. No application to NICE means at best a soft launch, at worst (from a patient perspective) is no launch.

Lack of progress or lack of transparency?

A great deal of reading between the lines is needed to be able to try to understand both what was committed to in the VPAS and whether progress is being made with respect to the objectives for patients. It’s really hard to know if the aim to simplify, streamline and improve access, pricing and uptake arrangements for cost effective medicines and whether the aim to deliver faster adoption of the most clinically and cost effective medicines with the aim of improving patient outcomes are being delivered upon. These seem to be buzz words, not concrete goals.

Public sources seem to suggest progress is limited at best at the end of the first two years of the VPAS, but perhaps it’s because it’s only those in the know that really know. That in itself is a problem, most particularly in the context of delivering of aims for patients. How can patients know if they are reaping the benefits promised to them if there is so little clarity and so little information in the public domain? Industry too will want to see progress, especially with up to £6bn in payments expected over the lifetime of the scheme.

Given the scope of the VPAS, it should also not just be for discussions between those patient groups who are part of working groups, such as those involved in the NICE methods review.

There is still three years to go and that means three years to translate buzz words into better outcomes for patients and to provide an evidence base to help judge the scheme and inform future deals. Let’s hope the DHSC, NHSE&I and ABPI are up for the challenge.

About the author

Leela Barham is researcher and writer who has worked with all stakeholders across the health care system, both in the UK and internationally, on the economics of the pharmaceutical industry. Leela worked as an advisor to the Department of Health and Social Care on the 2019 Voluntary Scheme for Branded Medicines Pricing and Access (VPAS).

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Problems After COVID-19 Vaccination More Prevalent Among Naturally Immune: Study

Problems After COVID-19 Vaccination More Prevalent Among Naturally Immune: Study

Authored by Zachary Stieber via The Epoch Times (emphasis…

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Problems After COVID-19 Vaccination More Prevalent Among Naturally Immune: Study

Authored by Zachary Stieber via The Epoch Times (emphasis ours),

People who recovered from COVID-19 and received a COVID-19 shot were more likely to suffer adverse reactions, researchers in Europe are reporting.

A medical worker administers a dose of the Pfizer-BioNTech COVID-19 vaccine to a patient at a vaccination center in Ancenis-Saint-Gereon, France, on Nov. 17, 2021. (Stephane Mahe//Reuters)

Participants in the study were more likely to experience an adverse reaction after vaccination regardless of the type of shot, with one exception, the researchers found.

Across all vaccine brands, people with prior COVID-19 were 2.6 times as likely after dose one to suffer an adverse reaction, according to the new study. Such people are commonly known as having a type of protection known as natural immunity after recovery.

People with previous COVID-19 were also 1.25 times as likely after dose 2 to experience an adverse reaction.

The findings held true across all vaccine types following dose one.

Of the female participants who received the Pfizer-BioNTech vaccine, for instance, 82 percent who had COVID-19 previously experienced an adverse reaction after their first dose, compared to 59 percent of females who did not have prior COVID-19.

The only exception to the trend was among males who received a second AstraZeneca dose. The percentage of males who suffered an adverse reaction was higher, 33 percent to 24 percent, among those without a COVID-19 history.

“Participants who had a prior SARS-CoV-2 infection (confirmed with a positive test) experienced at least one adverse reaction more often after the 1st dose compared to participants who did not have prior COVID-19. This pattern was observed in both men and women and across vaccine brands,” Florence van Hunsel, an epidemiologist with the Netherlands Pharmacovigilance Centre Lareb, and her co-authors wrote.

There were only slightly higher odds of the naturally immune suffering an adverse reaction following receipt of a Pfizer or Moderna booster, the researchers also found.

The researchers performed what’s known as a cohort event monitoring study, following 29,387 participants as they received at least one dose of a COVID-19 vaccine. The participants live in a European country such as Belgium, France, or Slovakia.

Overall, three-quarters of the participants reported at least one adverse reaction, although some were minor such as injection site pain.

