Don't postpone vaccination while waiting for a nasal spray
As the autumn of 2020 drew near, Americans found themselves standing at the intersection of two viral threats — a familiar seasonal foe and an unfamiliar pandemic. Into this moment of compounded vulnerability, an old tool quietly returned: the nasal spray flu vaccine, once discredited during the H1N1 era, had been reformulated and restored to official recommendation. Health experts, weighing the evidence and the urgency, offered a measured reminder that the form of protection matters far less than the act of seeking it.
- With COVID-19 still surging, the prospect of a simultaneous flu season in fall 2020 raised alarms among public health officials who feared hospitals could be overwhelmed by two respiratory threats at once.
- The nasal spray vaccine carried a complicated history — pulled from CDC recommendations between 2016 and 2018 after failing against H1N1 — leaving many patients and providers uncertain whether to trust its return.
- Supply shortages threatened to make the nasal spray's comeback more symbolic than practical, with pediatricians like Dr. Dawn Johnson noting that patient demand was already outpacing available stock.
- Doctors across the board urged the public not to delay vaccination while searching for the spray — any CDC-cleared flu vaccine, needle or not, was far better than waiting and leaving oneself exposed.
- The clock was ticking: the CDC recommended vaccination by end of October, and with flu effectiveness already ranging only 40–60% in the best years, every week of hesitation narrowed the window of protection.
In the fall of 2020, public health officials confronted an unsettling overlap: flu season was arriving just as COVID-19 continued its spread. Against this backdrop, the nasal spray flu vaccine was quietly making a comeback after years on the sidelines.
The spray had been sidelined following the 2009 swine flu pandemic, when studies showed it performed poorly against H1N1. The CDC stopped recommending it entirely from 2016 to 2018. After the manufacturer reformulated the product, the CDC revisited its stance and restored its recommendation — though notably, no new American studies had confirmed the updated version's effectiveness. The agency instead relied on international data suggesting it performed comparably to the traditional shot.
The nasal spray comes with firm eligibility limits: approved for ages 2 to 49, it cannot be used by pregnant women, young children with asthma, or anyone immunocompromised. For those who do qualify, the appeal is straightforward — no needle required. But availability was already proving to be a significant obstacle.
Dr. Joseph Chang of Parkland Health and Hospital System and pediatrician Dr. Dawn Johnson of Children's Health both offered the same grounded advice: the spray and the shot had each cleared rigorous regulatory review, and neither deserved preference over the other. What mattered was getting vaccinated at all. Johnson acknowledged that parents frequently asked about the spray, but she also knew the supply simply couldn't meet the demand.
Flu vaccine effectiveness shifts each year — anywhere from 40 to 60 percent — depending on how closely the selected strains match what actually circulates. With the CDC recommending vaccination by end of October, doctors were unambiguous: don't delay looking for a preferred delivery method. If the spray was available, fine. If not, the shot was equally sound. In a season defined by compounding risks, hesitation was the one option no one could afford.
As autumn approached in 2020, public health officials faced an unusual convergence of threats: flu season arriving just as COVID-19 cases continued to surge. In this moment of dual vulnerability, an old vaccine option was making a quiet comeback. The nasal spray flu vaccine, sidelined for years after proving ineffective against H1N1, was being reconsidered as a legitimate choice for the coming months.
The vaccine had fallen from favor after the 2009 swine flu pandemic. Studies at that time showed it performed poorly against H1N1, prompting the CDC to stop recommending it entirely from 2016 through 2018. But the manufacturer had reformulated the vaccine, and the CDC, after reviewing the changes, resumed its recommendation. The catch: there were no new American studies proving the reformulated version actually worked. Instead, the CDC pointed to data from other countries suggesting it performed as well as the traditional shot.
The nasal spray option comes with clear boundaries. It's approved only for people aged 2 to 49. Pregnant women cannot use it. Neither can children between 2 and 4 with asthma, or anyone with a compromised immune system. For those who do qualify, the appeal is obvious—no needle, just a spray into each nostril. But availability would prove to be a problem.
Dr. Joseph Chang, chief medical officer at Parkland Health and Hospital System, offered a measured perspective on the choice between spray and shot. Both had cleared rigorous FDA and CDC review processes, he noted. Neither deserved preference over the other. The important thing was getting vaccinated, period. Dr. Dawn Johnson, a pediatrician at Children's Health, echoed this pragmatism. Parents frequently asked about the nasal spray, she said, and it was a reasonable option. But she also knew the reality on the ground: there simply wasn't enough of it to meet demand.
Flu vaccine effectiveness fluctuates year to year, ranging between 40 and 60 percent depending on how well the vaccine strains match the viruses actually circulating. The CDC selects which strains to include based on what had spread during winter months in other parts of the world. It's an educated guess, not a certainty. This uncertainty meant that neither the spray nor the shot offered guaranteed protection—only a meaningful reduction in risk.
As the season approached, the CDC recommended vaccination by the end of October, giving the immune system time to build defenses before influenza began spreading widely through communities. For those considering the nasal spray, the message from doctors was clear: don't wait for it. If your local pharmacy or clinic had the spray in stock, fine. But if they didn't, the shot was equally sound. Delaying vaccination while hunting for a preferred option was the real mistake.
Notable Quotes
Things that are cleared by the CDC have a very rigorous process they have to go through. If the CDC and FDA has cleared them, then I would say either are good to use.— Dr. Joseph Chang, chief medical officer of Parkland Health and Hospital System
Generally speaking, there's not enough of it to give to everyone who prefers it. I would encourage parents to get the flu vaccine that is available and to definitely not postpone it while waiting for a nasal spray.— Dr. Dawn Johnson, pediatrician at Children's Health
The Hearth Conversation Another angle on the story
Why did the nasal spray vaccine fall out of favor so completely after 2009?
The H1N1 outbreak exposed a real problem—the spray just didn't protect people against that particular virus the way the shot did. So the CDC stopped recommending it. That's how public health works: the evidence changes, the guidance changes.
And now they're recommending it again. What changed?
The manufacturer reformulated it. But here's the honest part: we don't have new American studies proving it works. The CDC is relying on data from other countries. It's a calculated judgment, not ironclad proof.
So doctors are basically saying both are fine?
Yes. Dr. Chang was pretty clear about it—if the FDA and CDC cleared it, either option is good. The real issue isn't which is better. It's that there isn't enough spray to go around.
Parents want the spray because kids don't like needles?
Exactly. But Dr. Johnson's point is important: don't let that preference become an excuse to delay. In a year when flu and COVID are both circulating, waiting is the bigger risk.
How effective is either vaccine, really?
Somewhere between 40 and 60 percent, depending on the year. It's not perfect, but it's meaningful protection. And in 2020, meaningful was what mattered.