Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: C Raina MacIntyre currently receives funding from Sanofi for research on seasonal influenza and pertussis; and is on the WHO COVID-19 Vaccine Composition Technical Advisory Group. Dr. Poland is the chair of a Safety Evaluation Committee for novel investigational vaccine trials being conducted by Merck Research Laboratories. Dr. Poland provides consultative advice to 3D Communications; AiZtech; AstraZeneca; Dynavax; Emergent; Exelixis; GlaxoSmithKline; Invivyd; Johns Hopkins; Johnson & Johnson/Janssen; Laura Lee Hall; Medicago; Medscape/WebMD; Merck & Co. Inc.; Moderna; NovaSource/NorthStar Energy; Novavax; Ocugen; Regeneron; Sanofi; Syneos Health; and Valneva. These activities have been reviewed by the Mayo Clinic Conflict of Interest Review Board and are conducted in compliance with Mayo Clinic Conflict of Interest policies. Dr. Poland holds patents related to vaccinia, influenza, and measles peptide vaccines. Dr. Poland has received grant funding from ICW Ventures for preclinical studies on a peptide-based COVID-19 vaccine. This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and was conducted in compliance with Mayo Clinic Conflict of Interest policies. Dr. Poland is an adviser to the White House and World Health Organization on COVID-19 vaccines and monkeypox, respectively.