Re-imagining Measles Eradication: Self-Vaccination With an Inhaled Powder. Plus Using Social Networks and Financial Incentives

Despite global vaccination campaigns going back 60 yearsthat twice came close to eradicating measles, the highly contagious disease still kills more than 100,000 children worldwide each year.

What’s preventing success? The centralized approach to immunization campaigns that fails to reach enough children in low- and middle-income countries’ more remote regions, exacerbated by missed vaccinations during the Covid-19 pandemic, according to a trio of researchers. And they propose an intriguing solution to the problem

In a short communication published in December 2022 issue of the Journal of Virus Eradication, Benjamin L. Sievers, Robert E. Sievers and Eric L. Sievers suggest that self-vaccination with an inhaled, dry powder vaccine combined with inventive incentives could go a long way toward eradicating measles worldwide.

The Sieverses represent three generations of one family with largely different areas of interest and more than 50 published articles among\ them, although this opinion piece was their first collaboration. Robert Sievers, Ph.D., is an emeritus professor of chemistry at the University of Colorado Boulder who for decades conducted fundamental and applied studies in environmental and analytical chemistry He has recently been working with medical professionals and engineers to develop ways to deliver aerosol particles for the administration of drugs and vaccines. His son, Eric Sievers, M.D., is chief medical officer of BioAtla Inc., a San Diego-based biotechnology company that focuses on cancer therapeutics. And Benjamin Sievers, Eric’s son, is a Fulbright scholar at the InstitutPasteur du Cambodge in Cambodia and a research fellow at the J. Craig Venter Institute.

While celebrating the “top-down” approach to global disease eradication efforts that has saved hundreds of millions of lives, Sieverses note that measles vaccination rates have been stuck for five years at 86% for the first dose and 60% for the second. Those rates are far below the 95% required to fully halt transmission of the single-stranded RNA virus that causes measles. They point out that a needle-free, temperature-stable dry powder live-attenuated inhaled measles vaccine was developed years ago. A 2014 phase I clinical trialfound that it was safe and provoked an immune response in healthy, seropositive individuals. It could even be packaged for delivery in a whistle.

Still, getting millions of people, many in remote areas, to self-administer a new type of vaccine would be an immense behavioral challenge. This is where the Sievers get creative.

“We believe that broad adoption of self-vaccination by individuals will be positively influenced by the ease of use and by what people’s peer networks think of such a novel approach,” they write, a so-called complex social contagion model akin to how people often decided whether to wear a mask for Covid-19.

They suggest three ways to support such a campaign. First, “targeting and educating influential community members” to spread the news through social networks. Second, providing small financial incentives, perhaps through digital vaccine coin distributed through decentralized finance systems, at least in countries where they exist — a secure blockchain approach. And third, “cultivating friendly, convivial competition between local regions to achieve the highest protective measles seropositivity rates.”

The Sieverses conclude with what is essentially a marketing pitch to a global public health audience:

“Imagine a brightly-colored vaccine whistle in simple packaging festooned with pictorial instructions. Imagine simply taking one deep inhalation. As you hear the whistle's tone, you know the vaccine has been delivered and that measles will not be able to use your body to infect others. Your vaccination experience is memorable in its simplicity. You did not wait in a healthcare facility and there were no needles. You encourage your family and friends to self-vaccinate. And the whistle is yours to keep.”