Adverse reactions described as serious were reported by 0.24 percent of people who received a first or second dose and 0.26 percent for people who received a booster. Different examples of serious reactions were not listed in the study.

Participants were only specifically asked to record a range of minor adverse reactions (ADRs). They could provide details of other reactions in free text form.

“The unsolicited events were manually assessed and coded, and the seriousness was classified based on international criteria,” researchers said.

The free text answers were not provided by researchers in the paper.

“The authors note, ‘In this manuscript, the focus was not on serious ADRs and adverse events of special interest.’” Yet, in their highlights section they state, “The percentage of serious ADRs in the study is low for 1st and 2nd vaccination and booster.”

Dr. Joel Wallskog, co-chair of the group React19, which advocates for people who were injured by vaccines, told The Epoch Times: “It is intellectually dishonest to set out to study minor adverse events after COVID-19 vaccination then make conclusions about the frequency of serious adverse events. They also fail to provide the free text data.” He added that the paper showed “yet another study that is in my opinion, deficient by design.”

Ms. Hunsel did not respond to a request for comment.

She and other researchers listed limitations in the paper, including how they did not provide data broken down by country.

The paper was published by the journal Vaccine on March 6.

The study was funded by the European Medicines Agency and the Dutch government.

No authors declared conflicts of interest.

Some previous papers have also found that people with prior COVID-19 infection had more adverse events following COVID-19 vaccination, including a 2021 paper from French researchers. A U.S. study identified prior COVID-19 as a predictor of the severity of side effects.

Some other studies have determined COVID-19 vaccines confer little or no benefit to people with a history of infection, including those who had received a primary series.

The U.S. Centers for Disease Control and Prevention still recommends people who recovered from COVID-19 receive a COVID-19 vaccine, although a number of other health authorities have stopped recommending the shot for people who have prior COVID-19.

Another New Study

In another new paper, South Korean researchers outlined how they found people were more likely to report certain adverse reactions after COVID-19 vaccination than after receipt of another vaccine.

The reporting of myocarditis, a form of heart inflammation, or pericarditis, a related condition, was nearly 20 times as high among children as the reporting odds following receipt of all other vaccines, the researchers found.

The reporting odds were also much higher for multisystem inflammatory syndrome or Kawasaki disease among adolescent COVID-19 recipients.

Researchers analyzed reports made to VigiBase, which is run by the World Health Organization.

“Based on our results, close monitoring for these rare but serious inflammatory reactions after COVID-19 vaccination among adolescents until definitive causal relationship can be established,” the researchers wrote.

The study was published by the Journal of Korean Medical Science in its March edition.

Limitations include VigiBase receiving reports of problems, with some reports going unconfirmed.

Funding came from the South Korean government. One author reported receiving grants from pharmaceutical companies, including Pfizer.

Tyler Durden Fri, 03/15/2024 - 05:00

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‘Excess Mortality Skyrocketed’: Tucker Carlson and Dr. Pierre Kory Unpack ‘Criminal’ COVID Response

‘Excess Mortality Skyrocketed’: Tucker Carlson and Dr. Pierre Kory Unpack ‘Criminal’ COVID Response

As the global pandemic unfolded, government-funded…

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'Excess Mortality Skyrocketed': Tucker Carlson and Dr. Pierre Kory Unpack 'Criminal' COVID Response

As the global pandemic unfolded, government-funded experimental vaccines were hastily developed for a virus which primarily killed the old and fat (and those with other obvious comorbidities), and an aggressive, global campaign to coerce billions into injecting them ensued.

Then there were the lockdowns - with some countries (New Zealand, for example) building internment camps for those who tested positive for Covid-19, and others such as China welding entire apartment buildings shut to trap people inside.

It was an egregious and unnecessary response to a virus that, while highly virulent, was survivable by the vast majority of the general population.

Oh, and the vaccines, which governments are still pushing, didn't work as advertised to the point where health officials changed the definition of "vaccine" multiple times.

