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Moderna (MRNA 0.17%)
Q1 2024 Earnings Call
May 02, 2024, 8:00 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Good day, and thank you for standing by. Welcome to the Moderna's first-quarter 2024 conference call. [Operator instructions] Please be advised, today's conference is being recorded. I would now like to hand the conference over to your speaker today, Lavina Talukdar.
Please go ahead.
Lavina Talukdar -- Head of Investor Relations
Thank you, Kevin. Good morning, everyone, and thank you for joining us on today's call to discuss Moderna's first-quarter 2024 financial results and business updates. You can access the press release issued this morning as well as the slides that we'll be reviewing by going to the investor section of our website. On today's call are Stéphane Bancel, our chief executive officer; Stephen Hoge, our president; and Jamey Mock, our chief financial officer.
Before we begin, please note that this conference call will include forward-looking statements made pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995. Please see Slide 2 of the accompanying presentation and our SEC filings for important risk factors that could cause our actual performance and results to differ materially from those expressed or implied in these forward-looking statements. I'll now turn the call over to Stephane.
Stéphane Bancel -- Chief Executive Officer
Thank you, Lavina. Good morning, or good afternoon, everyone. Thank you for joining us today. I will start with a review of a business, Jamey will then present our financial results.
Stephen will review our late-stage clinical programs and I will close by sharing our 2024 commercial priorities and major upcoming milestones. Our COVID vaccine has already impacted hundreds of millions of people. I'm excited by the progress we've made with our pipeline that has the potential to impact many more people. During the first quarter, we presented substantial clinical progress during our vaccine date with exciting data on EBV, VZV, and norovirus.
In addition, along with our partner Merck, we expanded studies for individualized neoantigen therapy, INT, into three new indications. In addition to our ongoing phase 3 studies in adjuvant melanoma and adjuvant non-small cell lung cancer, a phase 2 free study has started in neoadjuvant and adjuvant cutaneous squamous cell carcinoma, another form of skin cancer. phase 2 clinical trials have started in adjuvant bladder and adjuvant kidney cancer. Together, our vaccines and therapeutic portfolio have a potential to impact hundreds of millions of people each year.
I am pleased with our Q1 performance. Since the beginning of the year, we announced four important business agreements and collaboration. We entered into a non-exclusive IP out-licensing agreement with a leading pharmaceutical company in Japan. The agreement includes a lump sum payment and low double-digit royalties to Moderna on net sales of COVID-19 products marketed in Japan by this company.
It is nice to see a company recognizing our IP and asking us for a license. Second, we recently announced a contract to provide 12.5 million doses of COVID-19 vaccine to the Ministry of Health in Brazil. I am very pleased with this partnership as it is the very first time that Moderna works with the Brazilian government and we look forward to providing these doses to protect people in Brazil as they go into their winter season. We announced a project financing program for up to $750 million in funding with Blackstone to further develop our flu program.
We also made public our collaboration with OpenAI to use AI as a transformative tool to increase speed and efficiency, and ultimately to improve patient outcomes across our business. Finally, we agreed to Metagenomi to terminate our gene editing collaboration. All rights granted under the collaboration will be returned to Metagenomi. It is a good proof point of Moderna's continuing to prioritize our assessment for best opportunities to drive returns.
Turning to Q1 financial results. In revenues, we were ahead of our plans at $167 million, reflecting the highly seasonal nature of our respiratory vaccine business. The net loss was $1.2 billion. We ended the quarter with $12.2 billion of cash and investments.
We communicated during the November call our focus on financial discipline. I am pleased with what the team has achieved. Our operating expenses, cost of manufacturing expenses, plus cost of R&D expenses, plus cost of SG&A expenses were down almost $800 million in Q1 2024 versus Q1 2023. Jamey will elaborate on this in his section.
With that, I will now turn to Jamey.
Jamey Mock -- Chief Financial Officer
Thanks, Stephane, and hello, everyone. Today I will walk you through our financial performance for the first quarter and provide commentary on our 2024 financial framework. Let me start with our commercial performance on Slide 8. Net product sales for Q1 were $167 million, down 91% year over year, mainly driven by lower sales volumes of our COVID-19 vaccine in regions outside the United States.
This decline aligns with the anticipated transition of the COVID-19 vaccine market toward a seasonal pattern. Whereas in the first quarter of 2023 we primarily delivered doses that were deferred from 2022. Q1 was driven by sales in the U.S. and the rest of the world, largely Latin American markets.
For Q2, we expect about $100 million in sales for a total of approximately $300 million in the first half of 2024. Q2 will include a portion of our recently announced contract with Brazil. Moving to Slide 9, net product sales were $167 million as I just explained. For the first quarter of 2024 our cost of sales was $96 million which included third-party royalties of $8 million, inventory write-downs of $30 million, and $27 million related to unutilized manufacturing capacity and wind-down costs.
This resulted in our cost of sales representing 58% of net product sales up from 43% in the same quarter last year. The increase in cost of sales percentage was primarily due to the lowest level of sales in the quarter. We continue to expect the full-year cost of sales to be approximately 35% of product sales. However, due to the strong seasonality of our business, we expect a higher percentage in the first half.
Moving to our R&D efforts, Q1 R&D expenses were $1.1 billion, reflecting a decrease of 6% year over year. This reduction was primarily due to the absence of upfront collaboration payments being made this quarter. The upfront payments made in the first quarter of 2023 were related to our strategic collaborations with Generation Bio and Life Edit. With the Q1 spend of $1.1 billion, we are tracking toward the full-year expected spend of approximately $4.5 billion.
