Drug delivery
At the start of 2021, McManus published an article on ‘Tackling the big four vaccine challenges’, which he identifies as: structural barriers to equitable access; hesitancy; data; and disinformation. We need “a combination of measures”, McManus explains, including, “confidence and trust that the vaccine is safe and effective, through good quality information and good quality communication; ability to access the vaccine; and then ensuring that the means of getting the vaccine are acceptable”. A lot has been made of vaccine hesitancy in the press – with most of it being blamed on nonsensical conspiracies – but McManus believes this is a misleading label. In reality, as McManus explains, people’s responses to the vaccine fall into a spectrum of categories, ranging from those “we could call anti-vaxxers”, to those who “are not hesitant [but] just want information”, to those “who really have problems with needles”.
Little mention has been made of this third group – and yet, they comprise a substantial part of the population. According to McManus, around 10% of the population suffer from trypanophobia (a fear of needles), and that is before you take into account the people with learning disabilities and people with autism. “And I would put them as a separate category of people from fear of needles, because it’s not needles that are the issue, it’s the significant disruption to a routine that they’re used to, and the needle is a part of that,” he explains.
Face the fear
The findings of one systematic review published in 2019 indicate that the majority of children exhibit trypanophobia, while prevalence estimates ranged 20–50% in adolescents, and 20–30% in young adults. This may be, as McManus suggests, something of an overstatement, but “there is no doubt that if an oral vaccine became available […] then that would make it easier for a portion of the public to take it up” – but that’s a big scientific “if”. Oral vaccines are not unheard of. The rotavirus vaccine is administered orally to babies in the UK as a routine part of their childhood vaccinations and, for many years, polio vaccines were also given orally – though, as Professor Azeem Majeed, head of department of primary care and public health at Imperial College London, notes, “this has now been replaced [in the UK] by an injected vaccine”. Like McManus, Majeed is sceptical about the chances of seeing an oral Covid-19 vaccine anytime soon. “I think it’s unlikely we will see oral vaccines for Covid-19 introduced in the near future,” he admits, because we simply “don’t know yet how well oral vaccines will work”. An oral vaccine for Covid-19 is not straightforward to produce, as a method is
World Pharmaceutical Frontiers /
www.worldpharmaceuticals.net
Jim McManus’s article states that fear of needles plays a role in the lack of vaccine uptake.
needed to stop it being broken down by the acid in the stomach. Majeed’s point is not that an oral vaccine is an impossibility per se, rather, that our efforts may be better spent elsewhere. “The priority,” Majeed notes, “is vaccines that are much better at preventing infection than our current vaccines, reduce transmission of infection, and provide longer- term immunity. Current vaccines have limited effects in these areas, which is why we are still seeing high infection rates in the UK despite a high vaccine uptake in the population.”
“The priority is vaccines that are much better at preventing infection than our current vaccines, reduce transmission of infection, and provide longer-term immunity.”
Professor Azeem Majeed
The race to freedom Clearly, the UK has got its priorities right: the Oxford/ AstraZeneca vaccine was one of the world’s first internationally distributable vaccines. But there are biotech companies that were working on oral vaccines before the pandemic, and that have spent the past 18 months putting other programmes on hold to channel their efforts into the development of a viable oral vaccine for Covid-19. Vaxart is one such company, with an oral Covid vaccine already in phase-II clinical trials – and so far, things are looking positive. “In a phase-I trial,” Dr Sean Tucker, chief scientific officer of Vaxart, explains, “the oral Covid-19 vaccine (VXA-CoV2-1) was well tolerated and induced substantial T cell responses, as well as an antibody response in the nose”. In fact, there may even be early signs that the oral vaccine has some medical advantages over the jab.
2/3 Our World in Data 11
More than two thirds of the UK’s population are fully vaccinated.
Lightspring/
www.shutterstock.com
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