Healthcare ETF Quarterly Report | April 2026

Health Care ETF Manager Review

Market in review

Health Care equities declined during the first quarter of 2026, alongside the broader market, as escalating geopolitical tensions in the Middle East disrupted energy markets and weighed on risk sentiment broadly. Within health care, the investment backdrop was shaped by two dominant themes: a resurgence of biopharmaceutical merger and acquisition (M&A) activity, accelerated by drug pricing clarity that prompted large pharmaceutical companies to advance dealmaking; and continued pressure on medical technology and managed care, where procedure volume trends and structural policy uncertainty weighed on sentiment.

Biotechnology was the standout sub-industry, driven by clinical data catalysts, robust M&A activity, and improved regulatory visibility for vaccine-focused companies. Pharmaceuticals delivered mixed results, with large-cap drug pricing headwinds offset by selective strength in specialty names. Medical technology and life sciences tools lagged meaningfully – -26.99% and -18.55% respectively – as procedure volumes softened and biopharma research and development spending remained under pressure.[1]

We remain constructive on Health Care. The M&A environment for biopharma assets with established commercial franchises is unusually favourable, and we believe the portfolio’s emphasis on commercial-stage biopharma and selective medical technology exposure is well-positioned to participate in continued consolidation while managing exposure to the more structurally challenged sub-industries.

Portfolio Performance

During the quarter, the Harbor Health Care UCITS ETF (the “portfolio”) returned -7.87% (gross, preliminary), outperforming the Russell 3000 Growth Health Care Index (the “index”), which returned -8.92%.[2] Strong stock selection within Biopharma was the primarily driver of relative performance. Within the segment, we benefited from strong execution from commercial stage companies as well as positive sentiment towards development stage companies, including those benefiting from M&A activity from large-cap pharma and favourable clinical catalysts.

Quarter performance – contributors and detractors

Biotechnology

Vaxcyte, Inc.: The anti-vaccine regulatory overhang that had weighed on Vaxcyte in 2025 largely dissipated as the administration clarified that pneumococcal vaccines were unaffected by the vaccine review underway, and the company’s pivotal adult Phase 3 data remains on track for later this year.

Ascendis Pharma A/S: The FDA approved Yuviwel (navepegritide) for achondroplasia with a favourable label that includes explicit switching guidance from competing therapies, and 52-week Comparing Cochlear implants with Hearing aids (COACH) trial data showed patients on the TransCon CNP and human growth hormone combination reaching normal-height growth velocity after one year of therapy,[3] a result we believe positions this regimen as the new standard of care. Yorvipath commercial momentum continued well ahead of consensus, and we trimmed into periods of strength while maintaining strong conviction in the name.

Revolution Medicines, Inc.: For Revolution Medicines, a clinical stage oncology-focused biotech company, the quarter was marked by significant M&A-related volatility — acquisition speculation involving multiple large pharmaceutical acquirers drove a sharp initial move before contradictory reports created turbulent trading conditions. We trimmed position size ahead of the most acute period of binary risk and retained meaningful exposure. The fundamental thesis remains intact, with a pivotal pancreatic cancer data readout expected in the first half of 2026.

ADMA Biologics, Inc.: The biopharma company focused on plasma-delivered therapies’ underperformance (-36.12%) was driven by a combination of company-specific factors that emerged during the quarter, including rising days-sales-outstandings and CFO turnover. The stock triggered our internal flag system, and we exited the position given our decreased conviction in the thesis.[4]

Health Care Equipment

Masimo Corporation: The medical technology company specializing in non-invasive patient monitoring, outperformed – returning +35.56% over the quarter – following news the company was being acquired by Danaher. As a result, we exited the position and redeployed proceeds within the strategy. [5]

Pharmaceuticals

Eli Lilly and Company: The index’s largest constituent by a wide margin (index weight of 30.3% as of 31/03/2026), declined during the period, and our underweight relative to the index was a meaningful source of positive relative contribution. We maintain conviction in Eli Lily as we believe they are the best positioned player in the GLP-1 market, supported by strength of weight loss data and longer Interest Period (IP) duration relative to Novo Nordisk, and took advantage of the opportunity to add to our position during the quarter. We continue to believe that GLP-1 remains one of the most powerful product cycles in global pharma with a long runway ahead. However, we remain underweight relative to the index weight of over 30%.

Abbvie, Inc.: The global pharmaceutical company delivered strong absolute performance during the quarter and our underweight allocation weighed on relative results (portfolio weight of 5.6% vs. index weight of 15.8% as of 3/31/2026).[6] We remain selective in our large-cap pharma exposure, with a preference for balanced risk-reward and clearer valuation support, and trimmed our position during the quarter.

Health Care Providers & Services

UnitedHealth Group: The health insurer and managed care organisation was under pressure during the quarter. The political and reimbursement environment for managed care is difficult, with Medicare Advantage rate dynamics constrained ahead of midterm elections and meaningful uncertainty around whether large payers can take the price increases needed to restore profitability without losing membership. While we still have conviction in the long-term thesis, we have concluded that its challenges are longer-duration and more structural than previously assessed and we reduced our exposure during the quarter.

