Needle-free flu sprays could transform winter

As a paediatric doctor who has cared for sick children in hospitals around Aotearoa New Zealand for almost 15 years, this year’s influenza season has been devastating. If we want to avoid the same thing happening next year, the intranasal needle-free influenza vaccine would certainly help, particularly for children and their parents.

I have watched influenza take previously well children and make them critically unwell – admitted to intensive care, relying on breathing tubes and multiple medications just to keep them alive. I have watched parents sit beside their child’s hospital bed, facing some of the worst days of their lives. Their everyday lives on hold as they get through each day.

Watching a family go through that is heartbreaking. What makes it particularly difficult for me, as the doctor caring for these children, is knowing that some of their suffering is potentially preventable.

Influenza is one of the world’s most important respiratory infections. The World Health Organization estimates that seasonal influenza causes around one billion infections globally each year, including millions of cases of severe illness and hundreds of thousands of respiratory deaths. Young children are particularly vulnerable to complications such as pneumonia, respiratory failure and hospitalisation.

It gets worse: influenza does not affect all children equally. In Aotearoa New Zealand, Māori and Pacific children experience a disproportionate burden of influenza-related illness and hospitalisation. I’m a Pacific doctor and these are the children and families I care for, and the inequities I see playing out in our hospitals.

I am also a mother of two young boys and know that one of the hardest parts of protecting a child from influenza is getting them through the doctor’s door.

I have held them close while they cried as the needle went in. I have had to remind myself that watching them in distress for a few seconds is better than watching a child struggle to breathe in a hospital bed later. But then, I’m a doctor and know that it’s worth it. I also know why parents find it difficult.

It would be so much easier to protect children from influenza if we could vaccinate them without a needle. And we could if we decided we should.

There is already an influenza vaccine designed to be delivered through the nasal route, which is where the virus enters the body.

Intranasal influenza vaccines, which are administered as a nasal spray rather than an injection, are already widely used in children 2-17 years in Australia and the United Kingdom, and in various age groups in the United States of America, Canada, the United Kingdom, and many countries across Europe. They are and have been studied extensively in children, and evidence suggests that their effectiveness is comparable with injected influenza vaccines.

The nasal route also has a biological advantage: it delivers the vaccine directly to the tissue linings in the nose where influenza first establishes infection. That raises the possibility of generating an immune response at the very front line of exposure.

This is another tool to fight influenza that we could offer, particularly to children, should we prioritise it. Imagine how much easier it would be for parents to get their kids vaccinated. It certainly would be for me. The difference between a vaccine that is offered as a nasal spray and one that requires an injection is likely to mean the difference between accepting vaccination and refusing it, particularly for families who have needle phobia.

And if we are serious about reducing inequities in childhood influenza, we need to think beyond simply making a vaccine available and consider whether the way we deliver that vaccine works for the children and families we are trying hardest to reach.

Pharmac and Health New Zealand took the important step of expanding funded influenza vaccination to all children under five. If we want to plan ahead for next year’s flu seasons, we could start talking about this and putting pressure on those who can help bring it into use sooner, including through an accelerated Medsafe approval process.

Influenza places a substantial seasonal burden on our children, our families and our health system every year. Intensive care beds fill. Parents take time away from work. Children miss school and early childhood education. Some children become profoundly unwell.

We cannot prevent every influenza infection. But we can choose how ambitious we want to be now about preventing its consequences. As the influenza virus continues to change, perhaps our approach should change too. One that doesn’t ask parents to hold their children still while we put a needle into their arm.