Ending transmission of SARS-CoV-2: sterilizing immunity using an intranasal subunit vaccine

Abstract

Immunization programs against SARS-CoV-2 with commercial intramuscular (IM) vaccines prevent disease but not infections. The continued evolution of variants of concern (VOC) like Delta and Omicron has increased infections even in countries with high vaccination coverage. This is due to commercial vaccines being unable to prevent viral infection in the upper airways and exclusively targeting the spike (S) protein that is subject to continuous evolution facilitating immune escape. Here we report a multi-antigen, intranasal vaccine, NanoSTING-NS that yields sterilizing immunity and leads to the rapid and complete elimination of viral loads in both the lungs and the nostrils upon viral challenge with SARS-CoV-2 VOC. We formulated vaccines with the S and nucleocapsid (N) proteins individually to demonstrate that immune responses against S are sufficient to prevent disease whereas combination immune responses against both proteins prevents viral replication in the nasal compartment. Studies with the highly infectious Omicron VOC showed that even in vaccine-naive animals, a single dose of NanoSTING-NS significantly reduced transmission. These observations have two implications: (1) mucosal multi-antigen vaccines present a pathway to preventing transmission and ending the pandemic, and (2) an explanation for why hybrid immunity in humans is superior to vaccine-mediated immunity by current IM vaccines.

Recent advances in respiratory immunization: A focus on COVID-19 vaccines

“…However, the intramuscular COVID-19 vaccine only elicits strong IgG responses and not mucosal secretory IgA (sIgA) responses, while circulating IgG cannot effectively protect the upper respiratory tract from infection [ 6 , 13 , 14 ]. Therefore, mucosal vaccines that can stimulate sIgA production on the mucosal surface of the respiratory tract and that can thereby provide sterilizing immunity by blocking the virus at the entry point and preventing the initial replication of the virus, would be preferable [ 15 , 16 ]. Additionally, the intramuscular injection has low compliance due to needle phobia, logistical limitations of cold-chain transport, and the necessity for trained medical professionals, which dramatically diminishes the possibility of rapid mass vaccination, particularly in developing nations.…”