Tucker Carlson recently sat down with Dr. Pierre Kory, a critical care specialist and vocal critic of vaccines. The two had a wide-ranging discussion, which included vaccine safety and efficacy, excess mortality, demographic impacts of the virus, big pharma, and the professional price Kory has paid for speaking out.

Keep reading below, or if you have roughly 50 minutes, watch it in its entirety for free on X:

"Do we have any real sense of what the cost, the physical cost to the country and world has been of those vaccines?" Carlson asked, kicking off the interview.

"I do think we have some understanding of the cost. I mean, I think, you know, you're aware of the work of of Ed Dowd, who's put together a team and looked, analytically at a lot of the epidemiologic data," Kory replied. "I mean, time with that vaccination rollout is when all of the numbers started going sideways, the excess mortality started to skyrocket."

When asked "what kind of death toll are we looking at?", Kory responded "...in 2023 alone, in the first nine months, we had what's called an excess mortality of 158,000 Americans," adding "But this is in 2023. I mean, we've  had Omicron now for two years, which is a mild variant. Not that many go to the hospital."

'Safe and Effective'

Tucker also asked Kory why the people who claimed the vaccine were "safe and effective" aren't being held criminally liable for abetting the "killing of all these Americans," to which Kory replied: "It’s my kind of belief, looking back, that [safe and effective] was a predetermined conclusion. There was no data to support that, but it was agreed upon that it would be presented as safe and effective."

Carlson and Kory then discussed the different segments of the population that experienced vaccine side effects, with Kory noting an "explosion in dying in the youngest and healthiest sectors of society," adding "And why did the employed fare far worse than those that weren't? And this particularly white collar, white collar, more than gray collar, more than blue collar."

Kory also said that Big Pharma is 'terrified' of Vitamin D because it "threatens the disease model." As journalist The Vigilant Fox notes on X, "Vitamin D showed about a 60% effectiveness against the incidence of COVID-19 in randomized control trials," and "showed about 40-50% effectiveness in reducing the incidence of COVID-19 in observational studies."

Professional costs

Kory - while risking professional suicide by speaking out, has undoubtedly helped save countless lives by advocating for alternate treatments such as Ivermectin.

Kory shared his own experiences of job loss and censorship, highlighting the challenges of advocating for a more nuanced understanding of vaccine safety in an environment often resistant to dissenting voices.

"I wrote a book called The War on Ivermectin and the the genesis of that book," he said, adding "Not only is my expertise on Ivermectin and my vast clinical experience, but and I tell the story before, but I got an email, during this journey from a guy named William B Grant, who's a professor out in California, and he wrote to me this email just one day, my life was going totally sideways because our protocols focused on Ivermectin. I was using a lot in my practice, as were tens of thousands of doctors around the world, to really good benefits. And I was getting attacked, hit jobs in the media, and he wrote me this email on and he said, Dear Dr. Kory, what they're doing to Ivermectin, they've been doing to vitamin D for decades..."

"And it's got five tactics. And these are the five tactics that all industries employ when science emerges, that's inconvenient to their interests. And so I'm just going to give you an example. Ivermectin science was extremely inconvenient to the interests of the pharmaceutical industrial complex. I mean, it threatened the vaccine campaign. It threatened vaccine hesitancy, which was public enemy number one. We know that, that everything, all the propaganda censorship was literally going after something called vaccine hesitancy."

Money makes the world go 'round

Carlson then hit on perhaps the most devious aspect of the relationship between drug companies and the medical establishment, and how special interests completely taint science to the point where public distrust of institutions has spiked in recent years.

"I think all of it starts at the level the medical journals," said Kory. "Because once you have something established in the medical journals as a, let's say, a proven fact or a generally accepted consensus, consensus comes out of the journals."

"I have dozens of rejection letters from investigators around the world who did good trials on ivermectin, tried to publish it. No thank you, no thank you, no thank you. And then the ones that do get in all purportedly prove that ivermectin didn't work," Kory continued.

