Good news on COVID-19 may be just a nose away

Since COVID-19 was declared a pandemic in 2020, the world has settled into an existence where the options are either constant vigilance against the SARS-CoV-2 virus or placing your health, and the health of everyone around you, at risk. Even those who have regularly updated their vaccinations have been forced to settle for a decreased risk of serious illness rather than the freedom to carry on without continuing precautions.

But as sharply as things changed three years ago, they may be about to change again thanks to a new generation of vaccines that are in testing right now. Over the past three months, medical journals and preprint sites have published promising studies about COVID-19 vaccines that go in through the nose rather than a needle. None of these vaccines is likely to become available in the short term, but for those who got an updated jab this fall (and if you haven’t, do so now), there’s hope that the 2023 round may be the last such shot.

Rather than becoming an annual rite, as flu shots have been for decades, future COVID-19 protection may be provided with a sniff. Better still, some of the vaccines are promising to not just reduce the risk of serious illness but also protect against infections. Best of all, at least one of the vaccines has hinted at the COVID-19 Holy Grail: robust and durable immunity.

Over the past few weeks, yet another set of new COVID-19 variants have shoved their way to the front in both the United States and Europe. However, the Centers for Disease Control and Prevention predicts that the U.S. rates of hospitalization are likely to remain flat through the holidays. Cases are up from where they were over most of the year, and things could change, but at the moment they are not calling for the scale of holiday spike seen at this time in previous years.

JN.1 variant rising quickly in the United States.

This should not be considered permission to gather without taking precautions. Family and friends should test before getting together, masks should still be worn when indoors in crowded public places, and if you feel sick or believe you’ve been exposed, please give everyone in your family a break. Long-term effects of COVID-19 infection remain serious, and more infections mean more opportunities for the virus to mutate, leading to new variants that may prove more severe. With the JN.1 variant headed for dominance just ahead of the holidays, increased caution is the best move.

JN.1 is not moving to the front as quickly as some past variants, such as delta or the original form of omicron. This likely indicates that it is only marginally more infectious than other circulating variants. However, part of that increase is likely because JN.1 appears to be more transmissible and/or better at evading immunity from past infections and vaccinations. So take care.

Now here’s the good news: In October, this paper at the Proceedings of the National Academy of Sciences offered hope so strong you can taste it. The researchers behind this particular vaccine effort noted that while new technologies like mRNA vaccines offer great promise and have been widely successful, they have real limitations, “including their reduced effectiveness against SARS-CoV-2 [variants of concern], short duration of protection, inability to induce a mucosal immune response to protect the airways, and high cost of production or distribution.”

Because of this, the paper’s authors set about developing a cheap, long-lasting vaccine candidate that could be administered as a nasal spray. As a bonus, it was created using the same well-tested techniques as those behind the MMR (measles/mumps/rubella) vaccine, which has been safely administered billions of times.

Naturally, there’s a disappointing part of this story. This particular vaccine has made it only as far as animal trials, and the outstanding results were seen in mice and “golden Syrian hamsters” (a new one for me). Hopefully, considering the well-trod technological path and the excellent early results, they’ll proceed quickly.

At the start of this month, a paper in the British medical journal The Lancet covered the results of a nasal vaccine developed by a team in China. Unlike the other nasal vaccine, this one boasts results from phase III testing in humans, in particular a group of health care workers in an environment where they were regularly exposed to COVID-19, including new and emerging variants.

The results of the paper indicate that a single dose of the “dNS1-RBD” vaccine can provide 87% effective protection against symptomatic disease for previously unvaccinated people. That’s not serious disease. It’s symptomatic disease at any level. For those who had been previously vaccinated, improvement was only 12% … which sounds counterintuitive. However, that’s a 12% improvement over a baseline that was already much better than it was for the previously unvaccinated.

But again, there’s an issue with the paper. In this case, the study lasted a bit under a month. So while it shows the nasal vaccine’s high effectiveness over a short period, it doesn’t indicate whether this represents the highly desired durable protection.

Finally, there’s this article from Nature. Describing this new vaccine requires taking a deep breath. Ready? Go.

The vaccine encapsulates assembled nanoparticles comprising proteinaceous cholera toxin B subunits displaying the SARS-CoV-2 RBD antigen within microcapsules of optimal aerodynamic size, and this unique nano–micro coupled structure supports efficient alveoli delivery, sustained antigen release and antigen-presenting cell uptake, which are favourable features for the induction of immune responses.

In other words, it’s a very fine dry powder that’s designed to put a fragment of the SARS-CoV-2 antigen in your nose and keep it there. Those bits of antigen are attached to fragments of cholera toxin, which sounds like a bad thing to sniff. But it’s safe. Really.

What do you get as the result of all that tech turned into nearly invisible particles? The study findings suggest this single-use nasal spray promotes high levels of antibody production and high levels of response by T-cells in the immune system. This appears to work against any current COVID-19 variant. The protection here should be both robust and more durable than current vaccines. It should also be effective against infection, not just in reducing symptoms. That’s about as good as possible.

The bad news here is … animals again. This time the list of animals includes nonhuman primates, which are a much better predictor of human responses than the notoriously bad mouse model. At the same time, animal testing means the vaccine is well away from showing up at the corner Walgreens. But the vaccine is stable at room temperature over an extended period, single dose, easy to deliver, effective against known variants, and appears to be longer-lasting than existing vaccines.

Now we just need to wait for it to be one more thing: available.

In the here-right-now news, the existing vaccine, the one you can get at your local pharmacy today, has been shown to provide high levels of protection against new and emerging variants. It’s not long-lasting, it’s not proof against infection, and it can’t be administered via sniffer. But it’s there. If you haven’t already done so, go get it.

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