Q1 SG&A expenses were $274 million, marking a 10% decrease year over year. Importantly, this decrease was driven by all functions in SG&A, and it is a result of our strong focus on cost discipline and strategic investments driving productivity. I will provide additional color on the next page. We reported an income tax expense of $10 million for the first quarter of 2024, compared to an income tax benefit of $384 million in the same period last year.
The shift is primarily due to the continued application of evaluation allowance on the majority of our deferred tax assets, which we first established in the third quarter of 2023. Net loss for the period was $1.2 billion, compared to net income of $79 million last year. Diluted loss per share was $3.07, compared to diluted earnings per share of $0.19 in 2023. We ended the first quarter with cash and investments totaling $12.2 billion, down from $13.3 billion at year-end 2023, largely attributable to research and development expenses and operating activities.
Moving to Slide 10, I want to take a moment to elaborate on the efficiencies we are now seeing across the company. As a platform company, we have the opportunity to build a unique operating model. And over the last few years, we have invested purposely into people, processes, and technologies to build foundational capabilities that will allow us to scale efficiently. First, we ended 2023 with nearly 6,000 employees, up from 1,300 at the end of 2020.
Every function scaled capabilities to enable the increasing product launches we expect over the coming years. Additionally, as you know, Moderna has always led with a digital-first mindset. Over the past three years, we have nearly doubled our built-for-purpose software applications to digitally enable our teams. As an example, we recently went live with a newly implemented rebuilt ERP system.
SAP 4 HANA is our new digital backbone for all our operational activities. We've used SAP in the past, however, it was built for a research and development-focused company. And now we have implemented an entirely revised version supporting our end-to-end business processes more effectively and efficiently. Another example is our rapid adoption of artificial intelligence.
Over the past year, we've built over 750 GPTs. One example in the legal space, our Contract Companion GPT, streamlines the task of reviewing and summarizing contracts across the business, with the GPTs providing step-by-step guidance to craft a tailored, insightful summary. This enables any function to extract critical insights from contracts whenever needed, minimizing bottlenecks, and freeing up Moderna's legal department to focus on work of higher strategic value, thus enhancing operational efficiency and decision-making. Another example in G&A is a purchase-to-pay GPT for all questions around our procurement and payment processes.
Instead of our employees having to find and read policies and procedures, they can easily query the GPT. It also saves time for our procurement and payables teams from answering numerous questions. AI has already changed our way in a short period. In general, we see the area developing at an incredible speed that allows for an unprecedented impact on productivity in many areas.
We have rolled out a comprehensive training program and are committed to driving this technology breakthrough. As a result of these strategic investments in the people, processes, and technology, we were able to significantly reduce purchased services and our use of external consultants, which contributed heavily to the 10% year over year reduction in SG&A spend. We are also seeing similar benefits in R&D and manufacturing. In general, we now have a solid foundation with our operating model.
As we continue to grow our commercial activities, we will need to further invest, however, we will be able to do that more efficiently. Now let's turn to the 2024 financial framework on Slide 11, which is in line with what I shared on our last earnings call in February. We continue to expect net sales for 2024 of approximately $4 billion, which we think will be a low point as we expect to return to growth in 2025. Sales in the first half of the year are now expected to be approximately $0.3 billion.
We continue to expect cost of sales of approximately 35% of product sales for the full year. For R&D, we continue to expect full-year expenses to be approximately $4.5 billion, down from $4.8 billion in 2023, rest we continue to expect full-year expenses to be approximately $1.3 billion, down from $1.5 billion in 2023. And we expect taxes to be negligible in 2024 and capital expenditures in 2024 to be approximately $0.9 billion. Finally, we expect to end 2024 with approximately $9 billion in cash after touching a low point of approximately $8 billion at the end of Q3 due to the seasonality of collections.
Finally, let me also touch on our recently announced project financing deal with Blackstone, which we are excited about. In March, we entered into a development and commercialization funding arrangement, which commits Blackstone to providing us with up to $750 million of funding for our flu program so that we can strengthen the product label and fulfill our remaining regulatory applications. Subject to the regulatory approval in the United States, which depends on data from the funded activities, Blackstone will be entitled to receive up to $750 million in sales in milestone payments. These milestone payments are contingent upon achieving specified cumulative net sales targets for our future influenza and combination vaccines.
Additionally, Blackstone will earn royalties on applicable net sales at a low single-digit percentage rate. This funding will offset R&D expenses and is factored into our R&D framework for the year of approximately $4.5 billion. Overall, we are excited that this deal enables us to accelerate the advancement for our pipeline. And with that, I will now hand the call over to Stephen.
Stephen Hoge -- President
Thank you, Jamey. Today I will review updates from our clinical programs that were shared during our recent Vaccines Day, as well as new developments in our therapeutics portfolio. Starting with respiratory vaccines, we shared updates to many of our respiratory programs at Vaccines Day in March. Our RSV vaccine candidate is undergoing regulatory review in multiple countries, and pending approval we expect to launch the product in the United States following the June ACIP Meeting and Recommendations this year.
At Vaccines Day, we shared updates from core administration studies of RSV confirming the ability to administer our vaccine and other vaccines given during the respiratory season. With our flu program we have recently presented data from our phase 3 P303 study at ESCMID, and continue discussions with regulators globally toward the goal of filing this year. For our next-generation COVID vaccine and mRNA-1283, we've presented positive phase 3 safety and immunogenicity data and are engaging with regulators on the path to approval for that product. Our combination Flu and COVID vaccine mRNA-1083 is in phase 3, and we look forward to sharing those clinical data in the current quarter.