"So and then when you look at the ones that actually got in and this is where like probably my biggest estrangement and why I don't recognize science and don't trust it anymore, is the trials that flew to publication in the top journals in the world were so brazenly manipulated and corrupted in the design and conduct in, many of us wrote about it. But they flew to publication, and then every time they were published, you saw these huge PR campaigns in the media. New York Times, Boston Globe, L.A. times, ivermectin doesn't work. Latest high quality, rigorous study says. I'm sitting here in my office watching these lies just ripple throughout the media sphere based on fraudulent studies published in the top journals. And that's that's that has changed. Now that's why I say I'm estranged and I don't know what to trust anymore."

Vaccine Injuries

Carlson asked Kory about his clinical experience with vaccine injuries.

"So how this is how I divide, this is just kind of my perception of vaccine injury is that when I use the term vaccine injury, I'm usually referring to what I call a single organ problem, like pericarditis, myocarditis, stroke, something like that. An autoimmune disease," he replied.

"What I specialize in my practice, is I treat patients with what we call a long Covid long vaxx. It's the same disease, just different triggers, right? One is triggered by Covid, the other one is triggered by the spike protein from the vaccine. Much more common is long vax. The only real differences between the two conditions is that the vaccinated are, on average, sicker and more disabled than the long Covids, with some pretty prominent exceptions to that."

Watch the entire interview above, and you can support Tucker Carlson's endeavors by joining the Tucker Carlson Network here...

Tyler Durden Thu, 03/14/2024 - 16:20

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Shakira’s net worth

After 12 albums, a tax evasion case, and now a towering bronze idol sculpted in her image, how much is Shakira worth more than 4 decades into her care…

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March 14, 2024

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Shakira’s considerable net worth is no surprise, given her massive popularity in Latin America, the U.S., and elsewhere. 

In fact, the belly-dancing contralto queen is the second-wealthiest Latin-America-born pop singer of all time after Gloria Estefan. (Interestingly, Estefan actually helped a young Shakira translate her breakout album “Laundry Service” into English, hugely propelling her stateside success.)

Since releasing her first record at age 13, Shakira has spent decades recording albums in both Spanish and English and performing all over the world. Over the course of her 40+ year career, she helped thrust Latin pop music into the American mainstream, paving the way for the subsequent success of massively popular modern acts like Karol G and Bad Bunny.

In late 2023, a 21-foot-tall bronze sculpture of Shakira, the barefoot belly dancer of Barranquilla, was unveiled at the city's waterfront. The statue was commissioned by the city's former mayor and other leadership.

Photo by STR/AFP via Getty Images

In December 2023, a 21-foot-tall beachside bronze statue of the “Hips Don’t Lie” singer was unveiled in her Colombian hometown of Barranquilla, making her a permanent fixture in the city’s skyline and cementing her legacy as one of Latin America’s most influential entertainers.

After 12 albums, a plethora of film and television appearances, a highly publicized tax evasion case, and now a towering bronze idol sculpted in her image, how much is Shakira worth? What does her income look like? And how does she spend her money?

Related: Dwayne 'The Rock' Johnson's net worth: How the new TKO Board Member built his wealth from $7

How much is Shakira worth?

In late 2023, Spanish sports and lifestyle publication Marca reported Shakira’s net worth at $400 million, citing Forbes as the figure’s source (although Forbes’ profile page for Shakira does not list a net worth — and didn’t when that article was published).

Most other sources list the singer’s wealth at an estimated $300 million, and almost all of these point to Celebrity Net Worth — a popular but dubious celebrity wealth estimation site — as the source for the figure.

A $300 million net worth would make Shakira the third-richest Latina pop star after Gloria Estefan ($500 million) and Jennifer Lopez ($400 million), and the second-richest Latin-America-born pop singer after Estefan (JLo is Puerto Rican but was born in New York).

Shakira’s income: How much does she make annually?

