of the price drop, despite selling almost three times as many doses in 2005, the company reported $21 million in FluMist sales, compared to $48 million the previous year. Further cuts in pricing had to await FDA approval of a refrigerator-cooled FluMist formulation, as the initial formulation required freezer storage and thawing on demand before administration. Although it is positioned as a premium product, the remaining price premium for FluMist over the cost of needle-injected vaccine is small. Society and culture MedImmune is one company that manufactures the live attenuated influenza vaccine, which it sells under the brand name FluMist in the United States and the brand name Fluenz Tetra in the European Union. For the 2010–2011 flu season, FluMist was the only live attenuated influenza vaccine approved by the FDA for use in the US. All other FDA-approved lots were inactivated virus vaccines. In September 2009 a LAIV intranasal vaccine for the novel H1N1 influenza virus was approved and the seasonal intranasal vaccine was approved by the European Medicines Agency (EMA) for use in the European Union in 2011. The quadrivalent version was approved for use in the European Union in 2013. , the only other company holding LAIV vaccine rights was BioDiem of Australia. BioDiem licensed rights to private production of the vaccine in China to Changchun BCHT Biotechnology, which also holds public rights for production in China sublicensed from the World Health Organization. BCHT plans to market a trivalent LAIV vaccine for H1N1 flu by the end of 2016. The BCHT flu vaccine is one of several candidates for WHO prequalification in the near future, reflecting a shift of Chinese market priorities from a large domestic market toward export. BioDiem has also licensed production to the Serum Institute of India, which holds exclusive licenses for production in Mexico, Argentina, Peru, South Africa, Bangladesh, Bhutan, Nepal, Pakistan and Sri Lanka, and the Government Pharmaceutical Organization of Thailand. It was the first and () the only live attenuated vaccine for influenza available outside of Europe. In September 2009, a LAIV intranasal vaccine for the novel H1N1 influenza virus was approved. In 2011, the vaccine was approved by the European Medicines Agency (EMA) for use in the European Union under the brand name Fluenz. AstraZeneca acquired MedImmune and subsequently retired the MedImmune name. Research The live attenuated influenza vaccine is designed to be quickly modifiable to present the surface antigens