Turning now to our latent and other vaccines. I shared at Vaccines Day, we've had -- we've made significant progress in this portfolio. Our CMV vaccine, mRNA-1647, has fully enrolled its phase 3 trial, and we have the potential for an interim analysis of efficacy this year. We announced positive phase 1 immunogenicity and safety data from our EBV vaccine candidate, mRNA-1189, and we are now advancing toward pivotal trials with that program.
A second therapeutic EBV candidate, mRNA-1195, is in a separate ongoing phase 1 study. mRNA-1468, our vaccine against varicella zoster virus showed strong immunogenicity, including strong T cell responses, and we are preparing to move that program forward toward a pivotal phase 3 study as well. And our HSV vaccine against herpes simplex, mRNA-1608 is now fully enrolled in its phase 1/2 study, and we look forward to sharing clinical data updates when that's available. Now, rounding out this portfolio, we presented the positive clinical data from our norovirus vaccine candidate mRNA-1403 and shared that we are advancing that program toward its pivotal phase 3 trial.
Turning now to Oncology Therapeutics. We are happy to report our ongoing phase 3 studies are enrolling well. We were excited to announce three new INT trials, including a randomized phase 2/3 study in neoadjuvant and adjuvant cutaneous squamous cell carcinoma, a randomized phase 2 trial in adjuvant high risk muscle invasive bladder cancer, and lastly, a randomized phase 2 trial in an adjuvant renal cell carcinoma. Now, recently at AACR, we presented phase 1 data from our INT program in advanced unresectable HPV-negative head and neck cancer in the metastatic setting.
At AACR we also presented phase 1 translational data from another oncology therapeutic program, mRNA-2752 in various tumor types. Links to both of these presentations are provided on the slide. Now as a final note at ASCO we will be hosting another Moderna oncology event on the evening of June 3rd and we look forward to seeing you there or having you join us virtually. With that I'll turn it back over to Stephane.
Stéphane Bancel -- Chief Executive Officer
Thank you, Stephen and Jamey. Slide 18 is an overview of our COVID-19 strategy for 2024, which is focused on the needs of each region. In the U.S. our focus is working with public health officials, healthcare providers, and pharmacies to increase vaccination coverage rates.
In Europe we are actively participating in the 2024 tender process. The tender allows for up to $36 million per year for up to four years. And in the rest of the world we have reoriented our commercial teams to prioritize markets for greater commercial focus and impact. As mentioned earlier, the Brazil contract is an example of how this is working.
In the Fall of 2023, U.S. COVID vaccination rates lagged behind flu vaccination rates. U.S. COVID vaccination rates were 11%, with flu vaccination rates at four times that.
And yet COVID continues to show a higher burden of disease. U.S. hospitalizations for COVID between October 2023 and last week were 424,000 people which is markedly higher than hospitalization from either flu or RSV infection. Actually, COVID hospitalizations were around the same level as hospitalizations of flu plus RSV combined.
In addition, long COVID coughs continues to be a serious risk. Too many healthy young adults in their 20s, their 30s, their 40s are losing lung capacity and/or mental capacity due to long COVID. The data shows that COVID-19 vaccine reduces the risk of long COVID by 70%. We believe education and awareness will be very important.
We are working on educating consumers about the need for an annual COVID vaccine just like flu. Too many people are getting hurt when we have safe and effective vaccines available. Our job will not stop until these hospitalization numbers come down significantly. As you know, strength detection will help authorities receive approval and launch of COVID vaccine.
Health authorities, including the W.H.O. and EMA in Europe, have recently selected JN.1 strain for the 2024-2025 formula. The FDA will host the VRBPAC Meeting on May 16th to select a strain for the U.S. market.
Moderna has already manufactured JN.1 drug substance to support the potential August launch. We have also prepared for backups in case the FDA does not select JN.1. In 2023 COVID vaccines were available five weeks later with flu vaccine. In the recent channel alone, more than 3 million flu vaccines were administered before the updated COVID vaccines were available.
As we look into the Fall 2024 season, we see the potential to align the timing of flu and COVID vaccine approvals. We are encouraged by an earlier VRBPAC for this year's COVID front selection versus last year. And we're working with the FDA and regulators to offer timely COVID approval. We expect higher vaccination updates if COVID vaccines are available sooner.
Turning now to the anticipated launch of a second respiratory vaccine, or RSV vaccine, which is expected to launch into a large market. In its first year, the older adult RSV market was $2.5 billion in sales, and analysts expect the older adult market to grow between $6 billion and $8 billion per year. With marketing applications filed in markets globally, we anticipate seeing approval beginning in the first half of 2024. In the U.S.
we are targeting a launch after the June ACIP meeting. We're very excited to bring a product with a strong differentiated profile to market. Our vaccines has shown stronger efficacy and safety data in clinical trials. And will be the only product available in a pre-filter range of PFS presentation.
Let me now double-click on what we believe are the benefits of PFS. We recently published a time-and-motion study that shows faster preparation time for PFS relative to vaccines that require constitution. Recall that both RSV competitors' vaccines on the market require multiple steps to prepare their vaccines for administration. One vaccine requires four steps and the other nine steps to prepare.
Our PFS presentation is ready to use vaccine straight out of the box. The study found that PFS presentation to be three to four times more efficient as measured by preparation time. Details from the study can be found through the link on the slide. We believe our PFS presentation for RSV vaccine has the potential to ease the personal burden on pharmacies during the fall respiratory season.
Big pharmacies chains but also independent pharmacies were looking forward to launch. Let me close with major upcoming pipeline milestones. While we are excited about our commercial prospects for the year, we are even more excited about the upcoming pipeline milestones and the effect they will have on our commercial outlook for the next several years serving patients. In respiratory vaccines, we are eagerly awaiting the approval of RSV and ACIP.
