Will You Be Able to Get a COVID-19 Vaccine in Your Nose?

Instead of getting a COVID-19 vaccine in your arm, imagine having the option to get a dose sprayed in your nose. It could be a reality in the near future, as researchers across the world are working on intranasal vaccines and trials are already underway.

What Are Intranasal Vaccines?

Unlike vaccines that require a needle and typically go into the arm muscle, an intranasal vaccine is dosed into the nasal passage through a spray container, like products used to treat sinus infections. Intranasal vaccines not only remove the need for a needle, but the hope is that they could offer better protection.

“Theoretically—and we have to prove this—you may be able to stop the coronavirus right in the nose itself,” Purvi Parikh, MD, an allergist and immunologist at New York University Langone Health, tells Verywell. 

There are already several COVID-19 intranasal vaccines in the works, and human trials have started in the United Kingdom for the COVI-VAC vaccine as well as in China.

In the United States, phase one of a clinical trial of AdCOVID—another intranasal COVID-19 vaccine—recently began after preclinical studies using mice were conducted by the University of Alabama.

Intranasal Versus Traditional COVID-19 Vaccines

Aside from how the vaccine is administered, a major difference between intranasal and regular in-the-arm vaccines is the immune responses they generate.  

Intramuscular vaccines—the shots that go into your arm muscle—trigger an immune response in a lymph node close to the injection site that then travels throughout the body.  

“Those cells that are reactive against the vaccine can go from one lymph node to the next and into the spleen, but they’re not going to go to what we call mucosal tissues,” Frances Lund, PhD, chair of the department of microbiology at the University of Alabama at Birmingham, tells Verywell. 

Generating a Local Response

Intranasal vaccines, on the other hand, are designed to prompt a response in the mucosal tissues—including the lining of your nose and your lungs—as well as in the lymph nodes.

In other words, Lund says that “you get a response in two places” with an intranasal vaccine. That matters because the virus can spread through sneezing or coughing, and the nose and mouth are places where you can get infected, too. 

The idea is that with intranasal COVID-19 vaccines, you get an immune response right at the site of infection—what’s called a local response. “Because it’s local, it has the potential to very quickly disrupt the virus from replicating, and what that means is that you don’t get what we’ll call a local infection,” Lund says. “And when you don’t get that local infection, the idea is that that will help prevent you from transmitting it to anybody else.”

Reducing Risk of Illness and Spread

While the currently approved COVID-19 vaccines are designed to protect you from getting seriously sick with COVID-19, they may not prevent you from spreading the coronavirus to others if you are infected. Theoretically, an intranasal COVID-19 vaccine could prevent you from getting sick and from spreading the virus.

While COVID-19 intranasal vaccines sound promising so far, Parikh points out that there is still a lot to learn—and prove—about them. “We still have to see if it’s effective in human trials because, in the past, we found that sometimes the intranasal vaccines are not always as effective as their injection counterparts,” Parikh says.

How Effective Would Intranasal Vaccines Be?

It’s too early to tell how effective intranasal COVID-19 vaccines are since no results from human trials have been published yet.

Lund, who was the lead on the preclinical testing of AdCOVID on mice, says that her research found that animals dosed with the intranasal vaccine developed local immunity (immune cells and antibodies) in the nasal passage, lung airways, and lung tissue. 

“If we vaccinate an animal intramuscularly, we don’t find those [immune] cells there,” Lund says.

Michael Diamond, MD, PhD, a professor of infectious diseases at Washington University School of Medicine in St. Louis, tells Verywell that intranasal COVID-19 vaccines may show better efficacy because of their ability to generate IgA—an antibody found in mucous membranes.

“This point needs to be demonstrated [as it’s] not certain yet,” Diamond says. “It could, in theory, minimize variant generation—a setting of upper respiratory infection in vaccinated individuals with intramuscular vaccines could select for escape variants, [but] again, this needs to be demonstrated.”

Potential Benefits of Intranasal COVID-19 Vaccines

While they aren’t ready for noses yet, an intranasal COVID-19 vaccine could have other benefits over intramuscular shots.

Storage

For one, Lund says that the intranasal COVID-19 vaccines being tested can be stored at room temperature—an advantage over the mRNA vaccines that have to be shipped and stored in freezing temperatures. 

Needle-Free

“Another big advantage is that [an intranasal vaccine] doesn’t require a needle,” Lund says. For communities where access to trained professionals who can administer a needle-based vaccine is limited, an intranasal vaccine may be more accessible. “I’m not saying that the FDA will say that you can just give yourself your own vaccine, but it does not require somebody who knows how to give a shot to do it,” Lund says.

Another plus of needle-free vaccines? Children or people who are less comfortable with needles might be more willing to get a vaccine in the nose.

Another Tool Against COVID-19

If a COVID-19 intranasal vaccine is approved for human use, it will offer another way to inoculate the population at a time when all efforts to increase vaccination uptake are important.

“No infection in history has reached herd immunity without a vaccination,” Parikh says. “So they’re extremely important for us to be able to get past this pandemic. I know everyone’s worried about side effects of the vaccine, but in reality, we should be far more afraid of the virus.”

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