Many vaccines have been approved for emergency use in adults and children across the world, with some gaining full, standard approval from 2022 onwards based on additional trial results and real-world evidence. While estimates of efficacy against symptomatic COVID-19 have varied from 50% to 95%, efficacy estimates against severe infection/hospitalization have been consistently high across all vaccine approaches investigated thus far. However, the emergence of the Omicron variant, the first variant to show meaningful immune evasion, led to a substantial reduction in vaccine efficacy. A booster dose largely restores efficacy, which is an important finding as severe/hospitalized COVID-19 infections represent the greatest social and economic disease burden, and the primary aim of vaccination campaigns is to reduce mortality and ease pressure on hospitals by reducing hospitalization rates. 

Importantly, pricing has become a more prominent factor post-pandemic as supply constraints have been resolved and companies have adopted a more typical vaccine pricing strategy to ensure longer-term profitability. The shift to an endemic market was heralded by an announcement of list pricing for the three products used in the 2023/24 vaccination campaign: Pfizer/BioNTech’s at $120 per dose, Moderna’s at $129 per dose and Novavax’s at $130 per dose. As it stands, Pfizer/BioNTech’s vaccine is priced the cheapest for its 2024/25 formulation, at approximately $137 per dose, with Moderna’s and Novavax’s vaccines priced similarly at $142 per dose in the US. The close pricing range of these vaccines highlights the competitive nature of the market as vaccine supply outstrips demand. Indeed, there has been significant pipeline attrition as minor players have reallocated resources to other, more profitable indications. The start of pipeline attrition was evidenced by Sanofi suspending development of its own mRNA vaccine despite reporting positive Phase I/II results, stating that the program was no longer commercially viable given the dominance of Comirnaty and Spikevax. Sanofi initially redirected its resources to the GSK-partnered VidPrevtyn Beta in the EU and, more recently, to its collaboration with Novavax for the commercialization of Nuvaxovid and the development of respiratory vaccination combinations utilizing Novavax’s vaccine platform.