Is it the Department of Defense or the Department of War? The Gulf of Mexico or the Gulf of America? A vaccine—or a “personalized neoantigen treatment”?
That’s the Trump-era language dilemma confronting Moderna, the creator of the covid-19 vaccine whose ambitions for advanced mRNA vaccines targeting flu and emerging pathogens have been thwarted by vaccine skeptics within the federal government. Terminated contracts and unsupportive regulators have brought the Massachusetts-based biotech company to a tipping point. Last year, Robert F. Kennedy Jr., leading the Department of Health and Human Services, focused on mRNA, withdrawing support for numerous initiatives—including a $776 million allocation to Moderna for a bird flu vaccine. By January, the firm was cautioning it might need to halt late-stage endeavors to create vaccines against infections entirely.
This escalates the stakes for another segment of Moderna’s research. In collaboration with Merck, it has been applying its mRNA technology to eliminate tumors using a highly promising procedure referred to as cancer vacc—
“It’s not a vaccine,” a Merck representative interjected before I could articulate the V-word. “It’s a personalized neoantigen therapy.”
Oh, but it is a vaccine. And here’s the process. Moderna analyzes a patient’s cancer cells to identify the most abnormal, distinctive molecules present on their surface. It then encloses the genetic information for those molecules, known as neoantigens, into an injection. The patient’s immune system is instructed: Destroy any cells exhibiting those undesirable surface markers.
Mechanically, it resembles the covid-19 vaccines. The distinct aspect, of course, is that the patient is being immunized against cancer, not a virus.
And it appears to be a potential breakthrough. This year, Moderna and Merck demonstrated that such injections reduced by half the likelihood that patients with the most lethal form of skin cancer would die from a recurrence post-surgery.
In its formal statements, such as regulatory documentation, Moderna has not referred to the injection as a cancer vaccine since 2023. That was when it partnered with Merck and rebranded the technology as personalized neoantigen therapy or INT. Moderna’s CEO remarked at the time that the name change was to “better capture the intent of the initiative.” (BioNTech, the European vaccine manufacturer also engaged in cancer research, has adjusted its terminology as well, transitioning from “neoantigen vaccine” in 2021 to “mRNA cancer immunotherapies” in its latest report.)
The rationale for framing it as a therapy is that patients already have cancer—therefore, it serves as treatment rather than a preventive strategy. But the ulterior motive is evident: to separate vital innovation from vaccine-related anxieties that have been exacerbated by high-ranking US officials. “Vaccines may be perceived negatively nowadays, but we still have faith in the science and in leveraging our immune system to not only combat infections but hopefully also to defeat … cancers,” Kyle Holen, head of Moderna’s cancer initiative, stated last summer during BIO 2025, a significant biotech event in Boston.
Not everyone appreciates the linguistic games. Consider Ryan Sullivan, a doctor at Massachusetts General Hospital who has enrolled patients in Moderna’s trials. He is concerned that the shift raises issues regarding whether trial participants are adequately informed. “There is some apprehension that certain patients might refuse to treat their cancer because it is labeled a vaccine,” Sullivan expressed to me. “However, I also believed it was crucial, as many of my peers did, to name it what it truly is.”
But is it worthwhile to fight over terminology? Lillian Siu, an oncologist at the Princess Margaret Cancer Centre in Toronto, who has contributed to safety evaluations for the new injections, observes US politics from a distance. She considers the name alteration permissible “if it ensures the research can proceed.”
Holen conveyed to me that the physicians expressing dissatisfaction with Moderna were primarily driven by a desire to support vaccines—which are indisputably among the most significant public health advancements ever. They wanted the company to hold firm.
However, that’s not what is occurring. When Moderna’s latest findings were published in February, the main text of the paper made no mention of the term “vaccine.” It only appeared in the footnotes—cited in the titles of earlier papers and patents.
All of this may indicate that Kennedy’s approach is effective. His agencies often seem to spotlight mRNA vaccines as a source of public anxiety, obstruct their dissemination, diminish their value for businesses, and marginalize their advocates.
Nevertheless, Moderna’s approach may also be paying off. At least thus far, the government hasn’t commented much on the company’s cancer vacc— I mean, its personalized neoantigen therapy.
This article initially appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday and access articles like this ahead of others, sign up here.