We are also waiting for data for RSV in the age group 18 and above. We are in discussion with regulators on our flu program, and intend to file in 2024. With our next-gen COVID vaccine, mRNA-1283, we are pleased with positive phase 3 immunogenicity data and are engaging with regulators. Our flu plus COVID vaccine combo should get its phase 3 data soon.
In latent, with CMV fully enrolled and occurring cases, we look forward to potential for phase 3 data efficacy data in 2024. In INT program, we are looking forward to completion of our enrollment for phase 3 adjuvant melanoma study. In addition, we are keen to discuss the possibility of accelerated approval with regulators based on phase 2 study data. As we shared before, there are three things we view as necessary before we could consider pursuing accelerated approval for INT.
First, durability data from our phase 2 study, which we announced in December last year. Second, a substantially enrolled phase 3 adjuvant melanoma study. And third, manufacturing readiness at our Marlboro site. And last but not least, our [Inaudible] portfolio, we look forward to initiating pivotal study for PMMA.
This milestone will represent continued progress toward our mission to deliver the greatest possible impact to people through mRNA medicine. And as Moderna, we are dedicated to achieving them all. Every data continues to confirm the power of our platform and its breadth in the service of patients. Two important save-the-dates for your calendars.
We will discuss oncology program in Chicago on June 1st and our Annual R&D day will be held in New York the morning of September 12th. Thank you for listening and we look forward to taking your questions. Operator?
Questions & Answers:
Operator
Thank you. [Operator instructions] Our first question comes from Salveen Richter with Goldman Sachs. Your line is open.
Salveen Richter -- Goldman Sachs -- Analyst
Good morning. Thanks for taking my questions. Firstly, could you discuss your strategy for pursuing contracts for the RSV vaccine, given two approved vaccines that have a head start timing-wise and help us understand, if you've communicated with large retail pharmacies, how significant the PFS formulation is to them? And then secondly, with regard to moving into the three new indications for the INT program, maybe help us understand signals or specific data points that support that? Thank you.
Stéphane Bancel -- Chief Executive Officer
Good morning. On the RSV contract, so as you know we're not allowed to contract until the product is approved by the regulator. But what we are doing, because we can do that, is our medical team actively engage with retail pharmacies, but also IDN hospital networks, in terms of making sure the data on the efficacy profile of a product, on safety, and of course on the PFS and the benefits of PFS in terms of productivity. Those discussions are ongoing literally on a daily basis, including with leadership of those pharmacies.
And the next step, of course, is to wait for the FDA approval. Stephen?
Stephen Hoge -- President
Yeah, sure. So thanks for the question. So on the three additional INT indications, I think the short version of it is they are all adjuvant settings, similar to our melanoma phase 2 results is encouraging where our KEYTRUDA has a known benefit, and where we still believe that there's an opportunity to improve upon that by driving a specific T cell response with INT. And so, as you know, in phase 1 we looked across a range of different indications.
That was more in the metastatic setting. But as we announced, since we first saw that positive phase 2 results from melanoma, we have been aggressively pursuing adjuvant indications where IO is approved, and where we see an opportunity in all three of these fits squarely in that space.
Operator
Thank you. Our next question comes from Michael Yee with Jefferies. Your line is open.
Mike Yee -- Jefferies -- Analyst
Hey, guys. Thanks. Two questions as well. On RSV, I guess the competitor GSK as well this week was commenting about how they are expecting you to be in the mix and contracting is ongoing.
I know you have some RSV in your guidance. I think the math implies maybe hundreds of millions of dollars. Can you just perhaps comment on how you adjusted or probability adjusted or thought about how much is there in your guidance and your confidence on that for this year? And then secondly, on INT as well, I know you have some data at ASCO. I know you have breakthrough therapy and prime designation.
How important is the phase 3 enrollment progress, the confirmatory study, I feel like that's always an important discussion with FDA, so how important is that progress before you can really engage with FDA? Thank you.
Jamey Mock -- Chief Financial Officer
Yeah. Maybe I'll take the first one. Thanks, Mike, for the question. So as you may know, we haven't guided any specific guidance or number for RSV.
In the past, we did break down the 4 billion into three different segments around the U.S. market, the APAs we locked into the year with, and then another category of other COVID sales that didn't have any APAs across the rest of the world. So a good example is Brazil that we just signed, as well as RSV. So no specific guidance for RSV from a financial perspective.
Stephen Hoge -- President
And on the question of INT, I think you nailed it. It's a really important topic. In particular right now, as we think about accelerated approval, that we demonstrate the diligence and substantially enroll the confirmatory study. So really all you're waiting for is for that study to mature, could be several years.
We think it's really important. To be fair, we have not consulted with the agency on that yet. As we've said, we're waiting until we've crossed our own threshold and also at this point until we've established the manufacturing facility or outlined site to them. But we do feel that, as we've said, substantial enrollment demonstrating that essentially all you're waiting for is the readout on that confirmatory study is our obligation before we even want to go full of that question.
We are making great progress this year, and we're optimistic that both that and the facility will be available in short order. And then, of course, we'll want to start engaging with our data, including the FDA on the question of accelerated approval.
Mike Yee -- Jefferies -- Analyst
Got it. Thank you very much.
Operator
Our next question comes from Terence Flynn with Morgan Stanley. Your line is open.
