More children died from the flu this past season than any year outside of the swine flu pandemic in 2009. Most of them were unvaccinated.
That’s why some doctors are hoping that the first nasal flu vaccine available for use at home can improve vaccination rates among people, especially children, who are afraid of needles.
AstraZeneca’s FluMist Home, which was approved last fall, is now available with a prescription for children ages 2 and over, and adults up to age 49.
A 2019 review from researchers at the University of Michigan found the majority of children and up to 30% of young adults are afraid of needles.
Dr. Zachary Hoy, board-certified pediatric infectious disease specialist at Pediatrix Medical Group in Nashville, Tennessee, said many children are scared because they aren’t old enough to understand what vaccines are and why they are important.
“Most of the time, the anxiety and worry before the shot is scarier than the actual shot,” Hoy said.
How does FluMist Home work?
The vaccine was first approved in 2003 to be given in a doctor’s office. However, after the 2009 swine flu pandemic introduced the new H1N1 strain, several studies found the nasal spray was less effective than other flu vaccines. This prompted the Centers for Disease Control and Prevention to recommend against using the nasal spray in 2016. At the time, the CDC said the nasal spray accounted for one-third of all flu vaccines given to children.
In response, FluMist’s manufacturers reformulated it to more closely match circulating strains, including H1N1, and the nasal spray returned in 2018. Like injectable flu vaccines, FluMist is updated each season based on recommendations from global health officials.
“FluMist’s efficacy is comparable to injectable flu vaccines and is a safe and effective needle-free option for flu protection,” AstraZeneca spokesperson Andrew Leone said.
Experts say it’s too early to tell how bad the upcoming flu season will be.
Typically, flu vaccines are 40% and 60% effective in preventing severe illness, and FluMist Home should be equally protective. The doses for the 2026-2027 season contain three virus strains: an A/H1N1 strain, an A/H3N2 strain and a B strain from the B/Victoria lineage, according to the drugmaker.
The FluMist Home vaccine contains a weakened form of a live virus to stimulate the immune system. Pregnant women or people with compromised immune systems are advised to talk with their doctor before using it.
Does insurance cover it?
FluMist Home is available only online. People ordering the nasal spray will need to complete a medical screening questionnaire at FluMist.com that is reviewed by a health care professional, according to the drugmaker. FluMist Home’s online pharmacy will then collect the insurance information and bill the health plan directly.
A temperature monitor on the packaging will verify that the vaccine has been maintained at the appropriate temperature during shipping and delivery. Green means it’s safe to use. Red means it’s not.
Christina Aungst, senior pharmacy editor at GoodRx, estimates people with insurance will likely only have to pay an $8.99 shipping fee for the nasal spray.
“Currently, if you don’t have insurance, FluMist is only available in a health care setting,” AstraZeneca’s Leone said. “We hope to provide a cash pay option for FluMist Home in future seasons.”
When FluMist is given in a health care office or clinic, most insurance plans — including Medicare and Medicaid — will cover it.
Dr. Scott Roberts, associate medical director of infection prevention at Yale School of Medicine, worries people may not administer the nasal spray vaccine properly without a doctor’s supervision.
“What if they have a runny nose? How far back do they need to spray in the nose? What if they store it incorrectly in their house?” Roberts asked.
Dr. Kristina Bryant, pediatric infectious diseases physician at Norton Children’s in Louisville, Kentucky, and a member of the American Academy of Pediatrics Committee on Infectious Diseases, said the bottom line is that all the available flu vaccines offer comparable protection.
“The most important thing to know is that vaccines only work if they are actually administered,” Bryant said. “Hopefully, the availability of a vaccine that can be administered in the home will make it easier for some people to be protected against flu.”
