The coronavirus disease of 2019 (COVID-19) pandemic launched an unprecedented global
effort to rapidly develop vaccines to stem the spread of the novel severe acute
respiratory syndrome coronavirus (SARS-CoV-2). Messenger ribonucleic acid (mRNA)
vaccines were developed quickly by companies that were actively developing mRNA
therapeutics and vaccines for other indications, leading to two mRNA vaccines being not
only the first SARS-CoV-2 vaccines to be approved for emergency use but also the first
mRNA drugs to gain emergency use authorization and to eventually gain full approval.
This was possible partly because mRNA sequences can be altered to encode nearly any
protein without significantly altering its chemical properties, allowing the drug
substance to be a modular component of the drug product. Lipid nanoparticle (LNP)
technology required to protect the ribonucleic acid (RNA) and mediate delivery into the
cytoplasm of cells is likewise modular, as are technologies and infrastructure required
to encapsulate the RNA into the LNP. This enabled the rapid adaptation of the technology
to a new target. Upon the coattails of the clinical success of mRNA vaccines, this
modularity will pave the way for future RNA medicines for cancer, gene therapy, and RNA
engineered cell therapies. In this review, trends in the publication records and
clinical trial registrations are tallied to show the sharp intensification in
preclinical and clinical research for RNA medicines. Demand for the manufacturing of
both the RNA drug substance (DS) and the LNP drug product (DP) has already been
strained, causing shortages of the vaccine, and the rise in development and translation
of other mRNA drugs in the coming years will exacerbate this strain. To estimate demand
for DP manufacturing, the dosing requirements for the preclinical and clinical studies
of the two approved mRNA vaccines were examined. To understand the current state of
mRNA-LNP production, current methods and technologies are reviewed, as are current and
announced global capacities for commercial manufacturing. Finally, a vision is
rationalized for how emerging technologies such as self-amplifying mRNA, microfluidic
production, and trends toward integrated and distributed manufacturing will shape the
future of RNA manufacturing and unlock the potential for an RNA medicine revolution.