Terence Flynn -- Morgan Stanley -- Analyst
Great. Thanks for taking the question. Maybe two parts for me. Just on the RSV vaccine, can you provide your latest perspective on what the most likely ACIP recommendation will be, will you get a parity recommendation to the competitors or do you think there's a potential for a differential recommendation here? And then just wondering, any update on your ongoing conversations regarding filing your seasonal flu vaccine, I know you mentioned in your prepared remarks, but just any more insight in terms of what the guiding steps are here? Thank you.
Stephen Hoge -- President
Thanks for both questions. So first on RSV, caveat by saying we have to complete the approval process with FDA. And then at the end of the day, the recommendation really falls to ACIP and the committee members that defer to them. Our expectation, our hope, is that when they review the data package that we already have, as well as additional data that we expect to be able to share at the ACIP meeting on durability through a second season and on immunogenicity across other populations, we expect a parity recommendation.
We certainly think the data supports that. But again, I'll defer to the committee members on the ultimate decision. On the question of flu, we are actively engaged right now with regulators on the process for submission of the flu vaccine. As I mentioned a moment ago, we are also closing in on clinical data from our combination flu COVID vaccine, mRNA-1083 and that obviously has an important role in our engagement with regulators generally on flu versus flu COVID combinations.
And so those discussions are ongoing. I won't provide any other update on it, except to say, as we said today, and we continue to say we expect to file the flu product this year. But it will be dependent upon a number of considerations, possibly also including the COVID data that we expect soon.
Operator
Thank you. Our next question comes from Ellie Merle with UBS. Your line is open.
Ellie Merle -- UBS -- Analyst
Hey, guys. Thanks for taking the question. On CMV, how are you thinking about the need or benefits of potentially boosting both from a clinical as well as a commercial perspective and if you would study this? And then second, just on CMV, if you don't meet the interim analysis there, would you disclose that? Thanks.
Stephen Hoge -- President
Great. Thank you. So first on the question of boosting. So, so far what we have, we obviously don't have the efficacy readout.
That's the phase 3 studies ongoing. But we do expect to have quite substantial durability data on immunogenicity. And it's quite possible the efficacy data will give us a signal what the core production could be. And so we don't right now have any evidence that they're not good, durable, multi-year, possibly as long as five years, or continue to track the immunogenicity protection.
It's possible that it will extend out to 10 years and then some boosting is necessary. It's also possible that we decide that a booster might be necessary shorter term, let's say five years or 10 years. We just don't know at this time. And so at present, the data we do have on the durability of the immunogenicity, it looks quite strong.
And so we do think a three-dose series will likely be productive for a very long period of time, all subject to the efficacy data that you just referenced. So on the interim analysis for efficacy, as we've said before, we're making great progress in that study in recurring cases and we do expect to be able to provide an update on or conduct at least an initial interim efficacy analysis this year. Because of the rate of case accrual and also because the protocol calls for us to cross a median of one year follow-up, the timing may be such that by the time we get to that first interim analysis, we also have enough cases for a final analysis or that a final analysis is imminent. Let's say it's a very short period of time away.
And so because of that uncertainty, until we see that data and understand how close we are to that final analysis, I don't think we can commit one way or the other, whether we're going to be updating. It will really depend upon the data we see and then how quickly we expect to get that final analysis. At the end of the day, if we have news to share both on the interim and the final, we, of course, will. But I don't think we can commit at this stage because we haven't seen the data yet.
Ellie Merle -- UBS -- Analyst
Great. Thanks.
Operator
Our next question comes from Hartaj Singh with Oppenheimer. Your line is open.
Hartaj Singh -- Oppenheimer and Company -- Analyst
Great. Thank you for the question. I just have a question on, you're developing a refrigerator stable vaccine and flu vaccine, I believe. And I'd just like to kind of understand how you think about that, when could that get approved, and then will the combo vaccines also be refrigerator stable? Thank you.
Stephen Hoge -- President
Great. Thank you, Hartaj.
Operator
[Technical Difficulty] Ladies and gentlemen, please stand by. Your conference will resume momentarily. Once again, ladies and gentlemen, please stay on the line. And, pardon me, can you hear me now? Could you try speaking again, your line was muted.
Stephen Hoge -- President
Yeah. I'm here. Can you hear me?
Operator
Yeah. We can hear you now. Your line got muted, but you can go ahead and continue.
Stephen Hoge -- President
Great. Sorry for that brief interruption. So, Hartaj thank you for the question. Just to quickly restate what I was saying.
All of our respiratory protocol portfolio, RSV, flu, COVID, and the flu COVID combo are being developed toward refrigerator stable PFS. And so our mRNA-1083 program, the flu COVID program, as well as the flu program are intended to be refrigerator stable, prefilled syringes. As Stephane mentioned a moment ago, we really view that as the ideal presentation now, whole presentation for healthcare providers really around the world to facilitate their delivery of the vaccine to patients.
Hartaj Singh -- Oppenheimer and Company -- Analyst
Great. Thank you. Thanks for the question, Stephen.
Stephen Hoge -- President
Thank you.
Operator
One moment for our next question. Our next question comes from Gena Wang with Barclays. Your line is open.
Gena Wang -- Barclays -- Analyst
Thank you for taking my questions. I have two. One is regarding COVID. So for the EU, you say up to 36 million doses every year in EU.
What could be the scenario, you can get 36 million doses in EU and also the price in Brazil and the EU, should we use pandemic price of $25 to $30 per doses as the benchmark? Quickly on key accelerator approval pass based on today's comments and the prior discussion, our impression as you could achieve all the three key components by the end of this year, is Merck is also fully on board to submit for the accelerator approval in melanoma?
