Moderna has a public development pipeline. It shows they are working on, among other things, an HIV vaccine and vaccines/therapies for multiple types of cancer.
> mRNA vaccines [...] generate a much stronger immune response than responses that are generated to the protein in a normal flu vaccine [...]
> One limitation of the current flu vaccines is that they take about six months to develop, meaning scientists must choose which strains they think will be prevalent in the next flu season — even before the current one is over. So by the time the vaccines are ready for distribution, a different strain may have emerged as the better target.
> An mRNA flu vaccine, on the other hand, can be developed in about a month or so, giving researchers much more time to determine which strains to protect against.
https://www.washingtonpost.com/health/2021/04/11/mrna-flu-sh...
The flu vaccine seems to me to have a better chance of working than an HIV vaccine because we have been trying for decades to come up with one for HIV, without any success at all. I'm not saying that their attempts won't work either, but it's more of a bet than a flu vaccine. An iterative improvement on the existing flu vaccines would still be very helpful.
What typically happens with HIV is that the body kills most of it initially, but the remaining ones keep rapidly evolving until an iteration evades your immune response, this takes about 12 years. Seems like an mRNA vaccine could be done every 3 years for individuals and either completely eradicate the HIV presence in the body or do it once every 12 years for a reset
Let me know if I fundamentally misunderstand something
What is the big driver of HIV is in the name, it's a Immunodeficiency virus - it kills CD4+ T cells and other cells of the immune system. At a certain point you don't have enough CD4+ T cells left and you lose your adaptive/cell-mediated immune system and then you're in big trouble. Essentially it's a war of attrition and unless you're part of some tiny proportion of people who have either a form of immunity against it or an immune system that for whatever reason is able to continue waging war on it then you will succumb
I have never understood this. How many strains are there? I thought there were only like 4 or so. Why don't they just do them all every year?
Turns out the answer can be found here:
https://www.cdc.gov/flu/about/viruses/types.htm
"There are four types of influenza viruses: A, B, C and D. Human influenza A and B viruses cause seasonal epidemics of disease (known as the flu season) almost every winter in the United States. Influenza A viruses are the only influenza viruses known to cause flu pandemics, i.e., global epidemics of flu disease. A pandemic can occur when a new and very different influenza A virus emerges that both infects people and has the ability to spread efficiently between people. Influenza type C infections generally cause mild illness and are not thought to cause human flu epidemics. Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people."
"Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: hemagglutinin (H) and neuraminidase (N). There are 18 different hemagglutinin subtypes and 11 different neuraminidase subtypes (H1 through H18 and N1 through N11, respectively). While there are potentially 198 different influenza A subtype combinations, only 131 subtypes have been detected in nature. Current subtypes of influenza A viruses that routinely circulate in people include: A(H1N1) and A(H3N2). Influenza A subtypes can be further broken down into different genetic “clades” and “sub-clades.” See the “Influenza Viruses” graphic below for a visual depiction of these classifications."
So the answer is: 198 possible strains, 131 that actually occur. That explains why they have to pick and choose.
It's not that hard to make a new vaccine, the process for flu is very accelerated because they're just a variation on the original theme which has been proven to be safe (though unclear on effective until AFTER the flu season hits). If you think about it, we make a new flu vaccine every year, and develop it in 6 months. Each one contains a few guesses as to which of the flus are going to be an issue, it's not just one antigen in the vaccine. Those guesses are just that, an informed prediction, which is why the vaccines tend to be fairly ineffective (40-60%) at preventing disease altogether, though perhaps better at preventing serious disease.
Moderna is claiming to be quicker, so they'd have a more accurate read on what the REAL flu strain this year is going to be, and so it should be more efficacious. The key variable will be dosing. mRNA vaccines can only deliver a certain amount of mRNA so it might be impractical to deliver very many antigens at once. Also delivery issues, the current flu vaccine is super easy to make and deliver to patients, mRNA vaccines with their complicated cold chains aren't. Obviously it's not an impossible problem, but it's less convenient.
Time will tell, it's certainly very promising!
Helpful: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619640/
It does raise the question of why they couldn’t just put a bit of all 131 subtypes in the vaccine. Or if that’d overload the immune system, say, the X subtypes most likely to makeup say 99% of probable flu season strains.
We’ve had people even recently refusing to give their kids polio, tetanus, or measles vaccines - and even 5 minutes of honest research or questions to a doctor will make quite clear how bad an idea THAT is. Getting 100+ flu vaccines, all which would have to go through a pipeline taking nearly a decade, when ‘nothing bad has happened’ on that topic for a hundred years?
Ain’t nobody going to pay for that.
We’ll see how the calculus is different soon. I for one would rather my tax dollars go towards figuring something like never having the flu again than blowing up some random middle eastern country a couple more times.
$20 (likely current retail cost of a flu shot) x the 46 million older adults in the US is a hair less than a billion a year. Making 131 or so effective flu vaccines and getting them through the process with the prior known and effective process? (including all the failed attempts)
Hopefully we’d get some economies of scale, estimates [https://www.passporthealthusa.com/2018/02/how-much-does-it-c...] I found had it between 500m to 2.5billion and a decade each. So 65billion to 327billion.
So between 65 to 327 years for positive ROI if that was your metric.
If you’re talking public good, it would be immeasurable for us and the world though, no question, and on the high end that’s less than a third [https://www.google.com/amp/s/www.bbc.co.uk/news/world-473918...] of what we’ve spent in Afghanistan alone.
We'd need try to find out, which I personally think would be way better for everyone involved than many other things we spend money on. So take that as my vote for trying?
https://www.who.int/influenza/vaccines/virus/recommendations...
But in general, being exposed to (say) seasonal flu every year might not help you at all when a new strain of pandemic flu shows up. The 1918 flu tore through young healthy people.
To make up an unrelated tech example of that, my impression was this would be like picking a Blackberry phone, while all your friends have Windows phones. You weren't forced to pick a Blackberry by vendor lock-in, but you may miss out on being in some social circles. Changing that group dynamic would require everyone to switch, not just on a case-by-case basis. But in this example though, the Window's phones (aka vaccination) have strictly more features than the Blackberry (aka kills you less often), so if you can afford to (aka you have an average immune system), it would be more logical to get a new phone yourself and join the network, than to ask all of your friends to get new phones.
We have two examples of safe (so far), effective and mass produced mrna vaccines; so it's probably easier to get funding to research and test other targets. HIV is a popular target, although it's also very difficult.