Forget vaccine jabs—next-generation COVID-19 pills and nasal sprays are on their way

Even as the world tries to inject billions of people’s arms to fight against COVID-19, the next generation of coronavirus vaccines could make some of that massively complicated rollout unnecessary—perhaps as early as next spring. Instead of vials shipped around the world, and having to be stored at sub-zero temperatures, the new drugs would look more like this: blister-pack tablets and nasal sprays.

“Our expectation is one tablet per year,” Sean Tucker, chief scientific officer of San Francisco biotech company Vaxart, told Fortune on a Zoom call on Monday, holding up a pill that looks like a simple vitamin tablet—the company’s new COVID-19 vaccine. The company has just completed Phase I trials, and Tucker says his team plans to conduct Phase II trials this summer, and efficacy trials late this year; he hopes to receive authorization for emergency use in the U.S. within a year. “We don’t need syringes,” he says.

The number of companies trying to create nasal spray and oral COVID-19 vaccines is still small, compared with dozens working to introduce new injectable versions. Of the 93 vaccine trials underway, just two are for oral tablets and seven are the nasal variety, according to the World Health Organization.

Yet even if only a few are approved by regulators in various countries, the impact would be huge on the world’s ability to rein in a virus that has wreaked global economic havoc. “There are really good ones coming, through nasal and oral vaccines,” WHO chief scientist Soumya Swaminathan told health officials last week during an online panel coordinated by the Unicef Innocenti research center in Florence, Italy. “That will make it much easier.”

In a survey commissioned by Vaxart, and released last week, about 23% of people polled in the U.S. said they did not want to be jabbed with a COVID-19 vaccine. But about one-third of those said they would take a vaccine tablet if it were available. Based on that, Vaxart estimates that a tablet might bump up by another 19 million the number of people in the U.S. who are willing be immunized—perhaps enough for the country to reach herd immunity. On Monday, Vaxart said its Phase I trials had shown bigger CD8⁺ T cell responses than the Pfizer and Moderna vaccines, and broad immunity to the coronavirus.

A Vaxart blister pack contains the biotech firm’s COVID-19 vaccine, which is adapted to be administered as a pill.

Optimism for less-developed countries

The impact could be greater still in less-developed countries, where vaccine distribution has been daunting, even in places that have them, and for people who want them.

Take India, whose explosive COVID-19 outbreak has left hospitals without oxygen supplies, and crematoriums struggling to keep pace with deaths. Even though India is a major producer and exporter of coronavirus vaccines, less than 10% of its 1.4 billion population has been vaccinated.

Swaminathan says what is needed is a well-knit logistics network across India, with vaccine hubs in hundreds of local hospitals. That is hard to imagine in a country with patchy electricity and poor infrastructure.

Oral tablets and nasal spritzes of COVID-19 vaccines could solve many of those logistical problems. “You can send this tablet by mail; you can immunize people 20 or 30 times more easily,” says Vaxart’s chief scientist Tucker, holding his pill up to the screen. “You can ship it to places that don’t have freezers. And you don’t need a qualified medical person to immunize people.”

A spritz up the nose

The same is true for nasal spritzes. The biopharma company Altimmune, in Gaithersburg, Md., is testing a new vaccine that would be a single spritz up the nose, one that could be stored for several months at room temperature—a drastically different scenario than the Pfizer-BioNTech or Moderna vials, which require ultra-cold storage.

Much like Vaxart, Altimmune says its vaccine stimulates broad immune response and boosts T cells, by generating mucosal immunity in the nasal cavity and respiratory tract. “That’s really the best opportunity to block infection and, importantly, block transmission of the virus from an infected individual to others,” the company’s chief scientific officer, Scot Roberts, told investors on a call in March. “At the end of the day, that is how we are going to bring this pandemic to an end as a walking transmission.”

First, however, companies need to convince regulators that the new generation of non-jab vaccines are safe. And for millions, the idea of swallowing a COVID-19 vaccine, or aiming it up one’s nostril, might seem less than a true inoculation.

“When you mention a vaccine to the general public, what pops into their mind immediately is a syringe,” says Michael Russell, professor emeritus of microbiology and immunology at the University of Buffalo and a specialist in nasal vaccines. “A lot of us who have worked in this field for decades think, ‘Hang on, you’ve got this all backwards.’”

For a virus that ravages the respiratory and gastrointestinal tracts, he says, oral and nasal vaccines could be at least as effective as the COVID-19 vaccines in use now. “To a lot of us, it seems to make sense,” he says.