From Blueberg News and iHeartRadio. It's the big take. I'm Weskosova today a flu shot that might actually work thanks to COVID. Hey remember to get your flu shot. You hear that every year at the start of flu season, and every year you might say to yourself, does it even do anything? Is the flu shot outdated?
With this year's vaccine only protecting one in four people, It's six to.
Eight month log time.
It's kind of like predicting the weather.
You tell people go buy a bunch of a bunch of snow coats, and if it rains, you're in trouble.
Okay.
So the solution is what Hopkins Sciences make a better flu shot. So if I want to avoid catching the flu, should I take a flu shot?
Yes?
Influenza vaccination clearly protects you. It isn't a perfect vaccine. It doesn't protect you one hundred percent, and it varies from year to year. But the best way to avoid influenza is to get your flu shot every year.
That hit or miss flu shot may soon be a thing of the past. Bloomberg biotech reporter Angelica Peebles is covering a huge push to fight flu with the same advanced technology behind the COVID nineteen vaccine.
We've all been.
Thinking about COVID so much these past few years, but flu is still very much a problem, and this year we saw it come back in a big way here in the US. I was looking at the data this morning from the Centers for Disease Control and Prevention, and they estimate there were twenty six to fifty million flu cases this year alone, which of course is not great if you're one of those people, if you're a parent
who's dealing with this. And so even though we've forgotten about flu a little bit, it's still very much a problem here in the US as well as around the world.
How many people actually get flu each.
Year it can vary depending on the severity. This year, even though it came early, it was considered a pretty normal flu year. But again, about fifty million people in the US alone, and it can kill hundreds of thousands of people every year. The World Health Organization estimates that it can be about six hundred and fifty thousand people a year die from flu.
And yet every year the flu shot comes out, a lot of people ignore it. Sometimes you can find out doesn't really work that well.
The flu shot is our best defense against the flu, but unfortunately it's still not that great. This year was a pretty good year, and it cut the risk of hospitalizations by about half, but in some years it only decreases your risk of getting infected with the flu by about ten percent, and so that variability is a huge problem that we face every year, and that unfortunately also causes people to not want to get the flu shot.
So in the US, only about half.
Of people who are eligible get a flu shot every year, and that's something that public health officials are fighting every year. There's always this big push to get vaccinated, but people have this idea that it's just the flu, and that the flu shot isn't that great, So why should I bother getting it?
Why isn't the flu shot that great?
There are a number of reasons why our flu shot isn't as good as it could be. And one of the problems is that we're using this method that's from the nineteen thirties, and we make the flu. We grow the virus in chicken eggs, and so it's exactly how it sounds. You have these fertilized chicken eggs, we inject them with the virus and it replicates in there, and then eventually we take that and activate it and put
it in a flu shot. And the problem is that while it's growing in the egg, the virus can adapt to its egg environment. So, as one scientist told me, if we were vaccinating chicken eggs, it would be perfect, but we're vaccinating humans, and that's why it's a problem. So the virus that we're vaccinating against can be a little bit different than what's circulating, and that's a problem.
And also because it takes so long, it takes about six months to make the vaccines using this method, that we have to make the predictions so far in advance. And the problem there is that flu isn't just the flu, even though we think of it.
As one virus.
It's really all kinds of viruses in the same family, and we never really know what we're going to get, and so the World Health Organization and public health officials around the world have to make predictions, usually six months at least in advance of when the flu season actually starts. And so they're making these predictions so far out about what actually circulates, and sometimes they're wrong. Sometimes even their
best guesses miss the mark. So that the vaccine that we're getting doesn't match what is actually circulating, and so we're constantly behind the virus and trying to keep up with it, and we usually aren't that great.
And what is it that the scientists have to guess?
Think of it a little bit like the covid variants, Right, we had this one, you know, covid that we thought of and now it's been changing. It's omicron ba one BA four five, and so similarly, flu is changing just ever so slightly, and they have to guess exactly which strains will be circulating. And it's not at all a guarantee because the viruses, as one scientist told me, the viruses are smarter than we are.
How many eggs do they use in a flu season to make all those doses?
