ERS 2022: mRNA Science and the Next Generation of Vaccines: Transforming the Management of Respiratory Infections
The panel of experts discussed the mRNA science in vaccine generation to manage respiratory infections.
The first talk focused on mRNA platform technology and its potential beyond COVID-19. Moderna's investments in platform research over 10 years established a scientific foundation to enable the current development pipeline. In 2021, Moderna focused on the scale of clinical development and manufacturing to respond to the COVID-19 pandemic. Investments in platform research and mRNA science have helped Moderna reach its goal. mRNA vaccines can be multiplexed to encode multiple individual proteins or multiprotein complexes. Antigens from different viruses can also be multiplexed. All mRNA vaccines and medicines tap into the same process by which the human body makes proteins. mRNA medicines have a small and highly flexible manufacturing footprint. Moderna combines mRNA engineering, delivery system discovery, and clinical manufacturing platform with a single, fully integrated organization. Only 4% of the viruses discovered since 1980 have available vaccines; some viruses with available vaccines also have unmet needs (e.g., influenza). Approximately only 25% of viruses have available vaccines. mRNA access will allow scientists worldwide to explore novel vaccine designs against prototype viral families in preparation for diseases.
The next talk focused on revolutionizing the respiratory disease landscape through advances in vaccinology. In England, about 60.5% of healthcare workers and 52.5% of individuals 50 to 64 years of age were vaccinated for influenza in 2021-22. By early January 2022, the last influenza season, pharmacists had delivered 4.80 million doses of influenza vaccine, and by the same time, they had delivered 22 million doses of COVID-19 vaccine. Modern intranasal technology is required to increase mucosal immunity, comfort, and acceptance of vaccines. Additionally, mRNA technology, abandonment of egg-derived vaccine production, the addition of adjuvants and an increase in antigen content may also be required in the future for influenza vaccines.
Respiratory syncytial virus (RSV) is the first respiratory virus infection in infants 0 to 2 years old. Within two years, most children in the UK contract RSV. It is a significant concern for infants under the age of 1 year and the elderly, particularly babies born prematurely and elderly with chronic diseases. Older adults may need hospital admission, and some may even die. Older adults are at greater risk than young adults of severe complications from RSV due to immunosenescence. Wearing masks, social distancing, and constrained population movements for SARS-CoV-2 have dramatically reduced the transmission of RSV and influenza viruses.
UK advice on co-administration of COVID-19 vaccines and other vaccines is as follows:
- COVID-19 vaccines can be co-administered with-
- Influenza and pneumococcal polysaccharide vaccines in those >65 years
- Pertussis-containing and influenza vaccines in pregnancy
- LAIV, HPV, MenACWY and Td-IPV vaccines in school programs
In June 2020, the World Health Organization (WHO), in their position statement, stated that the use of currently licensed vaccines based on the index virus confers high levels of protection against severe disease outcomes for all variants, including Omicron with a booster dose. Therefore, the continued use of currently licensed vaccines for primary vaccination and as a booster dose is appropriate to achieve the primary goals of COVDI-19 vaccination. In addition, available data indicates that the inclusion of Omicron, as the most antigenically distinct SARS-CoV-2 variant of concern, in an updated vaccine composition may be beneficial if administered as a booster dose to those who have already received a COVID-19 primary series.
On 18th August 2022, the WHO provided an excellent practice statement on using second booster doses for COVID-19 vaccines. The strategic goals for vaccination mentioned in the statement are as follows:
In the Interim recommendations for using the mRNA-1273 vaccine against COVID-19, the WHO stated that a booster dose of 50 µg administered >6 months after 100 µg mRNA-1273 primary series increased neutralizing antibody titers 13-fold, one month after vaccination versus pre-booster levels.
On 15th August 2022, the Medicine and Healthcare products Regulatory Agency (MHRA) authorized the first bivalent booster COVID-19 vaccine, Moderna's bivalent booster mRNA-1273.214. On 2nd September 2022, the first adapted COVID-19 booster vaccines are now authorized in the European Union. Comirnaty Original/Omicron BA.1 and Spikevax bivalent Original/Omicron BA.1 are for use in individuals aged 12 years and above who have received at least primary vaccination against COVID-19.
In conclusion, there is still room for improvement in vaccines against main respiratory viruses. Therefore, increasing awareness and vaccine coverage in at-risk populations in low-income countries is crucial.
European Respiratory Society (ERS) International Congress 2022, 3rd-6th Sept. 2022, Barcelona
