Combination respiratory vaccines show promise but face key challenges

With the development of multiple new vaccines, national immunisation programmes could face difficulties adapting to the expanding portfolio, paving the way for simplified schedules through combination vaccines. Prof. Hanna Nohynek (Finnish Institute for Health and Welfare, Finland) reviewed the current status of respiratory combination vaccine development and the hurdles to their implementation [1]. 

“What combination vaccines would make sense from a public perspective?” asked Prof. Nohynek. Based on the seasonality of respiratory diseases, combinations of COVID-19, influenza, and RSV vaccines could be administered before the onset of the infectious winter season. Multiple platforms are being assessed, including mRNA (all three viruses), protein subunit, viral vector, inactivated/live virus, and nasal/mucosal vaccines [1].  

Combination vaccines are at different stages of development. Positive phase 3 results have been observed with the mRNA-1083 platform, which demonstrated non-inferiority or superiority compared to licensed influenza and COVID-19 vaccines [2]. Other combination vaccines are still in development, but none have yet reported positive phase 3 outcomes [1].  

One challenge is the regulatory landscape, with recent, stricter FDA approval requirements further complicating the development process. Additional considerations include regional variation in circulating respiratory viruses, as well as issues of market access and pricing. The Strategic Advisory Group of Experts (SAGE) on Immunisation at the WHO is scheduled to meet at the end of September 2025, with a position paper on priority vaccines and policy recommendations [1].  

“Combination vaccines against respiratory viruses are needed to advance national immunisation programme development”, concluded Prof. Nohynek. “Promising candidates are in the clinical pipeline, and the WHO and GAVI, the Vaccine Alliance, have launched a consultation on combination vaccines. To move forward, we need a paradigm shift in regulatory, policy, and financing approaches.” 

1. Nohynek HM. Synergy in immunisation: The future of combination vaccines against respiratory viruses. 6th ESCMID Vaccines, 10–13 September 2025, Lisbon, Portugal. 


2. Spergel ARK, et al. JAMA. 2025;333;(22):1977-1987. 

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Posted on 21 October 202521 October 2025