Will people accept a fentanyl vaccine? Interviews draw thoughtful responses

In 2022, more than 100,000 people died from opioid overdoses in the U.S., according to the National Center for Health Statistics. Roughly three quarters of these deaths involved fentanyl, a highly potent synthetic opioid. Fentanyl-related deaths have spiked over the past decade, many of them occurring in people with no known history of opioid use who used other drugs laced with very small amounts of fentanyl.

Since 2019, the Precision Vaccines Program at Boston Children’s Hospital has received nearly $20 million from the National Institutes of Health to develop a new and unusual approach: a fentanyl vaccine. Still in pre-clinical development, the vaccine would protect people from lethal overdoses by blocking fentanyl’s entry into the brain (see sidebar).

But is the world ready for a fentanyl vaccine? Will people accept it? Who should receive it? Elissa Weitzman, ScD, MSc, director of research for Boston Children’s Division of Addiction Medicine, led a study to explore these questions. Participants expressed a range of views, distilled in a recent report in the journal Vaccine.

A mix of views

The research team conducted in-depth, 60- to 90-minute interviews with 74 volunteers. Interviewees included adolescents and young adults with a diagnosed opioid use disorder (from Boston Children’s ASAP program), their families, experts in substance use treatment, clinicians, scientists, and the general public.

Many study participants — including adolescents at risk for overdose — were enthusiastic about a potential fentanyl vaccine.

“Parents who had lost kids to overdose were especially enthusiastic, saying ‘Every kid should get this’ or ‘Every kid going to college should get this,’” says Weitzman.

But others had questions and concerns that suggested how seriously they took the idea of a fentanyl vaccine.

Would the vaccine’s protection wane over time, lulling people into a false sense of security? Would opioids work if needed for pain relief after surgery? Would the vaccine block the parts of the brain that perceive pleasure? Would it interact with medications like methadone or buprenorphine? Could fentanyl, blocked from entering the brain, accumulate in other tissues?

“I was surprised and impressed by the sophistication of the concerns,” Weitzman says. “Those are substantial and worthy questions.”

Different perceptions of addiction and vaccines

Attitudes varied according to people’s beliefs about addiction. Some participants took a “Let’s save lives” approach. Others saw addiction as a character flaw or moral issue, better addressed through behavioral or spiritual interventions to promote abstinence. Some felt a fentanyl vaccine would amount to condoning substance use.

Participants also had varied views on vaccines in general. The study period overlapped the COVID-19 pandemic, when many people had concerns about the rapid rollout of the new mRNA vaccines. Then add to that the unusual concept of a fentanyl vaccine.

“Vaccines have been mostly about infectious disease,” Weitzman says. “The idea of a vaccine targeting a behavioral health disorder is a cognitive ‘whaaatt?’ Wherever we have confusion, there’s potential for mistrust and the need to explain and be transparent about the state of the science.”

Informing a potential vaccine launch

The results have given Weitzman and the Precision Vaccines team plenty to think about. The input would help guide communications and educational strategies if a fentanyl vaccine is approved and rolled out.

Because this study was small and not quantitative, Weitzman is expanding it to include more youth, including more youth without opioid use disorder and larger numbers of people from minoritized racial and ethnic groups. Eventually she hopes to get population-level data.

“The feedback is incredibly important in thinking how to introduce a fentanyl vaccine to a broad community with different perspectives,” she says. “One size is not going to fit all.”

Meanwhile, solutions to the fentanyl overdose epidemic are desperately needed. More than 40 percent of Americans know someone who died from an overdose. And since 2017, the number of pills containing fentanyl seized by U.S. law enforcement has dramatically increased.

“And that’s just those that are seized,” says Weitzman. “The tiniest tip of the iceberg.”

Disclosure: Levy, Dowling, and Weitzman each have a relationship with OVAX, Inc., a company focused on approaches to detect and prevent opioid use and overdose, including a fentanyl vaccine. Levy is a co-founder and equity holder of OVAX, Inc., as is Dowling, and Weitzman is a consultant for OVAX, Inc.

Learn more about Boston Children’s Division of Addiction Medicine and listen to this podcast with the New York Times featuring the Precision Vaccines Program and the fentanyl vaccine.