Entertainers like Shakira don’t have predictable paychecks like ordinary salaried professionals. Instead, annual take-home earnings vary quite a bit depending on each year’s album sales, royalties, film and television appearances, streaming revenue, and other sources of income. As one might expect, Shakira’s earnings have fluctuated quite a bit over the years.

From June 2018 to June 2019, for instance, Shakira was the 10th highest-earning female musician, grossing $35 million, according to Forbes. This wasn’t her first time gracing the top 10, though — back in 2012, she also landed the #10 spot, bringing in $20 million, according to Billboard.

In 2023, Billboard listed Shakira as the 16th-highest-grossing Latin artist of all time.

Shakira performed alongside producer Bizarrap during the 2023 Latin Grammy Awards Gala in Seville.

Photo By Maria Jose Lopez/Europa Press via Getty Images

How much does Shakira make from her concerts and tours?

A large part of Shakira’s wealth comes from her world tours, during which she sometimes sells out massive stadiums and arenas full of passionate fans eager to see her dance and sing live.

According to a 2020 report by Pollstar, she sold over 2.7 million tickets across 190 shows that grossed over $189 million between 2000 and 2020. This landed her the 19th spot on a list of female musicians ranked by touring revenue during that period. In 2023, Billboard reported a more modest touring revenue figure of $108.1 million across 120 shows.

In 2003, Shakira reportedly generated over $4 million from a single show on Valentine’s Day at Foro Sol in Mexico City. 15 years later, in 2018, Shakira grossed around $76.5 million from her El Dorado World Tour, according to Touring Data.

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How much has Shakira made from her album sales?

According to a 2023 profile in Variety, Shakira has sold over 100 million records throughout her career. “Laundry Service,” the pop icon’s fifth studio album, was her most successful, selling over 13 million copies worldwide, according to TheRichest.

Exactly how much money Shakira has taken home from her album sales is unclear, but in 2008, it was widely reported that she signed a 10-year contract with LiveNation to the tune of between $70 and $100 million to release her subsequent albums and manage her tours.

Shakira and JLo co-headlined the 2020 Super Bowl Halftime Show in Florida.

Photo by Kevin Winter/Getty Images)

How much did Shakira make from her Super Bowl and World Cup performances?

Shakira co-wrote one of her biggest hits, “Waka Waka (This Time for Africa),” after FIFA selected her to create the official anthem for the 2010 World Cup in South Africa. She performed the song, along with several of her existing fan-favorite tracks, during the event’s opening ceremonies. TheThings reported in 2023 that the song generated $1.4 million in revenue, citing Popnable for the figure.

A decade later, 2020’s Superbowl halftime show featured Shakira and Jennifer Lopez as co-headliners with guest performances by Bad Bunny and J Balvin. The 14-minute performance was widely praised as a high-energy celebration of Latin music and dance, but as is typical for Super Bowl shows, neither Shakira nor JLo was compensated beyond expenses and production costs.

The exposure value that comes with performing in the Super Bowl Halftime Show, though, is significant. It is typically the most-watched television event in the U.S. each year, and in 2020, a 30-second Super Bowl ad spot cost between $5 and $6 million.

How much did Shakira make as a coach on “The Voice?”

Shakira served as a team coach on the popular singing competition program “The Voice” during the show’s fourth and sixth seasons. On the show, celebrity musicians coach up-and-coming amateurs in a team-based competition that eventually results in a single winner. In 2012, The Hollywood Reporter wrote that Shakira’s salary as a coach on “The Voice” was $12 million.

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How does Shakira spend her money?

Shakira doesn’t just make a lot of money — she spends it, too. Like many wealthy entertainers, she’s purchased her share of luxuries, but Barranquilla’s barefoot belly dancer is also a prolific philanthropist, having donated tens of millions to charitable causes throughout her career.

Private island

Back in 2006, she teamed up with Roger Waters of Pink Floyd fame and Spanish singer Alejandro Sanz to purchase Bonds Cay, a 550-acre island in the Bahamas, which was listed for $16 million at the time.