Stéphane Bancel -- Chief Executive Officer
Thank you, Gena, it's Stephane, I will take the COVID question and then Stephen will talk about INT. So the tender is up to $36 million. It will depend on the number of countries that apply to the tender for the EU. So this we will know at the end of the process.
And as you know it is a tender process so there's no dialogue which is enshrined all the files and all the data and that's really ongoing, but we are obviously very active on it. And on price for obvious competitive reasons, we're not going to share price in the markets because probably it doesn't know the price right away. Stephen, INT?
Stephen Hoge -- President
Yeah. So we haven't specifically got into when we expect to complete, obviously, the second and third parts of our three-part criteria, that being manufacturing readiness. As you can imagine work is going on around the clock, as well as the enrollment where we've made great progress, but you have to sustain that progress. On your question of where's Merck on this, I think you'll have to direct it to them.
Our view is that if we're able to get to the point where until your approval is appropriate, and regulators are supportive of that, we can't imagine why ourselves and Merck wouldn't want to make the product available to help people suffering from cancer right now. But the contingencies there are obviously we have to do our work and our diligence this year. And then ultimately, we have to speak to regulators, and they get to decide whether that pathway is available to us. And so I think for both ourselves and our partner, Merck will want to defer to regulators ultimately on that choice.
Gena Wang -- Barclays -- Analyst
Thank you.
Operator
Our next question comes from Luca Issi with RBC Capital. Your line is open.
Luca Issi -- RBC Capital Markets -- Analyst
Great. Thanks so much for taking my questions. Maybe a very quick one on RSV. I think the last press release actually cited May 12th as the PDUFA date.
While today, you're simply saying the initial regulatory approvals is in the first half of 2024. So is there anything to read to it, can you just confirm that the PDUFA date is still May 12th, which is actually the end of next week? And then maybe second, on IP, can you just comment on the recent decision by Judge Goldberg to rule in favor of Arbutus or you're looking on a particle, our understanding, this can have pretty material impact on both prior and future sales of COVID, so again, any thoughts there, much appreciated? And then super quickly on INT. Stephen, what's holding you back on starting the randomized trial intended at cancer into metastatic studies, I thought the data at ACL was pretty impressive so any thoughts there, much appreciated? Thanks so much.
Stephen Hoge -- President
Great. Thank you for the questions. I'll take this first from the third very quickly. So on the question of RSV, we continue working toward the same PDUFA date, and there's no change to that.
As you know, there's a lot of work and around the clock work by ourselves, obviously, and folks at the agency. And so we're hopeful that, that happens as planned, but if it takes a little bit longer, at the end of the day, what really matters is the -- meeting, but there's been no change to report. So don't read anything into that. As far as the INT question, on head and neck, I appreciate the question because we are also obviously enthusiastic about that data.
However, our partner, Merck and ourselves, we have not yet decided where that fits in the priority of other indications, pathologies, and opportunities we're pursuing. As you've already seen in the past year, we've stood up a very large number of study. And we're just trying to pace ourselves. And so it will take us a little bit of time with our partner, Merck to determine what the next steps are in head and neck.
And at this point, we do not have an update on it.
Stéphane Bancel -- Chief Executive Officer
Thank you. I'll take the IP questions. I mean as you know, our COVID-19 vaccine technology, including our lipid nanoparticle delivery system is the result of independent research and development. We have a strong belief that our technology does not impact on the patent asserted by Arbutus.
We are confident in our position, and we look forward to presenting our case and trial next year.
Luca Issi -- RBC Capital Markets -- Analyst
Thank you.
Operator
Our next question comes from Jessica Fye with J.P. Morgan. Your line is open.
Jessica Fye -- JPMorgan Chase and Company -- Analyst
Hey, guys. Good morning. Thanks for taking my questions. I had a few here.
So for INT, I know you mentioned you can't comment on when you expect to complete the manufacturing scale up. But can you provide a status update on where you stand with that today and the number of patients you can support right now as well as where you want to take that capacity once you get to the end of this three-phase scale-up process, even if you don't put a timeline on when you'll get there? Next one is coming back to flu, can you just refine a little bit when the 1083 immunogenicity data will be available and maybe elaborate on how the combo data play a role in the regulatory tox on 1010, I thought you previously said these products could stand on their own and that you might not need 1010 approved to get 1083 approval, so now wondering kind of why 1083 might factor in for 1010? And then lastly, on CMV, can you remind me how the risk of CMV and pregnancy compares in seropositive versus seronegative individuals, I'm thinking from a commercial standpoint, how you weigh the strategy of pursuing vaccinating everyone versus just seronegative people? Thanks.
Stéphane Bancel -- Chief Executive Officer
Great. Thank you for the questions. I'll start with the INT question on manufacturing, then Stephen can add. So we have not provided some capacity numbers of the factory in Marlboro.
But of course, as you can assume, we know the size of the melanoma market. And we know our stronger data. We have plenty of people benefiting from the phase 2 data. So we've sized the plant accordingly, as you can imagine.
But also we are building the plant of care because, as you know, Stephen and his team and his colleagues are running a lot of studies. So this is not a platform in melanoma. Again, from a manufacturing standpoint, we don't care which cancer is in terms of organ because we use genetic information to design an individual product for every human being. So basically, we bought a plant last year that was kind of a big building finished, saves us time to market.
Obviously, we don't have to get the permitting and build the building. And so the team since then, that is now more than a year ago, has been working actively to get the plant ready. And the plant we will reviewing in modules inside the building. So basically, we're going to launch with the first module of manufacturing capacity.
And then -- and one day maybe we do an opening of a facility like we did for Norwood. You will see that there's another empty space left behind, which has also a very quick ramp-up because the HVAC system and all the utility has been set up for the entire plant. And so then you just add modules as you go. So we'll be able to scale very quickly as we get more indication available.
