C. Buddy Creech, MD, MPH, director of the Vanderbilt Vaccine Research Program, discussed emerging trends in vaccine research and development during a presentation at the American Academy of Pediatrics (AAP) 2025 National Conference and Exhibition.
Advances in monoclonal antibodies and mRNA platforms
Creech noted that monoclonal antibodies are gaining traction for preventing respiratory infections in early life. “I think you can look at the success of RSV monoclonal with nirsevimab and now claustrovimab to be able to prevent respiratory infections early in life by giving a long-acting monoclonal,” he said. He also observed that parents often show “a lot less hesitancy around giving a monoclonal antibody than we do an active vaccination.”
The role of mRNA technology, widely recognized during the COVID-19 pandemic, is still evolving. “Now I think the question is, will that type of technology be suitable for everything that we want to do? Is it best used for some viruses or some pathogens over others? And I think we’re really too early to tell,” Creech said.
Novel adjuvants under development
Creech emphasized the importance of adjuvants in enhancing immune responses and reducing antigen amounts needed for protection. “Adjuvants are really incredibly helpful for us, and we’ve used them in vaccines for over 100 years,” he said. While aluminum remains the most common adjuvant, new options are emerging. “One of the things that we should be seeing in the next few years…are novel adjuvants that aren’t aluminum-based, but take advantage of our understanding of the immune system, like little droplets of oil inside water,” Creech explained. He highlighted the Novavax COVID-19 vaccine as an example, which used a derivative from the Chilean soap bark tree.
Creech also stressed that adjuvant safety is always assessed as part of the full vaccine. “We never study a vaccine, get a safety profile for it, and then add an adjuvant. That never happens. We always study the whole package together,” he said.
Combination vaccines and parental concerns
Regarding combination vaccines, Creech said that combining antigens is pursued carefully. “If we could combine every single childhood vaccine into one vaccine, well we probably wouldn’t do it. That’s just a lot of vaccines to slam into one injection,” he said. Instead, combinations are designed based on compatibility and dose schedules. Safety is less of a concern when antigens have already been given simultaneously, but “the efficacy concerns are a little bit more when we put them in the same needle.”
He acknowledged parents’ growing interest in spacing out vaccines despite the need for more injections. Pediatricians, he said, must balance efficiency and effectiveness while addressing parental preferences.
Expanding mucosal vaccine delivery
Creech pointed to oral and intranasal vaccines as an important frontier, citing rotavirus and nasal influenza vaccines as key examples. “It turns out the first time you see a germ that dictates how you will respond to that germ for maybe the rest of your life,” he said. This principle, he noted, supports research into nasal pertussis, influenza, and COVID-19 vaccines. “I think that mucosal delivery of vaccine is going to be one of the next big frontiers within vaccinology.”
Building trust with families
Creech concluded by underscoring the importance of transparency and communication with parents as new vaccines and technologies are introduced. “We want to really be able to communicate how these new vaccines come to market and all of the rigor that goes into testing them,” he said. He stressed that flexibility and trust-building will be critical in addressing vaccine hesitancy: “If we can get that balance right, I think we’ll find a lot of success.”
Disclosure:
Creech reports no relevant disclosures.
Reference:
Creech CB. New Technologies and New Vaccines for Prevention of Pediatric Infectious Diseases. Presentation. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.