Along with her two partners in the purchase, Shakira planned to develop the island to feature housing, hotels, and an artists’ retreat designed to host a revolving cast of artists-in-residence. This plan didn’t come to fruition, though, and as of this article’s last update, the island was once again for sale on Vladi Private Islands.

Real estate and vehicles

Like most wealthy celebs, Shakira’s portfolio of high-end playthings also features an array of luxury properties and vehicles, including a home in Barcelona, a villa in Cyprus, a Miami mansion, and a rotating cast of Mercedes-Benz vehicles.

Philanthropy and charity

Shakira doesn’t just spend her massive wealth on herself; the “Queen of Latin Music” is also a dedicated philanthropist and regularly donates portions of her earnings to the Fundación Pies Descalzos, or “Barefoot Foundation,” a charity she founded in 1997 to “improve the education and social development of children in Colombia, which has suffered decades of conflict.” The foundation focuses on providing meals for children and building and improving educational infrastructure in Shakira’s hometown of Barranquilla as well as four other Colombian communities.

In addition to her efforts with the Fundación Pies Descalzos, Shakira has made a number of other notable donations over the years. In 2007, she diverted a whopping $40 million of her wealth to help rebuild community infrastructure in Peru and Nicaragua in the wake of a devastating 8.0 magnitude earthquake. Later, during the COVID-19 pandemic in 2020, Shakira donated a large supply of N95 masks for healthcare workers and ventilators for hospital patients to her hometown of Barranquilla.

Back in 2010, the UN honored Shakira with a medal to recognize her dedication to social justice, at which time the Director General of the International Labour Organization described her as a “true ambassador for children and young people.”

On November 20, 2023 (which was supposed to be her first day of trial), Shakira reached a deal with the prosecution that resulted in a three-year suspended sentence and around $8 million in fines.

Photo by Adria Puig/Anadolu via Getty Images

Shakira’s tax fraud scandal: How much did she pay?

In 2018, prosecutors in Spain initiated a tax evasion case against Shakira, alleging she lived primarily in Spain from 2012 to 2014 and therefore failed to pay around $14.4 million in taxes to the Spanish government. Spanish law requires anyone who is “domiciled” (i.e., living primarily) in Spain for more than half of the year to pay income taxes.

During the period in question, Shakira listed the Bahamas as her primary residence but did spend some time in Spain, as she was dating Gerard Piqué, a professional footballer and Spanish citizen. The couple’s first son, Milan, was also born in Barcelona during this period. 

Shakira maintained that she spent far fewer than 183 days per year in Spain during each of the years in question. In an interview with Elle Magazine, the pop star opined that “Spanish tax authorities saw that I was dating a Spanish citizen and started to salivate. It's clear they wanted to go after that money no matter what."

Prosecutors in the case sought a fine of almost $26 million and a possible eight-year prison stint, but in November of 2023, Shakira took a deal to close the case, accepting a fine of around $8 million and a three-year suspended sentence to avoid going to trial. In reference to her decision to take the deal, Shakira stated, "While I was determined to defend my innocence in a trial that my lawyers were confident would have ruled in my favour [had the trial proceeded], I have made the decision to finally resolve this matter with the best interest of my kids at heart who do not want to see their mom sacrifice her personal well-being in this fight."

How much did the Shakira statue in Barranquilla cost?

In late 2023, a 21-foot-tall bronze likeness of Shakira was unveiled on a waterfront promenade in Barranquilla. The city’s then-mayor, Jaime Pumarejo, commissioned Colombian sculptor Yino Márquez to create the statue of the city’s treasured pop icon, along with a sculpture of the city’s coat of arms.

According to the New York Times, the two sculptures cost the city the equivalent of around $180,000. A plaque at the statue’s base reads, “A heart that composes, hips that don’t lie, an unmatched talent, a voice that moves the masses and bare feet that march for the good of children and humanity.” 

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