> Many vaccines require careful cold storage, which can be difficult or even impossible in some parts of the world. The adhesive patch does not need to be refrigerated.
At first glance I was thinking that this is a solution in search of a problem since SC/IM injections can be taught to a layperson quite quickly, but the lack of cold storage requirements is hugely significant. In their study protocol[0] they estimate a 60% reduction in the cost of delivery!
This would also eliminate the risk of needle-stick injuries which is a nice bonus, particularly in nations with high rates of blood-borne diseases.
In case anyone else was looking for the ethics statement, it's not mentioned in the article but per the protocol this study was funded by the Bill & Melinda Gates Foundation and conducted in collaboration with the London School of Hygiene and Tropical Medicine under the purview of the joint Gambian and LSHTM ethics board.
> At first glance I was thinking that this is a solution in search of a problem since SC/IM injections can be taught to a layperson quite quickly
Even then being painless is a big advantage. Also you can stick a patch to hundreds of children in a matter of minutes, which would be much slower with the conventional method.
My understanding of developing health systems (who stand to benefit the most from this) is regrettably limited but colleagues who participate in global health initiatives tell me that material costs are the biggest barrier rather than local labour which is relatively cheap in these economies.
Perhaps I'm a bit too jaded but I'm always skeptical of [new drug delivery technology for old medicine] as being a cash-grab since this is almost certainly more expensive than injections.
It's more that I'm pleasantly surprised this will greatly simplify the supply-chain and hopefully offset the added unit cost in a non-insignificant way, in addition to making delivery of care easier and the other benefits you mention.
Painless is nice but a subcutaneous injection isn't really that painful so I'm skeptical payers will see the value-proposition for that benefit in isolation if the vaccine costs substantially more per dose. As an example we've had intranasal flu vaccinations for a while now but my hospital still gives me the injection every year, presumably as it's cheaper.
> Painless is nice but a subcutaneous injection isn't really that painful
Painfulness aside, after you have kids and experienced needing two adults to pin down a writhing, screaming two year old to get vaccine injections, you might appreciate a sticker.
For this reason I refused dentist shots as a kid. The dentist was wondering how I could handle the pain without anesthesia, but for me the needle was more scary. This led to the most extreme pain I had when she did a root canal and I saw the worm like nerve coming out from my mouth.
I regularly refused as a kid, not so much out of fear but because I didn't feel like it was painful enough to be worth the hassle, coupled, I think, with a smug satisfaction of showing the dentist I could take it without complaint.
That quickly changed once I needed more extensive work done on adult teeth.
I opted out once, for a shallow filling, because I didn't want to have a numb face for the next 4 hours. Pain got unpleasant for a few moments but overall wasn't bad. For extractions or anything that gets into the nerves or pulp I get the shot.
Painless is nice but a subcutaneous injection isn't really that
painful so I'm skeptical payers will see the value-proposition
for that benefit in isolation
I'd expect that folks funding vaccination programs in underdeveloped countries won't look at any one cost or benefit in isolation. Well, I hope so anyways. Dropping the cold storage requirement is potentially huge IMO.
As for pain, I suppose that for some folks their fear of needles has more to do with the expected vs actual pain (or perhaps nothing to do with pain at all). No needles and thus one fewer excuse to avoid vaccination is a huge win IMO.
As an example we've had intranasal flu vaccinations
This was offered to me by my GP once and I wasn't a fan. It left me feeling worse than any flu shot I can remember. A quick look reveals that it's an attenuated ("live") virus vaccine (the common injected vaccines aren't) and carries a higher risk of side effects and lower efficacy. It's not recommended for children and comes with more contraindications than the injectable vaccines which goes a long way to explaining why it's not more commonly available.
As for pain, I suppose that for some folks their fear of needles has more to do with the expected vs actual pain (or perhaps nothing to do with pain at all). No needles and thus one fewer excuse to avoid vaccination is a huge win IMO.
True but in their protocol they mention the government of Gambia paid $1.3m (and that even the modest $80,000 on this trial was significant for them) for 802,000 patients of injectable MMR putting the cost at 1.67/person. Depending how much more expensive the transdermal version may have been (US/Can reformulations are usually significantly more expensive) I would be skeptical of how much you just have people "tough it out" in these economies in order to vaccinate more people.
The fact this drug is cheaper and better is really impressive.
