Prophylactic vaccines are saving lives
The discovery and development of prophylactic vaccines remains one of the major successes of global health with millions of lives saved every year through routine vaccination. (PMID: 34197271)
Today, more than 20 life-threatening diseases can be prevented by vaccination, helping people of all ages live longer, healthier lives.
Dose-sparing effect of a fractional vaccine dose
Numerous studies show that for vaccines like Hepatitis B [HBV], influenza, rabies, and others, intradermal (ID) prophylactic vaccination using a fractional dose exhibits similar, or even enhanced immune response compared to intramuscular (IM) or subcutaneous (SC) vaccination. (PMID: 32898704)
Indeed, studies show that only 1/5th and even up to 1/10th of the dose is needed to achieve a non-inferior immune response compared to the full dose administered IM or SC. Also in elderly people improved immune responses are described after ID flu vaccination.
True, the dermis is an attractive site for vaccination. It is highly vascularized and contains numerous immune cells, like dendritic cells and Langerhans cells.
Pandemics and Health Emergencies
Future pandemics are inevitable, but it is unlikely, that vaccine production plants can be scaled up rapidly enough to immunize the critical proportion of 60–70% of the world’s population. Therefore, dose-sparing approaches such as intradermal (ID) vaccination can offer a solution.
Indeed, intradermal prophylactic vaccination offered a solution for the recent health emergency of mpox (i.e. injection of the vaccine in the dermal layer of the skin) due to its dose-sparing potential. Importantly, only 1/5th of the dose given intradermally elicits a similar immune response to full dose given intramuscularly or subcutaneously. (PMID: 26143613)
In light of the recent COVID pandemic
mRNA for prophylactic vaccination
Recently, the widespread use of COVID-19 mRNA vaccines furthermore accelerates mRNA vaccine technology leading to the development of future prophylactic as well as cancer vaccines (see therapeutic drug delivery).
Advantages of intradermal prophylactic vaccination
Intradermal vaccination has three big advantages over intramuscular or subcutaneous vaccination:
(1) an improved immune response to vaccine antigens;
(2) potential reduction of antigen-dose, and
(3) decreased anxiety and pain.
VAX-ID to prevent infectious diseases
Vaccination with a reduced dose recombinant Hepatitis B vaccine administered via VAX-ID and the Mantoux technique, the current golden standard for ID administration, showed similar immune responses as full dose IM administration.
Importantly, VAX-ID is compatible with low-viscosity liquid formulated vaccines, no extensive formulation development work is needed.