Everything You Need to Know About Vaccinations

Results Are Looking Promising For A Combined COVID And Flu Vaccine. Here's How It Could Benefit Public Health

Earlier this week, Moderna announced positive results for its phase 3 clinical trial of a combined vaccine against COVID and influenza.

So what exactly did the trial find? And what sort of impact would a two-in-one COVID and flu vaccine have on public health? Let's take a look.

Combination vaccines are already used for other diseases

Combination vaccines have been successfully used for several decades in Australia and around the world.

For example, the DTP vaccine, a shot that combines protection against diphtheria, tetanus and pertussis (whooping cough), was first administered in 1948.

The DTP vaccine has since been further combined to offer protection against other diseases. A hexavalent vaccine, which protects against six diseases – diphtheria, tetanus, pertussis, polio, hepatitis B and Haemophilus influenzae type b (an infection that can cause brain swelling) – is today part of routine childhood immunisation programs in Australia and elsewhere.

Another important combination vaccine is the MMR vaccine, given to children to protect against measles, mumps and rubella.

So what did the trial find?

Moderna's phase 3 trial included roughly 8,000 participants across two age groups. Half were adults aged 50 to 64. The other half were aged 65 and up.

In both age groups, participants were randomised to either receive the combined vaccine (called mRNA-1083) or a control. The control groups received a COVID vaccine and a suitable flu vaccine delivered separately.

The control group in the 50-to-64 age category were given the Fluarix flu vaccine, as well as Moderna's mRNA COVID vaccine, Spikevax. The over-65 control group received Spikevax alongside Fluzone HD, an enhanced flu vaccine designed specifically for older adults.

Participants in the control groups received Moderna's COVID vaccine and a separate flu shot. Numstocker/Shutterstock

The study evaluated safety, including any reactions after vaccination, and the protective immune response the vaccines produced.

Moderna reported the combined vaccine elicited a higher immune response in both age groups against COVID and three influenza strains, compared to the co-administered shots.

From a safety perspective, the combined vaccine was well tolerated. Adverse reactions were similar across the experimental and control groups. The most common side effects included muscle aches, fatigue and pain at the injection site.

While the trial results are promising, they are yet to be published in a peer-reviewed journal, which means independent experts haven't yet verified them. And further research may be required to test how the combined vaccine works in younger age groups.

What are the advantages of combined vaccines?

We cannot overstate the importance of vaccines. Each year they prevent up to 5 million deaths around the world from a range of life-threatening infections.

At the same time, we can always do more to boost vaccination uptake, especially in areas with fewer resources and among vulnerable populations.

Combination vaccines have a variety of advantages. For example, the need for fewer injections reduces costs for health systems, decreases storage requirements and reduces the burden on parents. All of these things can be especially valuable in low-income countries.

Notably, research shows combination vaccines make it more likely people will take up routine vaccinations.

Many combination vaccines are already in use. Jacob Lund/Shutterstock Two important diseases

Every year, particularly during the winter months, millions of people contract respiratory infections. Indeed, parts of Australia are reported to be facing rapid increases in flu cases at the moment.

According to the World Health Organization, globally, roughly 3 million to 5 million people experience severe influenza annually, and around 650,000 people will die from the disease.

COVID has resulted in more than 7 million deaths around the world to date.

As the COVID pandemic has continued, we've seen pandemic fatigue setting in, as some people appear to have become complacent about their COVID shots. A 2023 study in Australia found 30% of the surveyed population were hesitant about and 9% were resistant to taking COVID boosters.

Uptake of the flu vaccine, which many people are in the habit of getting annually, may be higher. That said, in Australia the current flu vaccine rates for 2024 are still fairly low: 53% for adults over 65 years, 26% for those aged 50 to 65, and lower for younger age groups.

A two-in-one COVID and flu vaccine could be an important public health tool to increase vaccine coverage against these two important diseases. Beyond protecting individuals' health, this would have flow-on benefits for the economy and our health system.

Moderna said it will present its trial data at an upcoming medical conference and submit it for publication. The company has also said it will soon apply for regulatory approval, with the possibility of supplying the combined vaccine in 2025.

At the same time, Pfizer and BioNTech also have late-stage trials in progress for a combined COVID and flu vaccine. We will await further developments with interest.

Combined MRNA COVID-flu Vaccine Shows Promise In Moderna Trial

Insights from Bloomberg, BBC, The Washington Post, and CNN

The News

A combination COVID-19-flu vaccine may be more effective in boosting immunity than two separate shots in some people, according to preliminary results released by Moderna on Monday. The release comes from Moderna's ongoing Phase-3 clinical trial — the gold standard test a treatment, including a vaccine, must pass.

The results, while not published or peer reviewed, suggest the combined mRNA vaccine works as well or better than comparative vaccines against different strains of both viruses, Moderna stated.

The full trial results will be released later this year, Moderna added. If federal regulators approve the combined vaccine for use, then it could be available to people as soon as the end of 2025.