A quick look reveals that it's an attenuated ("live") virus vaccine (the common injected vaccines aren't) and carries a higher risk of side effects and lower efficacy.
I mean the evidence isn't really compelling for healthy adults 18-49 and kids for efficacy to begin with so I'm not sure we can make that statement with confidence.
In any case the ACIP (and UpToDate) makes no preference for live attenuated vs recombinant/inactivated in adults > 18 or children > 2 (with some exceptions in kids).
You are right though that there is a recommendation for healthcare workers to get an inactivated vaccine so that would explain my circumstances. Thanks, I learned something new today (actually two things, I had no idea we could use code blocks on HN).
I would be skeptical of how much you just have people "tough it out" in these economies
in order to vaccinate more people. The fact this drug is cheaper and better is really
impressive.
How does this compare to the price of the injectable vaccines? Retail cost out here seems to be $30–$40, of which I'd expect a large chunk of that goes to labor.
So you were offered both as an covered options?
I did this outside of insurance. Up until California started taxing people who didn't carry private health insurance it made sense to see a GP at a fee-for-service practice that didn't take insurance. This was long enough ago that I don't remember the exact cost, but it was in line with the more common injected flu vaccines.
I can't think of another time I've been offered the nasal spray. Megacorp had Kaiser nurses on site annually, and they only offered the injection. I'm with (ick) Kaiser now and they were making some noise about covering COVID and flu vaccinations at CVS and Walgreens. If the nasal spray is offered there then presumably it would be covered by insurance.
After the 2009 pandemic, several U.S. studies among 2 through 17-year-olds found that
the nasal spray vaccine was as effective against influenza B viruses and influenza A(H3N2)
viruses as inactivated influenza vaccines but was less effective than inactivated flu
vaccines against the 2009 pandemic H1N1 viruses. These data led ACIP and CDC to recommend
against use of the nasal spray vaccine for the 2016-17 and 2017-18 seasons.
Since the 2017-2018 season, the manufacturer of nasal spray vaccine has used new influenza
A(H1N1) vaccine virus ingredients in production. Because of limited use, there have been
no effectiveness estimates in the United States since LAIV was recommended again in the
2018-2019 influenza season. Data from other countries have demonstrated protection from
LAIV to be similar to that of standard-dose, egg-based inactivated flu vaccine in children.
Which sounds to me like there aren't a lot of compelling reasons to use the flu spray unless you're severely afraid of needles and thus most places don't offer it.
It seems like a huge win for mass vaccination drives. Maybe an alcohol swab and press on a sticker. It's much less traumatic for kids too. Seems like major UX advance for preventative healthcare.
Too late, I've already wrote 5 Facebook posts, shared an image macro, assembled a gorilla warfare group, destroyed HAARP and sent assassins to torch the vaccine fields.
I wondered a lot during Covid how much of the vaccine hesitancy was due to people's squeamishness about needles and how much that was consciously or unconsciously rationalized with the familiar takings points.
I think if the actual vaccine was a pill or spray, things would have turned out very differently.
Sample size 1, but I avoided getting a vaccine for over a year, and I only got it when extensive measures were taken to combat my anxiety about the needle. For sure, I would have been in line to get it day 1 if it had been a nasal spray or other method.
My husband, who is not a fan of needles, complained that in television coverage of covid vaccinations, the news coverage always showed closeup images of dripping needles while telling people to get vaccinated. He felt that would turn off people like him who try to avoid needles.
I think reservations were not at all about the needle (except perhaps for the strange guidance about not aspirating to check for potential blood vessel puncture without explanation).
Oh wow, this opens up a whole new set of pandemic control options like smear or droplet vaccination. Simply apply the vaccine onto surfaces or into air conditioner in public transportation for example.
I'm really kind of surprised that measles hasn't been eradicated. There's not a non-human biologica reservoir is there? Apparently there isn't. So could have been eradicated, should have been eradicated - just another public health failure.
Yes, it can be eradicated, but it's very contagious and stays airborne for a long time. You'd need very high rates of vaccination across all of humanity. Probably the reason this approach is being tried.
It's incredibly contagious and it's incredibly hard to kill. It doesn't appear to occur at all in animals, so that's not the reservoir. It's just that if one person has it, everyone around them will be infected if haven't either been vaccinated or already had it.
