Is the future of vaccines needle-free and digital?

Not too long ago, the most common cause of death and disability worldwide was infectious disease. Immunisations have significantly reduced our burden of disease and brought a number of major infections under control.

However, as far as we’ve come, there is still some way to go. Much of the world remains burdened with preventable infectious diseases and we continue to see very significant resurgences of life-threatening preventable conditions such as measles due to the anti-vaccine movement, fuelled by misinformation and propaganda.

The NHS Digital Child Health Programme and needle-free vaccines are two developments lying just around the corner that could start to address some of these problems, but what are they and when are we likely to see them in action?

Vaccine wins

Before we discuss the future of vaccines, let’s first give a nod to how successful immunisations have been to date, and take note of some facts and recent success stories.

We have seen a total of 39 vaccines introduced in the UK ¹, many of which form part of our routine childhood immunisation schedule. These vaccines offer us protection against a wide range of bacterial and viral infections, protecting us both at home and when travelling abroad. Vaccines have successfully reduced deaths from diseases that would once have claimed millions of lives. But vaccination isn’t only about preventing individuals from infections.

A great recent example of successful vaccination has been against the human papilloma virus (HPV), known to be responsible for the majority of cancers of the cervix (neck of the womb). A recent article published in the BMJ showed a 90% decrease in pre-cancerous cells on the cervix of 20 year old females that had been vaccinated when aged 12 or 13². Through preventing a viral infection, the HPV vaccine is eliminating the most common cancer in women aged under 35³.

Interestingly, not only were the group of 140,000 Scottish females in the study less likely to develop cervical cancer, but so were unvaccinated females around them, on account of herd protection.

Herd protection refers to how when you vaccinate a large number of people, it also protects the unvaccinated people around them. Females vaccinated against HPV aren’t passing the infection on to their sexual partners. There is therefore less HPV infection around to be spread and those that are unvaccinated also benefit.

This phenomenon is true for other vaccines too. If we look at the flu vaccine nasal spray for example that is given to children, it is as much given to reduce illness and hospital admissions in children as it is to do the same for older adults and other vulnerable members of society. Less flu being spread around by children means less flu all round. Herd immunity applies to many vaccines.

Vaccine losses

Despite significant gains, immunisation remains hotly debated and the anti-vaccine movement rumbles on.

Recently, falls in vaccination rates have led to a rise in measles and an increase in measles related deaths across Europe. In London there have been 300 cases of measles reported since October 2018, many in North East London where vaccination rates for the measles, mumps and rubella vaccine (MMR) are low, with only 70% of children completing the full course of 2 vaccines⁴.The WHO recommends a need to vaccinate 95% of children in order to gain herd immunity. Poor vaccination rates leave young children (as well as groups of adults that were not immunised around the time of Andrew Wakefield’s disproven claims that the MMR causes autism) vulnerable to measles.

Access to vaccines is poor throughout many countries where infection continues to be a common cause of death. According to World Health Organisation (WHO) and UNICEF estimates, 1 in 10 infants worldwide received no vaccinations at all in 2016⁵. Dr Jean-Marie Okwo-Bele, the director of vaccines at the WHO, said “Most of the children that remain un-immunized are the same ones missed by health systems."

The digital future of vaccines

Two amazing new developments in the world of immunization could help some of the issues we face currently.

Firstly, digitisation of our immunisation records lies just around the corner. The Digital Child Health programme will, as part of creating an online health record for children, incorporate the Red Book⁶, a booklet given to all parents as they leave the hospital with their newborn, where developmental milestones and vaccines are recorded.

An online system where our national immunisation schedule is held will be incredibly useful. Imagine a system that reminds you not to forget that 2nd MMR dose and makes it easier to stay up to date. A system that flags up whenever a child comes in contact with any service that has access to the digital red book and initiates an opportunity for education or discussion around vaccines.

Further digitalising any vaccinations received beyond childhood makes practical sense and hopefully is part of the future plan. Knowing what vaccines you’ve had (or not had) and when, without relying on your parent’s memory, would be welcomed by parents, children and occupational health departments alike.

The e-red book is currently under development and will start being used in 2020. 

Needle-free vaccines

Secondly, a new and potentially very exciting method of administering vaccines is undergoing research trials.

Being labelled as needle-free, the microneedle patch is a plaster impregnated with the flu vaccine that is released once the plaster is stuck onto skin. Although the vaccine is in fact delivered beneath the skin through 100 microneedles, they are not felt and the needles go on to dissolve.

Such methods of vaccine administration are an exciting prospect for more than the needle-phobes amongst us. A plaster can be taken off and thrown out with general household waste, eliminating the risk of needlestick injuries or special needle disposal bins.

The flu patch is just one of a number of needle-free alternatives⁷. Needle-free administration of medications has been in existence since the 1930s and includes using either compressed gas or spring-power to deliver a fine jet of medication under the skin, but what is amazing about the patch is the fact it wouldn’t need a trained healthcare professional for administration, nor would it rely on careful transportation and refrigeration.

The microneedle flu patch has been tested by researchers from Emory University in the US^8,9. It was found to have the same required effect as the injected flu vaccine, as well as lasting a year without refrigeration.

Applying such technology to other immunisations in future could improve vaccine uptake, as well as getting vaccines out to areas worldwide where access to immunisations and healthcare professionals is poor. This is a very exciting development and certainly one to watch out for.

When will this technology be available? The answer isn’t clear just yet. A pharmaceutical company has received additional funding from the Centre of Disease Control and Prevention to develop a needle-free rotavirus and polio virus vaccine however, so hopefully it is sooner than we think¹⁰.

Edging closer

As well as humans have done in the battle against infectious diseases, there remains plenty of room for improvement. Education and access lie at the heart of the challenge, but with a little help from technology, we might just be able to edge that bit closer to eradicating preventable diseases worldwide.

References

1. Public health matters blog 2015. Immunisation in numbers - 5 fascinating facts. [Online]. [12 April 2019]. Available from: https://publichealthmatters.bl...
2. BMJ 2019. Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. [Online]. [12 April 2019]. Available from: https://www.bmj.com/content/36...
3. Jo’sTrust.org.uk Cervical cancer and abnormalities. [Online]. [12 April 2019]. Available from: https://www.jostrust.org.uk/ab...
4. Inews.co.uk 2019. A measles outbreak in London has reached more than 300 people in the past six months. [Online]. [12 April 2019].Available from: https://inews.co.uk/news/measles-outbreak-london-hackney-haringey-cases-council-vaccination/
5. World health organisation. 2017. 1 in 10 infants worldwide did not receive any vaccinations in 2016. [Online]. [12 April 2019]. Available from: https://www.who.int/news-room/...
6. Digital.nhs.uk 2019. Digital Child Health. [Online]. [12 April 2019]. Available from: https://digital.nhs.uk/service...
7. Innovareacademics.in 2013. Needle free injection system: a review. [Online]. [12 April 2019]. Available from: https://innovareacademics.in/j...
8. NHS UK 2017. 'Painless' flu vaccine skin patch shows promise. [Online]. [12 April 2019]. Available from: https://www.nhs.uk/news/medica...
9. Rouphael NG, Paine M, Mosley R, et al. The safety, immunogenicity, and acceptability of inactivated influenza vaccine delivered by microneedle patch (TIV-MNP 2015): a randomised, partly blinded, placebo-controlled, phase 1 trialThe Lancet. Published online June 27 2017
10. Micron Biomedical 2018. Micron receives additional funding from the CDC for collaboration on the development of a microneedle patch for IRV-IPV co-administration. [Online]. [12 April 2019]. Available from: https://micronbiomedical.com/m...