◼ BUSINESS Bloomberg Businessweek February 8, 202112
drugmakers,PfizerInc.ChiefExecutiveOfficer
AlbertBourlasaidona Feb.2 callwithinvestors.
WhenModernaInc.saidonJan. 25 thatit was
workingona pairofboostershots,itsshareprice
increased12%.
Meanwhile,AstraZenecaPlcanditspartner,the
UniversityofOxford,plantohavea revisedver-
sionoftheirvaccinetailoredtonewvariantsavail-
ablebyfall,researchersinvolvedsaidonFeb.3. The
sameday,Germany’sCureVacNVandBritishdrug
giantGlaxoSmithKlinePlcannounceda €150million
($180million)pacttodevisenext-generationmes-
sengerRNAvaccinesagainstemergingvariants.
Clearly,there’smoneytobemadeinbooster
shots.Industryleadersandanalystshavebeen
talkingaboutCovidboostersintermssimilarto
thoseusedtodescribethemarketforflushots,those
never-endingannualjabsthatgointohundredsof
millionsofarmsaroundtheglobe.MorganStanley
analystMatthewHarrisonestimatestheyearlymar-
ketforCovidvaccineboostershotscouldrangefrom
$5billiontoalmost$23billion.It’simpossibletogive
a morepreciseestimate,becausenooneknowshow
widelymutationsthatevadethevaccines’effective-
nesswillspreadorwhatproportionofpeoplein
eachcountrywillneedtobevaccinated.
Untilrecently,theevidencethatvaccineswere
lesspotentagainstsomeofthevariantswasmostly
lab-based.TestsshowedvaccinesfromPfizerand
Modernaproducedmuchlowerlevelsofso-called
neutralizingantibodiesagainsttheSouthAfrican
strain.Inonestudy,scientistsfromtheAaron
DiamondAIDSResearchCenterfoundthatthe
PfizerandModernavaccineswere6.5to8.6times
lesspotentagainstthemutation.Still,thecompanies
havesaidthateventhesereducedantibodylevels
should be high enough to hold the strain at bay.
Then late-stage trials of vaccines developed by
Johnson & Johnson and Novavax Inc. came out.
They showed their shots to be highly potent against
the original forms of the virus. But results from
studies done in South Africa told a less impres-
sive tale. The J&J shot was found to be 72% effec-
tive in the U.S., but that fell to 57% in South Africa.
Novavax’s shot, 89% effective in the U.K., was only
49% effective in South Africa. Those results are
“sobering,” says Eric Topol, director of the Scripps
Research Translational Institute in San Diego. “We
see an unequivocal drop-off in efficacy.”
That means vaccine makers are now diverting
attention to work on either booster shots or a new,
adjusted vaccine that can work better against the
South African mutation, known scientifically as
B.1.351. “We are having enough of a struggle getting
the first round of vaccines in,” Topol says.Pfizer contends its existing vaccine can handle
the variants, because it produces high levels of anti-
bodies. Still, the company plans to start studies of
a third booster shot of its existing vaccine as well
as a customized booster against new strains. The
extra shot would be given six months to a year after
thefirsttwodoses.If boostershotscontinuetobe
neededafterthepandemicis over,Pfizerwilllikely
geta higherpriceforthefollow-up vaccine, execu-
tives said on its Feb. 2 investor call. The difference in
pricing could be substantial. Pfizer is selling its Covid
vaccine to the U.S. for $19.50 per dose, meaning $
for the full regimen. For normal vaccines, the com-
pany gets around $150 to $175 a dose.
Moderna said it also will begin work on two
booster shots, including one targeted to neutral-
ize the South African strain. The booster may work
ata lowerdosethanModerna’sexistingvaccine,
meaningModernacouldpotentiallymakeasmuch
aseighttimesasmanyboosterdoseswithitsexist-
ingmanufacturingfootprint.Meanwhile,Johnson
& JohnsonandNovavaxhavealsosaidthey’relook-
ingintoapproachesthatcouldhelpfighttheSouth
Africanstrain.
Detailsandtimingfortheboostershotstudies
arestillbeingworkedout,buttheylikelywon’t
requirebigtrialsonthousandsofpeopleasthefirst
roundofvaccinesdid.PeterMarks,directorofthe
FDA’sCenterforBiologicsEvaluationandResearch,
saidduringanAmericanMedicalAssociationwebi-
narthattheagencyis seekingtofinalizea playbook
withtheindustrytoaddressmutations.
If theagencyfeelsthevirushasdriftedenough
torequirea differentsequence,it willneedsmall
trials to make sure the vaccines produce an immune
response, he said. The first few studies may have to
go through an advisory committee, but the agency is
looking to streamline the process as much as possi-
ble and may require less data over time. “We would
intend to be pretty nimble with this,” Marks said, “so
we get these variants covered as quickly as possible,
because it is clear they can spread pretty quickly.”
So for now, it’s a race to vaccinate the U.S. and
Europe before the South African variant becomes
more common, or, worse yet, if new mutations
enable the virus to escape existing vaccines. If health
experts and drugmakers fail to get their arms around
the mutation conundrum, Anthony Fauci, the top
U.S. infectious disease expert, said on Feb. 2, the
timetable for ending the pandemic “could change
dramatically.” �Robert Langreth, with Jeannie
Baumann,CristinFlanagan,andEmmaCourt● Potential maximum
annual sales of Covid
vaccine booster shots,
according to Morgan
Stanley$23b
THE BOTTOM LINE After a yearlong development stint, the
world began widespread vaccinations against Covid-19. But new
mutations suggest the vaccine battle is far from over.