By Berkeley Lovelace Jr. -
NBC News
In the early days of the pandemic, the federal government launched Operation Warp Speed, the public-private initiative intended in part to speed up vaccine development.
It turned out to be a success, with the first COVID-19 vaccines hitting the market in about nine months, an unprecedented timeframe for a process that typically takes years or even decades.
But the same effort has not been made to develop the next generation of vaccines, which experts believe will provide even greater protection.
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Nasal vaccines, in particular, may hold great promise.
Many scientists believe that this approach has the potential to prevent infections altogether.
This is because nasal vaccines provide a boost of immunity right where the virus enters the body.
These vaccines "concentrate immune protection in the upper respiratory tract," explained Dr. Anthony Fauci, chief medical adviser to the White House, in an interview with our sister network, NBC News.
In this way, the "antibodies that try to protect you from the virus entering your body, are right on the front line protecting you."
The lack of initiative has been a disappointment to some scientists who say that vaccines administered through the nose or the upper respiratory tract may be better suited to prevent infections caused by the coronavirus compared to injections administered intramuscularly.
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"There's not much appetite to invest in these things anymore because Operation Warp Speed is over and a lot of people think this is all done and we don't need better vaccines," said Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai in New York. New York.
He is supporting an effort at Mount Sinai to develop a nasal vaccine.
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But as the pandemic continues, it is clear that existing vaccines do little to protect against infection, especially against omicron and its family of sub-variants that evade the immune system.
Vaccines and boosters from Pfizer-BioNTech and Moderna continue to resist hospitalization and death, but blocking infection entirely could prevent even mild illness.
It could also slow transmission of the virus and prevent other serious problems, such as chronic symptoms of a COVID-19 infection.
"With a traditional injection in the arm, you get what's called systemic immunity, meaning you build up antibodies that essentially distribute to different organs in the body," Fauci explained.
That's why those vaccines can be very effective in protecting against serious disease.
Testing for the coronavirus at a testing center in San Francisco, Calif., on Monday, January 10, 2022. David Paul Morris/Bloomberg via Getty Images
Nasal vaccines are also designed to induce antibody production, but in the mucosal tissue, the inner lining of the nose, throat and mouth, where the virus usually enters the body.
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To effectively protect against infection, "mucosal immune responses are needed," said Michal Tal, an immunologist at Stanford University.
Nasal Vaccines in the US
A nasal vaccine is still a long way off in the United States, though it's not for lack of trying: There are numerous nasal COVID-19 vaccines in development in the country, according to Fauci, but the vast majority are still in the preclinical phase or in development. the first clinical trials in humans.
The National Institute of Allergy and Infectious Diseases, which Fauci directs, is funding some of the early research on nasal vaccines.
Akiko Iwasaki, an immunologist at Yale University, is part of the group of researchers working on it.
His team is studying two approaches: a protein-based nasal spray and an mRNA vaccine delivered into the nose using nanoparticles.
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The strategy is called “
prime and spike
”.
“
Prime
is any type of mRNA vaccine that has already been approved to fight coronavirus.
And
spike
is the nasal reinforcement”.
So far, she and her colleagues have seen promising results in preclinical studies, publishing data on a preprint server this year that the nasal vaccine given as a booster dose elicited a strong immune response in the airways of mice.
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Krammer, from Mount Sinai, is working on a nasal vaccine that is in a phase 1 trial in the United States and a little further along in Mexico.
If the US trial is successful, they hope to start phase 2 sometime next year.
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This vaccine uses a modified version of a virus that typically infects birds to target the spike protein of the coronavirus, he said.
The vaccine generated an immune response in mice.
Research is more advanced in other countries: In India and China, for example, phase 3 trials are underway.
A long way to go
Fauci warned that nasal vaccines in the US are still "a couple of years" away.
Unlike Operation Warp Speed, which benefited from generous government funding, Congress has provided little for additional vaccine research.
Although the first results are promising, there is no guarantee that any of the vaccines will end up being successful.
Only one nasal vaccine is approved for use in the United States: FluMist, a flu shot.
But FluMist, while an attractive option for children who are afraid of needles, is less effective than traditional vaccines.
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If the research pans out, Fauci is hopeful that a nasal vaccine will be available in "a couple of years."
There's also no guarantee that either vaccine will be successful, she added.
But "any product that looks promising, I can tell you the FDA would be very eager to look at it," he said.
According to Iwasaki, the Yale immunologist, even a successful nasal vaccine is unlikely to be the final inoculation a person needs against COVID-19.
The nasal vaccine "will probably have to be repeated just like any other booster, not only because of decreased immunity, but potentially because of variants that may arise" that can bypass immunity.