We are currently making about five hundred million vaccines flu vaccines every year, and so you're thinking about hundreds of millions of eggs every single year to make enough flu
shots to vaccinate the world. We've asked specifically this year about bird flu and whether that's been a problem for the vaccine manufacturers, and what they've told us is that these are completely separate eggs that are under different sorts of protection and in theory immune from the problems that we're seeing at the grocery store and that you're dealing with when you try to buy eggs.
So to fix this problem that you describe, we now have scientists taking a look at the mRNA technology behind the COVID shots to use that for a flu vaccine.
Flu could be a big opportunity for mRNA, And the idea is that mRNA proved itself so well against COVID that flu could be the next big opportunity here. And so Pfizer and Maderna, of course, the two COVID titans, if you will, they are the leaders in this space right now. They're both testing their mRNA flu shots in late stage studies, so they should have data from their shots as soon as this year, possibly in the next few weeks, if not later this year.
And they're not the only ones.
The big flu shot manufacturers that are currently dominating the space, they're also getting in this and I think that just speaks to the excitement about mRNA as a possibility for flu shots.
Angelicoat why is mRNA better for a vaccine than the traditional flu vaccine We're all used.
To the thing that came up over and over in the course of my reporting was just how much faster mRNA technology is to make. And that is what people see as the biggest game changer here, because right now we're making our predictions for what will be circulating so far in advance that we're constantly behind the virus. And in theory, the mRNA technology could have the time between making the prediction and actually vaccinating people, and so that
is what people are so excited about. And the reason that it's so much faster is because right now, with the chicken eggs, you have to grow so much virus in these chicken eggs, and with mRNA, you don't need that. So the way it works is that your taking a virus that you've grown and injecting it into people and
showing your immune system this whole virus. And with mRNA, you can teach the body to make a particular protein, such as the spike protein and the novel coronavirus, and if you do that, you can then get the immune system to build a tailor made defense against a threat, and that eliminates the need to build this virus and you're just making it. You're using your body as a vaccine manufacturing facility.
So how do you make an mRNA vaccine? You don't need the chicken eggs, but they have to produce it. How is it produced?
It's a really fascinating process and honestly one that you need to use your imagination for. So I went to one of Pfizer's manufacturing facilities outside of Boston, and what struck me is that you go to this huge campus and the rooms where they're making the mRNA are just two little rooms.
Think of going to a brewery.
And I was actually at a brewery this past weekend and it was bigger than what it took to make all of this mRNA. So they only have a few tanks, and inside the tanks they're growing all of the all of these things called plasmids, which is basically a DNA template, and they're growing so much material in these little containers and a single one and ten liter batch produces enough for twenty two million doses of a vaccine.
Yeah, so what you're looking at is our DNA production facility as part of the COVID mRNA based vaccine. You see a number of my folks in there. This is probably one of the better windows we'll see on our tour the next windows quite a bit smaller, But as Jim said, the DNA is really the start of this process.
You walk in and you see these metal tanks like the ones that you'd find in a brewery, and inside those tanks they're growing tens of billions of bacteria to help make the material for the mRNA.
So we've got really good industrial controls. We control things like pressure, temperature, flow rates. So if you can't really see if we have a two thousand liters per manner, you can see some piping with some yellow labeling. These come down and actually feed our for manter it penetrates through the floor that you can see up in the upper back.
So all of this is happening in these small little rooms, and it's happening at such microscopic levels that you look inside the rooms and you can't even see what's happening, as opposed to going to say a chicken egg manufacturing facility, where you would see palettes of eggs everywhere.
So using this method, they're able to make all the various potential flu strains that might pop up in a given year and more quickly kind of put them all together into a single vaccine.
The way it works is that they make one strain at a time. So, for example, when I was there and they were walking me through the way that they've been making their most recent boosters that contain two strains, they make one strain at a time, They make tons and tons of that, and then they do the next strain and that's for cross contaminating purposes. But in theory, with the flu shot, which typically contains four strains, they would make one strain at a time and then you put them all together.
And are they more effective? Do we know whether they actually work better than the traditional flu vaccine.
We don't know yet, and that's what these big trials are for. So Pfizer and Maderna both are testing their mRNA flu shots in tens of thousands of people, and we will know as soon as this month what it will look like and whether these can truly live up to the promise that we've all been so excited about.
And Angelica, beyond the flu vaccine itself, you write that what these pharmaceutical companies are hoping is that they can then bundle this mRNA flu vaccine with vaccinations for other diseases too.
