The drama surrounding Sarepta's gene therapy, where a top regulator was ousted after political pushback and later reinstated, shows the FDA is now more amenable to outside influence. This case study indicates that presidential and activist pressure can directly impact regulatory enforcement and personnel decisions, moving beyond purely scientific considerations.

The decision to block Moderna's application was made personally by CBER Director Dr. Vinay Prasad, against the recommendation of the FDA's vaccine office staff. This unusual top-down intervention bypasses standard scientific review processes, raising concerns about politicization and the integrity of the regulatory process.

An ideologically driven and inconsistent FDA is eroding investor confidence, turning the U.S. into a difficult environment for investment in complex biologics like gene therapies and vaccines, potentially pushing innovation to other countries.

The FDA's quick reversal on reviewing Moderna's flu shot is not a simple policy change. It likely signals deep internal disagreements within the agency, potentially exacerbated by political pressure, which seeks to minimize vaccine-related news ahead of elections.

The key risk facing biomedical innovation is not just policy chaos, but the normalization of political and ideological influences on science-based regulation. This includes CEOs negotiating prices with the president and FDA enforcing pricing policies, breaking long-standing norms that separated science from politics.

Moderna spent $1 billion on a trial based on FDA guidance that was later deemed unacceptable. This arbitrary "changing of the rules" after the fact makes long-term, capital-intensive investment in new medicines like vaccines extremely risky for pharmaceutical companies.

The FDA's "refuse to file" decision is highly unusual, occurring in only 4% of cases and typically for incomplete or flawed applications. Using it to block Moderna's submission over a previously-agreed-upon trial comparator suggests a strategic shift in regulatory posture, not a simple procedural issue.

Recent events, like Moderna's rescinded 'refusal to file' letter, reveal that alignment with FDA staff on trial design is no guarantee. Senior leaders, notably Vinay Prasad, are reportedly overturning prior agreements, creating extreme uncertainty and making it impossible for companies to trust the regulatory guidance they receive.

Moderna's trial used a standard-dose comparator, the same design basis on which the FDA previously approved two other enhanced flu vaccines for seniors. The agency's refusal to review Moderna's data ignores its own scientific and regulatory precedent, suggesting the application of a new, unstated standard.