We did a good job of eradicating smallpox which is viral, and diptheria and whooping cough are almost gone (they'll probably never totally go, bacterial diseases are like that), polio isn't really a thing. If you look at a graveyard from the beginning of the 20th century when they started recording such things on gravestones (and maybe a ways back into the 19th) you'll see a lot of children died very young - pretty much all of that was diptheria.
And that brings me round to the last point - we're lucky because pretty much no-one dies or has life-changing aftereffects from measles. Diptheria killed just about everyone that caught it. Polio killed just about everyone that got it, or left them with crippling nerve damage. There are people alive today with disabilities caused by polio, and they were the lucky ones.
So, while it was pretty horrible watching my beautiful little baby boy get stabbed in the legs, two at a time, to get it done quickly - but you don't get over the instinct to defend your child from someone hurting them easily - I'm glad he will never have any of a laundry list of preventable diseases, even the ones that just give you some itchy spots and a few days off school.
> Polio killed just about everyone that got it, or left them with crippling nerve damage.
That's simply not true.
Polio is asymptomatic or a mild flu-like illness for the vast majority of people infected (still a major public health disaster).
This is well known and, sadly, conclusively demonstrated during the Cutter Incident, where live virus was accidentally injected, due to a manufacturing defect.
> The mistake produced 120,000 doses of polio vaccine that contained live polio virus. Of children who received the vaccine, 40,000 developed abortive poliomyelitis (a form of the disease that does not involve the central nervous system), 56 developed paralytic poliomyelitis—and of these, five children died from polio.
> Polio is asymptomatic or a mild flu-like illness for the vast majority of people infected (still a major public health disaster).
Okay, yes, you're right. What I posted was an oversimplification.
It's true that the vast majority of people who suffered significant complications of polio became very ill, and it was far far more common than measles complications.
This has the potential to “peel off” some portion of anti-vax moderates; maybe some who are looking for a way to save face as they re-enter the pro-vax fold.
Why would anti-vaxers be any less skeptical of this? From their standpoint it’s an even newer and less tested method.
My initial thought was that this, if popularized, will create even more conspiracy theories among anti-vaxers who will stop letting their kids have stickers. Actually it was common when I grew up, and now with my own kids, for doctors’ offices to give kids stickers for being a good patient or just generally bring a smile to a sick kid’s face.
Informed consent means it’s unethical to give this vaccine without parental permission anyways.. one would hope that the medical profession continues to be trustworthy in this way.
I let my kids get the nasal spray flu vaccine if it’s available only because it has a 20 year track record, this will be great for their kids if it works out (they, meaning my kids, got the MMR shot). Lots of parents are willing to use tried and true medicine but are more hesitant for brand new treatments regardless of what trials say. This isn’t a javascript framework.
The point you are responding to is this provides an excuse for anti-vaxxers who want to change their mind but don't want to admit they were wrong. "These vaccines are different and safe" they can say and get vaccinated (or get their kids vaccinated). Worse than them admitting they were wrong and getting their kids vaccinated. Better than measles outbreaks killing tons of kids when we can just prevent it.
No one needs to save face, getting a vaccine is possible without even mentioning it, or indeed lying about it. Harping on about making a personal medical decision like it's some measure of righteousness is very fashionable, if the pandemic was anything to go by, but it's still not normal.
A lot of people did get secretly vaccinated against COVID to save face. But this isn't to publicly save face. It's to save face with the kids who are going to actually get the shot or usually more importantly to save face with themselves so they don't have to admit they were wrong.
On the other hand, there will probably be a significant number who double down using some chain of nonsense connected to 'vaccines have chips in them' because of the larger size of the applicator.
And anti-sticker movements lest their children be secretly vaccinated against the parents wishes. Schools will stop giving out stickers to grade schoolers, or anti-vaxers will push schools to require opt-in sticker permission slips without which their child cannot be given stickers.
At first glance I was thinking that this is a solution in search of a problem since SC/IM injections can be taught to a layperson quite quickly, but the lack of cold storage requirements is hugely significant. In their study protocol[0] they estimate a 60% reduction in the cost of delivery!
This would also eliminate the risk of needle-stick injuries which is a nice bonus, particularly in nations with high rates of blood-borne diseases.
In case anyone else was looking for the ethics statement, it's not mentioned in the article but per the protocol this study was funded by the Bill & Melinda Gates Foundation and conducted in collaboration with the London School of Hygiene and Tropical Medicine under the purview of the joint Gambian and LSHTM ethics board.
[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472726/