The big thing that these companies are so excited about right now is the possibility of combining covid and flu into one shot, because if you think about it, it's a lot easier for people because who likes two needles? Not that many people, so then you get it all in one shot. And of course, if you're a COVID vaccine maker and you're watching your sales decline precipitously, you see flu as an opportunity to bring those sales back up.
So there's a business case here, but there's also, of course the public health side of things that, especially as people have lost interest in the COVID vaccines, if you have them coming in for flu, you could then use it as a way to get them to get the
latest covid booster. One other thing that Maderna wants to combine with is RSV, the respiratory virus that so many people heard about this past winter with tons and tons of kids getting infected with it, and so Maderna recently had positive phase through trial data for its RSV vaccine, and assuming that flu is also positive, they could then look to combine covid FLEW an RSB into one shot.
ANGELICAC remind us what is a phase three trial.
Phase through trial is typically the last test that a company needs to succeed before it can seek approval from the FDA for a new drug, and so a phase three trial looks at both efficacy and safety for a new drug.
So that means that these tests are getting close now to the point where they'll be able to submit them to the Food and Drug Administration for evaluation.
Yes, if these trials are successful, then Maderna and Pfizer are both planning to seek approval for these vaccines.
When we come back, will people weary of COVID vaccines and boosters line up for a new, improved flu shot? Angelica? This new flu shot sounds promising, but do you think people will we'll actually get it? We've obviously seen a lot of vaccine skepticism and even many people who've got their first COVID shots are choosing to skip the recommended boosters.
People have lost interest in the COVID vaccines for a few reasons, but one of the biggest ones is probably that people are still getting COVID anyway. And it's a question that I ask the vaccine makers all the time. You know, what would you tell people, and of course they say, well, these vaccines are still preventing people from getting really sick and dying, which is the most important thing.
But I don't know about you, but I talk to people all the time, my family, my friends, and people say well, I got COVID anyway, So these vaccines don't work, and that's a real challenge that they're going to have to contend with going forward, whether it's COVID or flu if we do see that same problem, and that's partially what's contributing to the fact that only sixteen percent of eligible Americans opted to get the last COVID booster.
Aside from COVID, of course the flu and RSV, are there other illnesses that are under consideration for mRNA vaccines.
One of the big ones right now that Maderna's exploring is a personalized cancer vaccine. And this is different than what we would think of as a vaccine. It's more
of a treatment. But they are still using mRNA technology to enhance the potency or the effect of another cancer drug, key Truda, and that one is really exciting right now, and we're expecting to see more data from Maderna and they're saying that they are ready planning to test mRNA and all kinds of other types of cancer based on that data.
What are these new vaccines going to cost? Are they going to be much cheaper because they're easier to make.
The current flu vaccines cost about thirty dollars, and although the mRNA vaccines are easier to make, it's conceivable that they will be more expensive. So even the current flu shot makers, when they've developed newer, more potent doses typically
use for older people, they've been more expensive. So the high dose vaccines that are currently on the market are about eighty five dollars, and the COVID shots Pfizer and Maderna have both talked about pricing them at up to one hundred and thirty dollars a shot, so you can imagine that the flu shots would be, if not one hundred and thirty dollars, let's say even one hundred dollars. Of course, the companies don't talk about price until something
is on the market. That's true of all pharma companies. They don't like to give the price until they absolutely have to. But if you just look at where the higher potency shots are today and their COVID vaccines. I would think it's fair to say that these are going to be more expensive than the typical flu shots that most of us are getting.
And why do you think that they're going to be more expensive? What's the rationale.
Behind that rationale?
Is that if they're more effective, then you can charge more. And it's this kind of an interesting dynamic that you see in every new drug product that comes to market. But we see companies give these calculations of, well, our vaccine is this effective and therefore will prevent this number of people from going in the hospital, and therefore will save the healthcare system this much money.
And so it's a lot more complicated.
Than just saying it cost us x amount to make and therefore it will charge x price.
It's this whole.
System of this is how effective it is, and this is how valuable it is to society, and we're going to base our price off of it.
During COVID, of course, the government stepped in and subsidized the price of the vaccine so people could get it for free. Do you think that there's going to be pressure not to charge a lot for a flu vaccine that people need to get every.
