“There are still many questions to be ans­wered before cancer vaccines can be used on a large scale”

Three take­aways regar­ding the invest­ment poten­tial of cancer vaccines:

The biopharma companies Moderna and Merck caused a stir on the stock markets at the end of August with the positive preliminary results from a Phase III study with a personalized mRNA cancer vaccine (see box below). The key question addressed by the study was whether the so-called INT vaccine is capable of reducing the risk of aggressive skin cancer recurring or spreading via metastases. Moderna’s share price alone rose temporarily by as much as 150 per cent following the study’s results. Did this massive reaction also take investment professionals like you by surprise?

Chi Tran-Brändli: First of all, let us be clear: This is not a classical vaccine because this is a therapy that one gets after and not before one has cancer. However, it is a vaccine in that you are training your immune system to target and kill a harmful foreign/abnormal entity in your body, stunting its spread. In this case, it is a particularly harmful type of skin cancer called melanoma, and that has been surgically removed. Because the neoantigens on each person's cancer are different from person to person, the vaccine has to be personalized: it is training your immune system to target your cancer cells and is unlikely to be effective in treating someone else.

And yet the investors broke out in cheers at the study results?

Chi Tran-Brändli: In our view, in addition to the genuinely transformational medical innovation, the storytelling around the “cancer vaccine” and probably also technical market factors influenced the share price performance. However, the fact that the combined market cap gain of Moderna and Merck was over USD 86 billion on the day after the announcement did indeed surprise us.

Why in particular?

Clément Maclou: The massive price increase occurred even though key parameters such as survival benefits and the economic framework – costs and therapy prices – were not yet clear. That said, the market must have assumed that the phase III data would confirm the extremely promising five-year efficacy data from a similar but much smaller phase II study that were reported earlier in January 2026. Those data indicated that the INT vaccine combined with Keytruda was able to reduce, five years after treatment, the risk of melanoma recurrence or death by 49% and the risk of distant metastasis by 59%. This time, the results came from a study involving more than 1,100 patients, making them very robust. However, the market cap gain only makes sense if we could expect this type of efficacy confirmed by the full data set from the phase III study.

Are we still waiting for this data set?

Clément Maclou: The data will be presented at a medical conference in November. In order to justify the additional market capitalisation, such a marked efficacy would also need to be observed in other common types of cancer, such as lung, breast, prostate and bowel cancer.

Returning to the sharp stock price movements: has the sustainable strategy you manage, which focuses on healthy longevity, benefited from this?

Chi Tran-Brändli: Merck is one of the biggest positions in our portfolio, which was able to benefit from the share price gains to a certain extent. However, our strategy is deliberately broadly diversified into long-term structural winners of the Healthy Longevity theme. We also don't bet on the outcome of binary events that could lead to extraordinarily high stock volatility. With regards to new innovative treatments, we only invest after a treatment has been significantly de-risked from the clinical, and usually regulatory, perspectives. All our holdings are already in the commercial-stage and. They are usually already profitable or have a clear view to earnings positivity within one to two years.

The new INT vaccine is still some way off achieving that – yet, despite this, Moderna CEO Stéphane Bancel told staff, on the occasion of the interim results, that they would be telling their grandchildren about this day. How do you assess the significance of the study results?

Chi Tran-Brändli: For the first time, a large phase III study has shown that a personalised mRNA tumour therapy in combination with a checkpoint inhibitor (in this case Keytruda) can reduce the risk of relapse and distant metastases significantly more than the previous standard therapy alone. This is a milestone in immuno-oncology and in the further development of the mRNA platform, and an important proof of concept for the platform in additional tumour types. However, the therapy is complex, expensive and likely limited to tumours with high immune activity and with a certain type of neoantigens. Our conclusion: Not yet the final destination, but an important step on the way there.

You’ve raised the outstanding issues. What do we know so far about the safety of this approach?

Clément Maclou: The safety profile of this cancer treatment looks relatively benign to us. In the studies conducted so far, no new, serious safety signals have emerged – the side effects were in line with the known toxicity of checkpoint inhibitors plus vaccination reactions – for example fever, fatigue and local reactions. Patients receive an mRNA therapy in addition to Keytruda; this signifies an additive immunological activation. So far, this gives an overall acceptable impression – particularly in the context of a life-threatening tumour with a high risk of recurrence. However, long-term safety is not clarified. The therapy modulates the immune system very specifically but also powerfully – we simply do not yet know how this may affect immunity or organs after many years. From an investment perspective these uncertainties must definitely be taken into account.

