Combination Flu, COVID-19, RSV mRNA Vaccine Could Change Immunizations Landscape

In an interview with Pharmacy Times, Francesca Ceddia, MD, senior vice president of respiratory vaccines at Moderna, said the company is in early stages of development for a combined mRNA vaccine for influenza, COVID-19, and RSV. Such a vaccine could prove effective, while also improving vaccine rates.

Aislinn Antrim: Excitingly, Moderna is also developing a new combination respiratory vaccine candidate against SARS-CoV-2, influenza, and RSV. So where does this work currently stand?

Francesca Ceddia, MD: So, currently it is preclinical, but by the end of the year we will be able to start a phase 1 clinical trial. And we have observed in preclinical results a very strong immune response against all the antigens. So, this is very encouraging. And we have also started a combination COVID and flu [vaccine], which is clearly very relevant, particularly when it comes to the fall season. And then, you know, we will progress more and more into additional combinations. That's another important feature of mRNA vaccines, particularly our mRNA platform, which allows for including more and more antigens in combination.

Aislinn Antrim: Absolutely. And how would such a combination vaccine change the immunization landscape for people?

Francesca Ceddia, MD: Well, imagine that if you have to go to the doctor and get a shot, that’s either 2 shots in 2 different arms, or you can get 1 shot in the same arm. I think we would all want to have a combination vaccine, right? And this is quite typical in the pediatric space, because the majority of the pediatric vaccines are vaccines in combination, to avoid giving too many injections to children who have to be up to date with a number of vaccines. So, having, for example, a COVID [and] flu vaccine or COVID, flu, [and] RSV vaccine, also in adults who are less familiar with vaccination, then younger children, is a major advantage in adherence to vaccination. And, and therefore, I mean, we have the opportunity to tackle 2 diseases or 3 diseases at the same time. That will be quite brilliant.

Aislinn Antrim: Definitely. COVID-19 booster shots have been a major area of interest, particularly with upcoming colder months and rumors that there may be more booster shots coming out soon. What work is Moderna doing in this area?

Francesca Ceddia, MD: So, clearly COVID-19 remains a critical area of focus for us. We're still in the pandemic, there are a lot of things that we are all learning, and the epidemiology is shifting very rapidly. So, we have made major progress with our booster strategy because we have identified the opportunity to put together the original Wuhan strain with an additional strain. And now we did several studies with different strains, depending on which epidemiological stage we were. We tried, for example, the Wuhan strain with beta when beta was relevant, and now we are in the Omicron era. And so, we have just come out with in 1 country—actually the UK was the first country to approve our bivalent vaccine, which contains Wuhan plus the BA.1 Omicron variant of concern. And we believe that there are a number of countries who will follow and will continue to approve this vaccine very soon.

In the US, we have guidance from the FDA to include another variant of concerns, which is again, a sub-variant of Omicron, which is BA.4 and BA.5 in this vaccine. So, upon request of the regulatory authority, we rapidly shifted to also produce this vaccine, which is currently in testing. And we will hopefully be submitting soon to the FDA for approval in preparation for the fall. So, there is a lot ongoing. We are constantly scouting the epidemiological environment to understand what the next variant to come is, but at this stage, we believe we're really ahead of the curve because for once we are not reacting but we were prepared to address the Omicron advent quite rapidly.

Aislinn Antrim: Wonderful. That's good to hear. You touched on this, but a combination vaccine could reduce the need for multiple seasonal shots. How could this potentially improve vaccination rates as people are kind of tired of getting more and more boosters, and the flu shot? And it's a little overwhelming for a lot of people.

Francesca Ceddia, MD: So, there are several elements where people don't get vaccinated. And sometimes it's some fatigue, like in the case of COVID-19, but sometimes it's a practical aspect, right? You know, if you imagine an adult that has to go to maybe several visits for several vaccinations, I mean, that can be a bit overwhelming, right? So, I think a combination is an amazing, pragmatic approach to vaccination. How could you refuse to get protection against multiple viruses into 1 shot, whereas you would normally receive, let's say, 2 to 3 shots. And I mean, I think that can be an opportunity to enhance vaccination rates and coverage. And this is extremely important, particularly in an age category with the adults and older adults. They are, as I mentioned before, less acquainted with vaccination. And so hopefully, we will have a way forward with a combination vaccines.

Aislinn Antrim: Wonderful. We've covered a lot of ground. What should pharmacists know about respiratory vaccines when they're talking to patients or counseling patients?

Francesca Ceddia, MD: In the pharmacy, pharmacists play an incredibly important role. And we have seen this through COVID-19. I think the collaboration of the pharmacists and many other health care practitioners has definitely helped a lot in addressing the emergency of the COVID-19 pandemic. So many more [patients] have gotten more and more acquainted with vaccination. So, on top of flu, which many of them were probably more aware of, now they're aware of COVID-19 and so in the future, hopefully, they will be aware also of RSV. And so, explaining the importance to patients when they go to the pharmacist, to the pharmacies, how important it is to get vaccinated against vaccine-preventable diseases. Nobody wants to get an acute lower respiratory tract infection, nobody wants to run the risk of ending up hospitalized, right? So, I think pharmacists play a very important role. And ultimately, for vaccination, of course, patients have to consult also with their doctors, but information given by the pharmacist is going to be more and more of absolute importance.