The availability of COVID-19 vaccines less than a year after the arrival of the novel coronavirus has showcased how mRNA vaccine technology could work and how quickly and safely it could be put to use. So, let's take a look at what's in the pipeline for future mRNA vaccine applications.
What is mRNA & what does it do?
More fully known as messenger RNA, mRNA is a type of genetic material that can create a copy of a protein in a virus that can cause illness. With mRNA vaccine technology, the body primes itself to recognize the copied protein and the immune system learns how to fight off infection should a person pick up the actual virus.1
Researchers have studied mRNA vaccines, which scientists developed as a way to create vaccines quickly and cost-effectively, for more than 30 years.2 The development of the mRNA COVID vaccines from Pfizer-BioNTech3 and Moderna4 both relied on technology that helped develop cancer immunology treatments, which work by telling the immune system to target and destroy specific cancer cells in the body, according to the National Cancer Institute.5
The technology has also been used to study vaccines for the flu, Zika, rabies and cytomegalovirus, per the Centers for Disease Control and Prevention (CDC).6 None are yet approved for use by the FDA, but many studies are ongoing.
Public concerns about mRNA vaccines
As the first COVID vaccines became available relatively quickly, people expressed concerns about how rapidly the process went. But because years of previous research and the immediate need to slow down a new and potentially deadly and/or disabling virus have supported the technology, there was no evidence of safety concerns being overlooked in the rush to make the vaccines accessible. As researchers wrote in the American Journal of Medicine , "Although there are no previously approved mRNA vaccines, these vaccines have been trialed in humans for oncologic therapies for nearly a decade, and have been trialed in humans for infectious disease for over three years."7
Similarly, researchers noted that subjects in phase 1 trials of an influenza mRNA vaccine and a phase 3 COVID- 19 mRNA vaccine trial "have demonstrated that injection site pain, erythema, swelling, fever, fatigue, headache, chills, muscle pain and arthralgia are more common in the vaccine group relative to placebo...These events are consistent with reactogenicity, which is expected after immune system instigation." And finally, the lack of long-term adverse effects reported in 2022 after more than 11.4 billion people received COVID-19 vaccines since the start of the pandemic suggests "that long-term adverse effects are unlikely," researchers noted.8, 10
According to Fierce Biotech, another concern surrounding mRNA vaccines is related to distribution.9 These vaccines need cold storage, which slowed down how quickly some people could receive COVID shots when they first became available. "While the companies have fine-tuned the distribution process, and governments have found ways to overcome the hurdles, some regions simply can't support vaccine programs using these first-generation mRNA shots," Fierce Biotech noted.
Other concerns relate to the need for booster shots, because it's unclear for how long one vaccine will effectively protect against some viruses such as COVID. Also, some viruses such as influenza and COVID mutate, requiring the need for booster doses (particularly in the case of these two respiratory illnesses).
Applications of mRNA vaccines (especially in relation to cancer care)
As mentioned earlier, researchers are studying mRNA vaccines for how well they can treat influenza, Zika, rabies and cytomegalovirus.11 As of last year, at least three phase 1 clinical trials from Sanofi/Translate Bio, Pfizer and Moderna were evaluating mRNA vaccines for flu strains for adults.
Moderna is using mRNA technology to evaluate both a vaccine for the Zika virus, which can cause stillbirth, miscarriage and birth defects, and for respiratory syncytial virus (RSV); both studies should conclude in 2023. Moderna is also in the lead in studying mRNA technology to treat HIV and cytomegalovirus (CMT), which is dangerous for people with weakened immune symptoms and babies.
Researchers are also studying mRNA vaccine technology for how it can help people with different kinds of cancer, both on its own and alongside other medications that help strengthen the immune system to help fight tumors.12 Medical professionals are evaluating such vaccines for the treatment of people with pancreatic cancer, colorectal cancer or melanoma. Other mRNA vaccines being studied in clinical trials include personalized cancer vaccines, whose basis for creation is a person's specific tumor sample. For example, Moderna is trialing two personalized cancer vaccines:13
1. The first vaccine addresses melanoma and is in phase 2 of clinical trials
2. The second addresses those with solid tumors and is in phase 1 of clinical trials
A third Moderna mRNA vaccine, currently in phase 1, works on a certain cancer cell protein in non-small-cell lung cancer, colorectal cancer and pancreatic cancer.
CureVac, Boehringer Ingelheim and Ludwig Cancer Research have produced another mRNA vaccine in phase 1 and phase 2 trials focusing on non-small cell lung cancer. An mRNA vaccine for ovarian cancer taken together with chemotherapy is in phase 1 and being evaluated by the University Medical Center Groningen with BioNTech. BioNTech is also working with Regeneron Pharmaceuticals on a phase 2 mRNA vaccine for advanced melanoma.
mRNA vaccines currently in production
Currently, the Pfizer-BioNTech14 and the Moderna15 COVID-19 mRNA vaccines are fully FDA-approved for use in the United States to prevent COVID-19; the Pfizer-BioNTech vaccine is approved for people ages 16 and older, and the Moderna vaccine for people 18 years and older. The FDA has granted approval for emergency use for the Pfizer-BioNTech vaccine, known commercially as COMIRNATY®, for those ages 5 to 15.
How the pandemic has potentially shifted the future of mRNA vaccines & public perception
The pandemic helped scientists and researchers join together to use the existing technology of mRNA vaccines to develop, study and ultimately make available vaccines that effectively protect people from getting seriously sick and/or dying from COVID-19. That success is hopefully going to shed light on how mRNA vaccine technology can work effectively both in ongoing clinical trials for current mRNA vaccines as well as pave the way for future use for other medical diagnoses.
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