And what can be said about the economic viability of the therapy? After all, there is hope that Merck and Moderna’s cell therapy could be available over the course of next year.

Chi Tran-Brändli: As we mentioned above, the cost of goods for this therapy is very high due to the complexity, limited scalability and logistics involved in making and administering it. According to our estimates, the price would need to be at least USD 500,000 for Moderna to achieve a margin in line with industry standards, given an estimated production cost of around USD 100,000. This would be in addition to the minimum of USD 150,000 for the drug Keytruda until it loses its patent protection in 2028. As regards pricing and reimbursement: in the US, the companies could argue that for most people this is a one-off treatment. This could meet with approval from US payers. In Europe, however, the authorities are likely to be considerably more price sensitive. Calculating a “fair” price between clinical benefit, costs and budget impact will be politically and regulatorily demanding. We are therefore probably quite a long way from broad economic use in everyday practice.

Besides Moderna and Merck, a handful of other healthcare companies are working on cell therapy for the treatment of cancer, including the Swiss SMI heavyweight Roche in collaboration with German company BioNTech. Does it make sense from an investment point of view to take positions in several of these companies in order to benefit as much as possible from cell therapy as a new driver?

Clément Maclou: Our approach to mRNA remains clearly selective and not “all-in”. Besides Moderna-Merck, BioNTech-Roche, Gritstone, Nouscom, Achilles-Arcturus and other companies are working on similar or related concepts. Some projects have already experienced setbacks, others are still in early stages. In this sector, we favour large, diversified healthcare companies with strong balance sheets and pipelines, as well as suppliers across the entire oncology/mRNA value chain, such as those in diagnostics and sequencing technology. In this way, we can capitalise on structural trends such as innovative medicines designed to promote Healthy Longevity or personalised medicine, without making the portfolio overly dependent on a small number of bets with binary outcomes.

Even with successful application, mRNA cell therapy does not protect against developing cancer, and in Europe alone the disease is responsible for 24% of deaths according to Eurostat. Does this mean that cancer remains the main obstacle to the vision of healthy longevity?

Clément Maclou: Cancer is and remains one of the major hurdles – but not the only one. In the EU, the three main causes of death are circulatory diseases (32%), Cancer (24%) and respiratory diseases (excluding COVID-19). The first two are mainly linked to aging but could be influenced by lifestyle and environmental factors, which are the main causes of respiratory diseases. For truly healthy longevity, progress is needed in all these areas – this is precisely why our strategy is broadly diversified in terms of themes and not focused on oncology alone. Cancer is therefore a central part of the answer, but not the whole story.

As part of your strategy you highlight the growing importance of prevention in order to maintain good health for people into old age. But is prevention also an area that lends itself to investments?

Chi Tran-Brändli: Yes – and in our view prevention is becoming increasingly important as a sub-area of the investment theme healthy longevity. The earlier you can detect a disease, the less costly the treatment and more positive the outcome. Investable prevention fields include, among others, investment opportunities within the prevention sector include, for example, screening and diagnostics. Here we are thinking of imaging, laboratory diagnostics and genetic testing. Another exciting area is what is known as ‘metabolic health’: companies that offer medicines and technologies for the treatment of obesity, diabetes and cardiometabolic risk factors. Added to this are digital health and monitoring using wearables, telemedicine and data-driven early detection. Not to be forgotten, too, are vaccinations in the traditional sense, such as those against cervical cancer or shingles.

From a sustainability perspective, an important concern is also to reduce the exploding healthcare costs, especially in Western countries. Are innovative but presumably expensive treatment approaches such as cell therapy in cancer helpful here?

Clément Maclou: New therapies such as personalised mRNA cancer therapies may be expensive at the beginning and put pressure on budgets. But efficiency arises not only through the price per drug, but through the overall picture: Does a therapy prevent costly relapses, intensive care stays, comorbidities and long-term disability? Does it allow patients to remain productive and independent for longer? Based on our rules-based approach to sustainability, we prefer companies and solutions that provide medically relevant added value while also strengthening prevention and making processes more efficient. mRNA cancer therapies will first have to prove themselves in this respect. Their place in the system will in our opinion depend on whether the medical benefit justifies the high effort and costs.

Investment theme «Healthy Longevity»: Insights