Year based on what we've seen recently. I don't know that the pressure will extend to the flu vaccines because even Maderna, when the CEOs to Fan Bonzel testified before the Senate panel a few weeks ago, he managed to brush off a lot of the heat and made his case that look, we are charging what is fair based on the value that our vaccines are providing, and as long as they can make the case that these vaccines are truly better and help keep people out of the
hospital and save money, they're going to charge what they think they can. But that's the big question here is that in theory, these vaccines could be better, they could be more efficacious, but they need to prove it. And that's something that when I talk to analysts who are making these predictions on how much money flu shots can make.
That's a big point of controversy, is whether they can be better and whether they can prove that they are worth the cost, because of course, with COVID there's nothing else to compare them to. There are other shots that have been approved but haven't been used that widely, and
so they dominate that market. But now they have to come in and prove that it's worth paying more money, especially for twenty year olds or thirty year olds for everyone, and those higher potency shots that do cost more today, those are typically used for the older populations, so people who are at risk, and it's easier to make that case now. To make the case that all of these mRNA shots for everyone should be more expensive, they're going to need to prove it with the data.
I suppose. Another thing that comes into play, are just insurance companies. Are they going to be willing to bear the extra cost or does it mean that we're all just going to wind up observing that cost because they're going to pass it down to us.
Yeah.
When I talk to Stefan Bonseel, the Maderna CEO, he says that people are really interested in a better flu shot because of the cost. Right now, that if you're an insurer and you have tons of people going into the hospital every year because of flu, than they are paying all this money for the hospitalization and everything that goes along with it, and that if you can give them a better vaccine, then you can save all these costs.
But again, they need to prove that, and right now it's theoretical and the only thing that's going to help answer that is what these studies show.
After the break. How long until this better flu shot is ready to go? Suppose the phase three trials of these vaccines that we've been talking about go well, the FDA evaluates it, they approve these new vaccines. How long until we actually start seeing them where we can use them.
It could be as soon as next year.
We need to see how soon the trial data come out, and once we have that, we'll have a better idea. But Maderna and Pfizer, assuming they have positive results from their studies this year, it's likely that we could see these shots as soon as twenty twenty four.
As you said earlier, a lot of people are just not taking the COVID vaccine anymore, a lot of people don't get the flu vaccine. And then we've had a lot of politics surrounding vaccines where people made all kinds of false claims they were dangerous, or there was a government plot. We've heard all sorts of things like that. Do you think that this could help or possibly hurt with the public's perception of vaccines.
It's interesting I spoke to a number of people while I was reporting this story, vaccine scientists, people who've been in this field for a long time, and they all say that in some ways it's counterintuitive, but the pandemic actually hurt perception of vaccines and it hurt the public's
willingness for immunization. And even though at the beginning, when the shots were rolled out and this data came out that was so amazing and people were standing in line for hours to get vaccinated, that that enthusiasm has been.
Replaced by skepticism.
And it's unfortunate because people don't know what to do from here, because people aren't sure how we're going to stem that tide. And one person I spoke to, one scientist, she was saying that you could create a perfect flu shot or a vaccine for anything, really that was one hundred percent perfect, but there would still be people who wouldn't take it. And it's going to take some work to figure out how to combat that and to get people excited about vaccination again.
And Jockay, you are covering mRNA technology pretty closely. Where do you think it heads from here?
When it comes to vaccines, many people will tell you that vaccines are just the beginning for mRNA, that it's sort of the low hanging fruit, and even Maderna. If you look at their pipeline, they have programs not just vaccines, but treating disease with mRNA, and so there's a lot more outside of vaccines, but even within immunizations. Like I said, we have cancer vaccines that are in development and other
ways to use mRNA. And so, although the pandemic really opened people's eyes and introduced people to this field, there's still so much more that we can do.
And jelicap Peebles, thanks for coming on the show. Thank you, thanks for listening to us here at The Big Take. It's a daily podcast from Bloomberg and iHeartRadio. For more shows from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen, and we'd love to hear from you. Email us questions or comments to Big Take at Bloomberg dot net. The supervising producer of The Big Take is Vicky Virgalina. Our senior producer is Katherine Fink. Rebecca Shasson
is our producer. Our associate producer is Sam Gebauer. Phil de Garcia is our engineer. Our original music was composed by Leo Sidrin. I'm west Kasova. We'll be back tomorrow with another big take down down Don Don Peple Barter