But again, we're aware of the melanoma number of cases. And so the plant will be sized so we make sure we can provide products to patients. Stephen?
Stephen Hoge -- President
Thank you for the clarifying question on flu. So let me just start by saying that independently, we are looking to submit both the flu program and the flu COVID combo program. So that's 1010 and 1083. Obviously, we need to see the 1083 data, and we'll announce that when we have it.
The question on the timing of that data, it's imminent. And so in the coming quarter, we expect to be able to share that update. The point about interdependency, I suppose, is just more about sequencing of those submissions and in some places and some regulatory geographies, obviously, you can't stack them on the same day, if you will. There's a logical sequence and what we will want to assess once we see the 1083 data is our regulatory strategy as well as our preparation and delivery of data for the submissions to determine which one will go first or second.
But at this point, we're trying hard to make sure that we can do both products across all of our major markets, if the data is filed this year. And so we'll go more on that as we move forward. But for now, we are proceeding without independent sorry for the confusion in your model. On the question of CMV and seropositivity.
So it's a really important point. Thank you for raising it. But while the majority -- well, the risk of vertical transmission of CMV to pregnancy to the fetus is highest in seronegative. It does happen in seropositives as well.
So congenital CMV is a disease that's seen in -- particularly in reactivation or sometimes reinfection, even in the seropositive context. And so we do believe that there's a potential for benefit for a vaccine even in the seropositive population. We are evaluating the study right now in seronegative because the rate of that transmission and obviously, the potential to prevent against infection is more enriched and therefore the study primarily are focused on seronegatives. But we are looking.
We have studied the vaccine from a safety perspective in seropositives. And we are looking at things like shank if you draw a little bit of an analogy to correlate to the EBV data that we've already put out there in a different virus, but we've been able to show that we can really control the rate of setting even in seropositive is the simpolovirus. And so we have some reasons for optimism and believe that when we pull together the totality of the data, there will both be the obvious potential benefit, which is that there is still vertical transmission in seropositives and some -- potentially some data on the rate of -- that would be supportive to that. Ultimately, though, we're studying all the way down to 16 year olds.
And our goal will be a label that 16 plus, with the goal going into a population that is not as highly seropositive as it is later in life and therefore, we see a very large opportunity, and primary infection in CMV with the vaccine and potential positive for [Inaudible]
Jessica Fye -- JPMorgan Chase and Company -- Analyst
Thank you.OperatorOur next question comes from Geoff Meacham with BofA. Your line is open.
Alex Hammond -- Bank of America Merrill Lynch -- Analyst
Hi, this is Alex Hammond on for Geoff Meacham. Thanks for taking our questions. So on your zoster vaccine candidate, when should we receive updates on your pivotal strategy and is there any color you can provide today in terms of your current thinking on the phase 3 design? And then our second question is on the PA and MMA programs that are advancing into pivotal trials, can you provide any thoughts on the nature of editorial and the comments on safety? Thank you.
Stephen Hoge -- President
Yes. Could you describe about the first part of the question was on which program? The booster?
Alex Hammond -- Bank of America Merrill Lynch -- Analyst
The zoster, the shingles.
Stephen Hoge -- President
Shingle booster, thank you. So on the VZV program, we have -- we're obviously very excited by the phase 1 data which was compared against a licensed product, and we saw really strong T cell response in immunogenicity. And generally, we've been seeing that across our programs. But in that one, it was very encouraging.
We're in the process right now of trying to find the pivotal strategy that will include, obviously, dose selection, the number of doses in that study and then how we're going to expect that study. We do not have an update today on what that will look like in addition to our own thoughts on it, we obviously want to consult with regulators before we finalize that. But we are moving toward a pivotal study in VZV. We do not have any more update yet.
As it relates to MMA and PA, the clinical data that we have continues to show a compelling benefit risk profile, good safety profile. In fact, in the PA studies, we have many folks who've been in those study on drug for well over a year. And over 30 years, I think, from our last update in overall patient dosing experience. So we are starting to get a very clear perspective on the safety profile.
The editorial question, I don't have a view on editorials or opinions based on the preclinical data. I think we stand behind the clinical data that we have and are quite encouraged by that profile, and we'll continue to watch it closely in our ongoing phase 1 studies, but we do not have any specific or new concerns based on the clinical data today.
Alex Hammond -- Bank of America Merrill Lynch -- Analyst
Thanks.
Operator
Our next question comes from Evan Wang with Guggenheim Securities. Your line is open. One moment.
Evan Wang -- Guggenheim Partners -- Analyst
Great. Two from me. First, on the combo 1083 program, so data, it sounds like this quarter, I believe enrollment was completed a few months ago. So I guess how comprehensive will the top line update be in terms of follow-up? And then with submission, is longer-term vault needed there and are there parallels from 1010 that we can take in terms of regulatory filing speed for 1083 or is that more impacted by the decision for buying one or the other first? And then second, on RSV, it's kind of early ahead of approval, but with some international markets, it seems that's more nascent in terms of establishing some reimbursement there.
So I guess how are you thinking about positioning internationally? Thanks.
Stephen Hoge -- President
Great. Thank you. So for the 1083 data, yes, on this quarter, and I would say that we're -- we enrolled the majority of the 1083 studies you know last fall. And the 1010 second-generation study.
So we talked about the P303 study. The first part of that enrolled over last summer, just a few months before the combo study. And the second part of it, there was a part B and C, as you know, looking head-to-head against Fluzone HD, that actually enrolled the same time as the 1083 study last fall. And so they've been actually kind of tracking right on top of each other.