SIGNALS Semafor Signals: Global insights on today's biggest stories.Fewer shots could boost vaccine uptake Sources: Washington Post, BBC Global News Podcast

Combining the flu and COVID-19 vaccines could prove "a sound public health strategy," experts told The Washington Post. There's also some evidence to suggest people are more skeptical of COVID-19 vaccines than the flu shot. Some 22.9% of adults in the US got a coronavirus vaccine this winter, while 48.5% got the flu shot, according to government data. A single shot lowers the burden for patients, who might not schedule or attend two appointments, or be willing to get two shots in one go. It also means that people already used to getting a flu shot every winter don't need to change that habit, and can still benefit. "You're getting one dose, one needle versus two needles," Moderna CEO Stéphane Bancel told the BBC Global News Podcast.

COVID-19 booster doses have limited efficacy Sources: StatNews, Bloomberg, BBC

The US Center for Disease Control and Prevention says booster shots control the spread of COVID-19, but their protective effect does seem to wane over time. Boosters significantly lower the odds of a serious infection, and at-risk groups, like pregnant people and the elderly, should get them. But past boosters have offered "weak and fast-waning" protection, Bloomberg's science columnist wrote in 2023, adding, "there's room to do better." That said, data from earlier this year showed COVID-19 boosters had similar performance to the flu jab — a highly trusted vaccine that is known for offering protection, but not a panacea. If Moderna's data on their new combined jab holds up, it could offer a better alternative.

The era of mRNA vaccines is now Sources: CNN, Medical News Today, Financial Times

COVID-19 vaccines were the first to use mRNA technology in the wild. The vaccines use a molecule called messenger RNA, which acts as a script DNA uses to make proteins. The COVID-19 vaccines carry viral mRNA, essentially giving the body's cells the instructions they need to recognize and fight the virus when it encounters it. But mRNA vaccines can be tweaked to other kinds of pathogens and cancers, Nobel Prize-winning chemist Thomas R. Cech told CNN. "We're at this fascinating moment in time, where the opportunities seem almost unlimited," Cech added.

View comments

Combined Covid And Flu Vaccine Could Be Approved For Use On NHS By Next Year

Sign up for our free Health Check email to receive exclusive analysis on the week in healthGet our free Health Check email

A new combined flu and Covid vaccine could be approved for NHS use this year or next following clinical trials.

New data from clinical trials held by Covid vaccine creator Moderna suggests combined jabs provoke a higher immune response than separate single jabs.

The results raise hopes the new vaccine could be approved by regulators by 2025, with the possibility of it being rolled out on the NHS. Most recent data showed more than 1,300 people were hospitalised with Covid.

A spokesman for Moderna said they hoped the jab would be available for the 2025 or 2026 flu season.

At the moment, Moderna's Spikevax vaccine for Covid is used in the NHS booster programmes, alongside Pfizer-BioNTech's Comirnaty.

A newer version of Spikevax has been created and tested by Moderna which includes a dose of flu vaccine.

The combination means people would only need one jab rather than two, as at the moment, to give them full protection against Covid and flu.

This is the first time final phase three data for a combined vaccine has been published by any firm.

The news comes after high street pharmacies this year began providing the Pfizer-BioNTech Covid vaccine over the counter.

The most recent data published by NHS England on Covid hospital admissions showed as of 31 March 2024, 1,384 hospital beds were filled with suspected Covid patients – compared to 2,780 confirmed patients in March 2023.

In the week up to 29 May, 1,604 community cases of Covid were reported by the UK Health Security Agency.

Any new vaccine would first have to be approved for use by the Medicines and Healthcare Products Regulatory Agency.

The findings from Moderna showed that the mRNA-1083 vaccine led to higher immune responses against flu and Covid than two other single vaccines currently in use, including the current Spikevax.

Stephane Bancel, chief executive of Moderna, said: "Combination vaccines have the potential to reduce the burden of respiratory viruses on health systems and pharmacies, as well as offer people more convenient vaccination options that could improve compliance and provide stronger protection from seasonal illnesses."

The randomised controlled trial involved two groups of about 4,000 people each, with the first group aged 65 and over testing the new jab compared with a flu vaccine, Fluzone, and the current Spikevax jab.

The second group included adults aged 50 to 64.

The mRNA-1083 jab matched or bettered current flu jabs and was better than the existing Spikevax at making the body produce antibodies – probably because it had been designed to fight more recent variants circulating around the world, Mr Bancel told the BBC.

Professor John Tregoning, Professor in Vaccine Immunology, Imperial College London, said: "Moderna have undertaken a phase III clinical trial of their new RNA vaccine that targets both influenza and Covid-19.

He said the results of the study looked: "the level of antibody against the viruses in the vaccine in the blood of volunteers. The press release does not include a large amount of data – it is quite a high level summary. What they state is that if you compare the antibody response between the new Moderna RNA vaccine and the existing licensed vaccines, there is not a significant difference."

Professor Tregoning said the main conclusion which can be drawn from the Moderna release is that their vaccine produces anti-influenza and anti-Covid antibodies in those who volunteered for the study.

This story was updated at 16:25 on 10 June following new comments from Moderna on when the vaccine could be available for NHS use and a comment from ProfessorJohn Tregoning.

---