Given we are in the Halloween season, I thought it would be fitting to talk about an aspect of vaccines that some people find “scary” but might not be in the near future. One of the most common reasons I hear why people are hesitant to get vaccines is because they are afraid of needles. That might sound childish to some, and I know people who have the attitude that getting a shot is not a big deal, that people with this fear need to “get over it.” But it is a very real thing. Did you know there is even a name for it? Trypanophobia is an intense fear of needles, and in severe cases, people with this fear can put themselves at great risk by not getting vaccines or even medical treatment when needed. To be very clear, I am not talking about a dislike of needles. I think most people dislike needles, especially being poked with them. Rather, here I am describing a true, irrational fear of needles that causes anxiety, panic attacks, even fainting, and other consequences. However, for those who have a genuine fear of needles and those who simply don’t like them, there could be good news in the pretty near future…
Another way to vaccinate
Vaccines for several diseases are currently undergoing testing — that can be delivered through a person’s nose! So far, early trials in the United States have had very promising results. For example, trials of two of these nasal spray vaccines have initiated multiple immune system responses against the virus that causes COVID. Results like these have researchers optimistic that there could be an approved COVID vaccine nasal spray available by even 2027! Some other countries, like China and India, are already using approved COVID nasal vaccines because they prioritized developing these types of vaccines during the pandemic. In the U.S. and many other wealthy countries, we chose to remain with our tried-and-true methods of arm injections. Many of the most recent efforts in nasal vaccines in the U.S. have focused on COVID-causing viruses, but nasal vaccines could also be effective against the flu, respiratory syncytial virus (RSV), and others.
Yes, a handful of nasal vaccines have already been developed in the U.S., but they have had a variety of issues. Maybe the most well-known of these is FluMist (a flu vaccine), but it never became a leading option because its effectiveness was widely debated. What is different about the ones being developed now? They use new technology that can produce stronger immune responses and is safer than the medicines used previously.
Could these vaccines be even better than traditional methods?
It is very possible. Researchers say it is possible that vaccines delivered through nasal spray or possibly inhaling through the mouth can offer stronger (and quicker) protection against respiratory viruses than our long-standing way of injecting into the arm. Why is that? When introduced to the body through inhaling (through nose or mouth), these vaccines stimulate part of the immune system that has adapted specifically for fast, comprehensive protection from airborne germs. This could help an infection from really setting in by fighting it off quickly and completely. While an injected vaccine is good at keeping a disease from spreading, it doesn’t stop the initial infection. A nasal spray, however, is much more effective at this because sprays are targeted where many viruses first enter the body — the nose and nasal tissue (called mucosa, which is a thick, multi-layered tissue that produces mucus, full of immune cells, to fight infections). So mucosal immunity gets your immune system ready to fight off infection, where it starts and offers three different types of protection, while shots provide two types.
Additionally, attacking the invading virus in the nose may prevent it from spreading to other people because it would lower the amount of virus the infected person inhales. Another positive consideration is that, by the spray limiting how far into the body the infection progresses, it is possible that it could prevent long COVID, the chronic, sometimes debilitating condition that so many individuals have faced in the aftermath of infection with COVID. Another pros of these vaccines? They should be less expensive and more convenient to transport to poor areas than the injections we use now (which require rigid, specific temperature regulations, etc.).
Regardless of how it is delivered (through a shot or a spray), developing any new vaccine is extremely complicated and challenging. Researchers have to find that perfect balance where they elicit an immune response intense enough to protect the body from future infections but not too strong so that it harms the individual. There is a delicate balance of individuals’ immune systems, exposures, various cell stimulations, and a host of other factors that will go into fine-tuning these sprays before they can be thoroughly tested and approved by the U.S. Food and Drug Administration. If you are interested in the nuts and bolts and very nitty-gritty details of immunology, I will include a couple of resources below where you can explore more thorough explanations of T cells and spike proteins and all of that good stuff related to this topic, and you can find plenty out there — it is a hot topic!
But for now, I hope some people might be a little less “spooked” knowing that the future of vaccination may be one free of needles…
Other Questions?
I am always interested to hear from you, to answer your questions and even have just interesting conversation! I love the engagement from readers, and all of you are fantastic. Also, feel free to send in topic suggestions if there is anything related to vaccines or similar that you’d like me to take a deeper dive into. I would love to hear what you are interested in reading more about!
Be Well; Be Kind,
Dr. Casey
Want to Learn More?
For a fairly brief discussion about the potential future of COVID-19 nasal vaccines, here is a pretty concise overview: https://abcnews.go.com/Health/clinical-trial-begins-generation-nasal-covid-19-vaccine/story?id=111605093
The National Institutes of Health (NIH) began trials of a nasal COVID-19 vaccine back in July of this year. This link will take you to a press release from when those trials first started and gives some information about the trials themselves: https://www.nih.gov/news-events/news-releases/nih-sponsored-trial-nasal-covid-19-vaccine-opens
This is a lengthier article from Scientific American, but contains a lot of detailed information and is great for anyone who wants to read about the in-depth mechanisms related to immunology and other technical details (particularly later in the article): https://www.scientificamerican.com/article/new-nasal-vaccines-offer-stronger-protection-from-covid-flu-and-more-no-needle-needed/
You can find another article (and briefer, if you are looking for more of a quick read) that discusses the potential greater effectiveness that nasal vaccine may have in stopping COVID-19 transmission compared to traditional injections by individuals from the Washington University School of Medicine here: https://scitechdaily.com/better-than-traditional-shots-new-nasal-vaccine-halts-covid-19-transmission/
If you are interested in learning more about what I described quite briefly, above regarding nasal immunity, etc., this article is fantastic. It is all about the immune cells of the nose, specifically, and how their effectiveness could be a great advantage to protecting us: https://www.nature.com/articles/d41586-024-02503-5
