Most vaccine researchers focus on developing vaccines that are administered through intramuscular injections. However, some have begun to wonder whether a vaccine delivered orally or intranasally would fare better against a virus that infects the respiratory tract than a vaccine that's injected into the muscle.
“If you want a vaccine that will really prevent infection and onward transmission, you want to have an antibody response in your nose, in your lungs,” said Robin Shattock, an infectious disease specialist at Imperial College London. “The most efficient way to induce that is by inoculating through that route.”
One of the main goals of inhaled vaccines is to stop the coronavirus from growing in the nose. The virus usually spreads from there to different parts of the body and is subsequently transferred to other people. Biotech company Altimmune, Inc. is hoping to prevent both by developing an intranasal vaccine.
Together with other nasal vaccine makers and researchers, Altimmune is also banking on the unique features in the nose, throat and lungs, which are lined with mucosa, to make their vaccine more effective. The mucous membrane is home to immune cells that produce immunoglobulin; hence, the mucosa contains high levels of immunoglobulin A (IgA). This antibody is known to act as a mucosal barrier that stops viruses from attaching to cells, effectively protecting against infection. By strengthening the respiratory tract and the mucosal immune system, vaccine makers believe that they can block the coronavirus from spreading to the lungs.
Another advantage of intranasal vaccines that its developers are highlighting is ease of distribution. Since these vaccines don't need to be stored and shipped at very low temperatures, production costs will be considerably lower compared to conventional vaccines. Intranasal vaccines will also be easier to transport. And because they're not injectables, they don't need to be administered by health workers.
“When you're thinking about trying to deliver that across the world, if you don't need to have an injectable vaccine, your compliance goes up because people don't like getting shots,” said Frances Lund, an immunologist working for Altimmune. “But secondly, the level of expertise needed to administer that vaccine is significantly different.”
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Oxford and Imperial College now testing inhaled vaccines
Imperial College London and the University of Oxford have already begun human trials on inhaled coronavirus vaccines. In mid-September, British researchers said they wanted to see if an inhaled vaccine can deliver a localized immune response in the respiratory tracts of trial participants.
Imperial's vaccine is in the earlier stages of its clinical trials. They recruited 30 people to receive an aerosolized form of their vaccine through the use of mouthpieces, similar to a common therapy for people with asthma. Previous studies suggest that not only will inhaling a vaccine be more effective, but it will also require lower doses than intramuscular injections.
Oxford's intranasal vaccine is licensed to British pharmaceutical company AstraZeneca. The study was paused in early September when a trial subject experienced spinal inflammation, a common side effect of vaccines. Fortunately for the company, Britain's safety watchdogs allowed the trial to resume. (Related: AstraZeneca's no-profit pledge for coronavirus vaccines may end in 2021.)
Oxford researchers believe that data from their trials will come out in the first quarter of 2021. Imperial's data will be published in June.
“We don't know whether it will work,” said Shattock, who's working with Imperial in their vaccine trials. “But if it does, then it could be very important.”
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