I think we're going to wait to see the data before we can provide growth guidance on timing. But obviously, we're -- we've been working toward that flu COVID combination product for a while, and we will want to make sure that we get that filed, if it is positive as fast as possible. I wouldn't draw too many, because of the difference in the structures of the study between the P303 study, which has a part A and the B and a C, and the 1083 study, which was done very quickly. I wouldn't too many correlations between -- reading out and the timing for submission on either one.
Stephane, do you want to take the RSV question?
Stéphane Bancel -- Chief Executive Officer
Sure. So the internal markets, obviously, very important, the U.S. is very important, the U.S. -- international also super important.
As we shared before, we found in all the major geographies already. Of course, EU, U.K., Canada, Australia, some countries in Asia, some countries in the Middle East. RSV is well known by public health leaders like it is in the U.S. So I think that there's a very strong desire, again, to protect the elderly with what we are doing here in terms of flu COVID RSV, that's becoming very kind of a standard that probably [Inaudible] across at least the developed world.
But even in developing countries, there's more and more interest as you see aging population everywhere. So it's not only the U.S. approval that we expect coming soon as we have several geographies that would start being approved.
Operator
Thank you. Our next question comes from Simon Baker with Redburn Atlantic. Your line is open.
Simon Baker -- Redburn Atlantic -- Analyst
Thank you for taking my questions. Two quick ones, if I may. Just in terms of the timing on the CMV interim data. You said this quarter, it could be as early as the end of 2024.
That sounds slightly later than you had previously said. I just wondered if that's me over-interpreting the semantics or whether there is a slight delay there? And then the second question is on the HSV vaccine. Previous quarters, we talked about the EBV vaccine and the potential utility in multiple sclerosis. I was just wondering what your thoughts were about HSV and it's the hypothesis that implicates its role in Alzheimer's disease? Thanks so much.
Stephen Hoge -- President
Thank you for both questions. So first on the clarification. There's no change to our expectations on when the CMV readout will happen. I think we previously tried to be careful in saying that we expect it to happen this year.
And so obviously, by the end of this year, it is meant to say the same thing, but there's no change in our expectations at this point. On the HSV Alzheimer's hypothesis, it's a very interesting -- there's a lot of neuro-inflammatory questions that go with the Herpes Simplex virus infection across a range of different mutations, Alzheimer's one of them. At this point, the studies that we expect to move forward with HSV will be for seropositive to improve outcomes. So shedding based for instance, or lesion based.
And then eventually, we will want to consider whether we want to go at prevention of infection, which is obviously a different standard of different indication. That might be more relevant for them, how you think about some of the neuro-inflammatory or long-term supply. I think you asked my opinion on it, I think it's incredibly interesting and exciting. I do think it's early for us to start drawing connection from a vaccine perspective in terms of our potential impact for it.
I hope over time, there is an opportunity to intervene and things like that. Obviously, in the EBV vaccine with multiple sclerosis, that science has firmed up to the point where there's reasonably high conviction that there's a potential for benefit there. We have to go prove that. But at this point, it's still earlier days, I think, with HSV and Alzheimer's.
Simon Baker -- Redburn Atlantic -- Analyst
Great. Thanks so much.
Operator
Our next question comes from Edward Tenthoff with Piper Sandler. Your line is open.
Ted Tenthoff -- Piper Sandler -- Analyst
Great. Thank you very much for taking the questions. And congrats on everything. Actually, most of my questions have been answered.
But I wanted to ask with respect to the cancer efforts, are you able to break out what the actual R&D cost is for that program and that's still a cause some profit share with Merck? And how many indications do you guys ultimately plan on pursuing? Thank you so much.
Stephen Hoge -- President
Maybe I'll take the first one, Ed. So we obviously know what we're spending, but at this point, we are not prepared to disclose. So maybe someday, but not at this time.
Jamey Mock -- Chief Financial Officer
Yes. On the expansion indication, look, it is a joint decision, our partnership with Merck has been really strong. We've been building this out. We do like to review those strategically and then bring them forward once we've started them.
And so I don't want to get ahead of that because those are our private strategic competition with Merck. But we are not done yet. We will keep adding in the years ahead.
Ted Tenthoff -- Piper Sandler -- Analyst
Very exciting. Look forward to seeing you in Chicago.
Operator
Ladies and gentlemen, this does conclude the Q&A portion of today's conference. I'd like to turn the call back over to Stephane for any closing remarks.
Stéphane Bancel -- Chief Executive Officer
Well, thank you, everybody, for joining in today for a great session. We look forward to seeing you at the latest ASCO. Have a great day.
Operator
[Operator signoff]
Duration: 0 minutes
Call participants:
Lavina Talukdar -- Head of Investor Relations
Stéphane Bancel -- Chief Executive Officer
Jamey Mock -- Chief Financial Officer
Stephen Hoge -- President
Salveen Richter -- Goldman Sachs -- Analyst
Mike Yee -- Jefferies -- Analyst
Terence Flynn -- Morgan Stanley -- Analyst
Ellie Merle -- UBS -- Analyst
Hartaj Singh -- Oppenheimer and Company -- Analyst
Gena Wang -- Barclays -- Analyst
Luca Issi -- RBC Capital Markets -- Analyst
Jessica Fye -- JPMorgan Chase and Company -- Analyst
Alex Hammond -- Bank of America Merrill Lynch -- Analyst
Evan Wang -- Guggenheim Partners -- Analyst
Simon Baker -- Redburn Atlantic -- Analyst
Ted Tenthoff -- Piper Sandler -- Analyst