GeneDx Holdings Corp.: The leader in genetic testing for rare diseases and paediatrics, traded lower after pre-announcing an in-line quarter which fell short of high expectations, despite strong volume growth in exome/genome, healthily above Street estimates. Despite the recent underperformance, we continue to have confidence in the company’s cost advantage and first-mover status in paediatric and rare disease diagnostics, supported by channel checks indicating strength in volume trends and recent insider buying, and we added to our position during the quarter.

Buys & Sells:

During the quarter, we benefitted from M&A activity in and sold our position in Avidity Biosciences, a clinical stage biopharma company focused on RNA therapies for rare muscle diseases, following the announcement that Novartis would be acquiring the company to help strength it’s neuroscience and rare disease pipeline. Additionally, we sold our position in Masimo Corp, a MedTech company focused on developing non-invasive patient monitoring tech, following the announcement that Danaher would be acquiring the company.

We initiated position in Madrigal Pharmaceuticals, a commercial stage biopharma co focused on developing specialty liver therapeutics, on a pull-back, providing a compelling entry point, in our opinion. Madrigal’s drug focused on treating serious liver disease is seeing strong early demand and we believe market is underestimating the drug’s long-term revenue potential and durability of demand.

Industry Overweights & Underweights:

Entering 2026, the Biotechnology industry represented the largest overweight relative to the index (54.65% compared to 40.22%) and it remains the largest overweight as of 31/03/2026. [7]   We continue to view Biotechnology as the most attractive area within Health Care, with exposure spread across both commercial-stage and development-stage names. Within the group, we are underweight more speculative and non-earning earlier stage names, which face disproportionate pressure from rising rates. M&A remains a tailwind, with large-cap pharma paying substantial premiums for commercial-stage assets.

The Pharmaceuticals industry represented the portfolio’s largest underweight as of year-end and continues to be the largest underweight as of 31/03/2026. We continue to believe that the industry includes many interesting opportunities, and the industry represents a large absolute weight in the portfolio, however we remain underweight given our focus on risk-adjusted opportunities within the industry.

Macro Outlook

We remain constructive on Health Care and enter the second quarter with our highest conviction concentrated in commercial-stage biopharma. The M&A environment for biopharma assets with established commercial franchises remains unusually active, as pipeline dynamics are becoming more acute for large pharmaceutical companies facing patent cliffs and heightened urgency to replenish growth. The first quarter’s M&A hit rate across our portfolio holdings was among the highest we have experienced, and we believe the structural drivers supporting continued dealmaking remain in place.

Biotechnology is our highest-conviction sub-industry. We believe the intersection of maturing commercial pipelines, compressed development-stage valuations, and an improved regulatory environment creates a favourable backdrop for both standalone performance and M&A outcomes. Several portfolio holdings have meaningful clinical data catalysts in the next two to three quarters that we believe could drive significant re-rating. We are selectively adding development-stage exposure with near-term catalysts while maintaining our underweight to non-earning biotech names, which we believe face disproportionate headwinds if rates and inflation remain elevated.

We remain more cautious on Managed Health Care and Life Sciences Tools, where structural challenges are likely to persist. Medical technology is an area of growing opportunity following significant valuation compression, and we initiated a new position in a best-in-class medical device company during the quarter. In Pharmaceuticals, we maintain a high-conviction underweight in Eli Lilly. Drug pricing headwinds and pharmaceutical reimbursement risk present meaningful near-term headwinds to the large-cap pharmaceutical space, and we see more compelling risk-adjusted opportunities in commercial-stage biopharma. We believe the portfolio is well-positioned to capture biopharma-driven outperformance while maintaining discipline around the sub-industries where we see the most structural headwinds.                                                                                                                

Active Healthcare ETF Performance

As of 31.08.2026

WELL (Fund)
1M6.48%
3M11.05%
6M7.33%
YTD6.51%
12M16.84%
3Y-
Since Inception (04/04/2019)16.87%


Please note that all performance figures are showing net data. Source: Bloomberg / HANetf. Data as of 31.08.2026

Past performance for the index is in USD. Past performance is not an indicator for future results and should not be the sole factor of consideration when selecting a product. Investors should read the prospectus of the Issuer (“Prospectus”) before investing and should refer to the section of the Prospectus entitled ‘Risk Factors’ for further details of risks associated with an investment in this product. When you invest in ETFs and ETCs, your capital is at risk.

[1] Source: Westfield Capital Management, Bloomberg. Data as of 31.03.2026

[2] Source: Westfield Capital Management, Bloomberg. Data as of 31.03.2026

[3] https://www.nctu.ac.uk/our-research/randomised-trials/current-studies/coach.aspx

[4] Source: Westfield Capital Management, Bloomberg. Data as of 31.03.2026

[5] Source: Westfield Capital Management, Bloomberg. Data as of 31.03.2026

[6] https://finance.yahoo.com/quote/ABBV/

[7] Source: Westfield Capital Management. Data as of 31.03.2026

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