What’s next for Pfizer, Moderna

Three years and billions of Covid vaccinations in the pandemic, Pfizer And Modern say their work is far from done.

The two pharmaceutical companies, whose Covid vaccines have become household names, usher in a new era for their vaccines that will elevate the role they play in protecting public health, but also simplify what people need to do to coexist with the virus.

This involves developing new versions of the vaccines that aim to provide broader, longer-lasting immunity against the virus, and combination shots that protect against Covid and other respiratory illnesses in a single dose, among other efforts.

These plans coincide with a broader shift in the landscape of the Covid pandemic.

Public health emergencies in the United States and globally are over, vaccine adoption and sales growth have slowed, and Pfizer and Moderna will sell their vaccines directly to healthcare providers at around $110 to $130. per dose as early as the fall, when the federal stock of free vaccines is expected to run out.

Neither company provided CNBC with an update on the exact price of their shots in the private market.

Many of Pfizer’s and Moderna’s plans for their vaccines may not reach the public for a few years, and the success of those efforts isn’t guaranteed.

“One of the greatest things about Moderna is the company’s willingness to lean, even if it’s not clear exactly where things will go,” Dr. Jacqueline Miller told CNBC. Head of Moderna’s Infectious Diseases Therapeutic Area.

Here’s what Moderna and Pfizer are saying for their Covid snaps.

Pfizer and Moderna aim to follow a trend in the United States towards annual Covid injections rather than frequent booster doses.

Regulators are moving towards a flu vaccine model for Covid vaccines, which means people will receive a single vaccine each year that is updated each year to target the latest variant that is expected to circulate in the fall and winter. A panel of independent FDA advisers will meet in June to select the Covid strain that new vaccines should target when rolled out later this year.

Both Moderna and Pfizer told CNBC that messenger RNA technology will allow them to keep pace with new variants of Covid each year.

This technology, which is used in both companies’ Covid injections, teaches human cells to produce a protein that triggers an immune response against a certain disease.

Miller, who helped lead Moderna’s 2020 Covid vaccine development, said the benefits of using mRNA became evident earlier in the pandemic. This includes the ability to quickly increase a shot’s craft and easily change the variants they target.

“The vaccine has become proof of the value of mRNA in a pandemic when you need to do something fast,” Miller told CNBC. “The speed of this platform — it allows us to do things three times faster.”

Dr Mikael Dolsten, scientific director of Pfizer, hopes that annual Covid vaccines will improve public sentiment around vaccination. He said the public grew increasingly unhappy with health mandates during the early stages of the pandemic, and “unfortunately some people see vaccines as part of that.”

An annual schedule can help people see Covid shots as another “very natural part” of protecting their health and encourage more of them to get vaccinated each year, according to Dolsten.

“I think of it like the introduction of seat belts for cars. People didn’t want to wear them at first, but over time they realized how much seat belts protected them. Now everyone world uses them today,” Dolsten told CNBC. “That’s kind of the way the vaccine story needs to be rethought.”

Pfizer’s and Moderna’s Covid vaccines both offer robust protection against the virus, but that immunity can start to wear off after four to six months.

Part of Pfizer’s strategy to move to an annual Covid vaccination schedule is to develop “next generation” versions of the vaccine, which aim to broaden and extend the protection people get for up to a full year.

“The protection is still there but is gradually diminishing, and we’re working with two different approaches to make it a bit more yearly durability for the majority of people,” Dolsten told CNBC.

Pfizer and its Covid vaccine partner BioNTech are working on a vaccine that will increase the level of antibodies a person receives after being vaccinated “several times”, according to Dolsten.

The vaccine won’t work too differently from the company’s current vaccine, which teaches cells how to make harmless copies of Covid’s spike protein. The immune system detects this protein and creates protective antibodies that help ward off the virus but wane over time.

The main difference is that the next-generation vaccine will teach cells how to make copies of an “enhanced” spike protein, which will generate a much higher level of antibodies that could last an entire year.

“If we raise the antibodies, say three times, that means they will last and protect for a year,” Dolsten said.

The company is working on a second vaccine that aims to boost T cells, another form of protection that targets and destroys cells infected with Covid.

In addition to antibodies, Pfizer’s existing vaccine triggers the creation of T cells against the spike protein. T cells decline more slowly than antibodies, which means they provide longer-term protection against the virus.

Pfizer is adding another strain of mRNA in its new vaccine that will expand this T-cell response.

The strain will specifically trigger an increase in T cells against other parts of the coronavirus called spikeless proteins. These T cells, in addition to those generated against the spike protein, will provide protection against “every corner of the Covid viral landscape”, according to Dolsten.

The non-spike proteins also mutate more slowly than the spike protein, meaning any T cells generated against them will likely protect against a wide range of Covid variants.

Dr Paul Burton, Moderna’s chief medical officer, said the company has its own “next generation” Covid vaccine, which aims to improve the way injections are stored and administered.

The current business plan should be kept in an ultra-cold warehouse. Once thawed, the vaccine can be stored in the refrigerator for up to 30 days, according to Food and Drug Administration guidelines.

Burton said Moderna’s new snap would be “refrigerator stable,” meaning it would have a longer shelf life in the fridge. The company will achieve this by shortening the length of the mRNA strand in the vaccine, according to Burton.

The vaccine could increase the number of vaccine suppliers around the world, especially in developing countries that may not have freezing capabilities.

Moderna is studying the shot in a Phase 3 trial, Burton said. The company’s existing Covid vaccine is its only commercially available product.

Pfizer and Moderna are both banking on a new list of combination vaccines, which are supposed to provide robust protection against Covid and certain respiratory diseases in a single dose.

Dolsten said there was a growing need for this type of vaccine because certain changes in society are creating a “more prosperous environment” for infections.

Climate change is causing the Earth’s temperature to rise. People live longer but become more vulnerable to disease as they age. A growing number of people are moving within countries and across borders.

Dolsten said these factors have contributed to the spread of different diseases, sometimes at the same time. The United States, for example, experienced a so-called tripledemic of Covid, respiratory syncytial virus and influenza last winter.

Dolsten said people may not remember or even feel comfortable taking three different shots for these respiratory conditions on a yearly basis. So creating a plan that will help people fight more than one at a time will “simplify their lives,” he said.

Pfizer and BioNTech are developing a vaccine that targets both Covid and influenza. The companies began a Phase 1 trial for the shot in November and said they plan to launch it in 2024 or later.

Dolsten said drugmakers were also conducting clinical trials for another vaccine targeting Covid and RSV. Pfizer first hopes to get FDA approval for its RSV vaccine for the elderly later this month, he noted.

Meanwhile, Moderna’s shot targeting Covid and flu is in early clinical trials. Another vaccine that protects against influenza and RSV is also in its infancy. Moderna is also developing a combined triple vaccine, which would target both Covid, influenza and RSV.

Burton said Moderna’s combination vaccines could be available by 2025 at the earliest, noting that the company still needs FDA approval of its individual flu and RSV vaccines.

The public health benefit of combination vaccines will be “enormous on a global scale” since Covid, RSV and influenza can be deadly, according to Burton. He added that the convenience of these snaps could encourage more people to take them.

“Having to get three different shots for each and going to a chain drug store multiple times can be a pain for people,” Burton told CNBC. “So to be able to get a single 3-in-1 or 2-in-1 injection, we know compliance and adherence is huge with just one administration.”