Canada Widens Access to RSV Shield for Infants, But Cost and Choice Remain Key

Toronto, ON – A new preventative antibody is poised to significantly reduce the burden of respiratory syncytial virus (RSV) on Canadian infants, as provinces expand access to nirsevimab, a long-acting monoclonal antibody designed to provide season-long protection. However, the rollout isn't uniform across the country, and the emergence of a maternal RSV vaccine adds another layer of complexity for parents and healthcare providers.

For years, RSV has been a major cause of bronchiolitis and pneumonia in young children, leading to countless hospitalizations and, in rare cases, severe complications. Previously, the only available preventative measure, palivizumab, required monthly injections and was reserved for high-risk infants. Nirsevimab, marketed as Beyfortus, offers a single dose of protection, making it a potentially transformative addition to Canada’s pediatric health arsenal.

“The introduction of nirsevimab represents a significant step forward in preventing severe RSV disease in infants,” says a public health official. “It has the potential to alleviate a considerable strain on our healthcare system, especially during peak RSV seasons.”

A Patchwork of Provincial Programs

The availability of nirsevimab varies significantly across Canada, reflecting different provincial healthcare priorities and budgetary constraints. Ontario, Quebec, Nova Scotia, Prince Edward Island, Nunavut, Northwest Territories, and Yukon have announced universal programs, offering the antibody to all infants, regardless of risk factors. Manitoba and Saskatchewan are expanding their programs to include all infants born during the RSV season, while Alberta, New Brunswick, and Newfoundland and Labrador are currently limiting access to high-risk infants. British Columbia has discontinued funding for palivizumab and is replacing it with nirsevimab for high- and moderate-risk infants.

“The inconsistency in provincial coverage is concerning,” notes a pediatric nurse. “It creates inequities in access to preventative care and places an additional burden on families who may need to travel to access the antibody.”

The logistical challenges of administering nirsevimab, particularly in remote communities, are also being addressed. Many provinces are offering the antibody in hospitals at birth, while others are providing it through public health clinics or primary care physicians.

The Rise of Maternal Vaccines and a New Choice for Parents

The landscape became more complex with the recent approval of Abrysvo, an RSV vaccine for pregnant individuals. By vaccinating expectant mothers, the vaccine aims to transfer protective antibodies to the developing fetus, providing passive immunity from birth through six months. This offers a different approach to RSV prevention, relying on maternal immunization rather than direct infant prophylaxis.

“The introduction of the maternal vaccine adds another layer of choice for parents,” says a family physician. “Some parents may prefer the vaccine, while others may opt for nirsevimab, depending on their individual circumstances and preferences.”

The choice between a maternal vaccine and direct infant prophylaxis isn't always straightforward. While the maternal vaccine offers broader protection against RSV subtypes, its efficacy may wane over time. Nirsevimab, on the other hand, provides longer-lasting protection but doesn’t offer the potential for broader subtype coverage.

Cost-Effectiveness and the Future of RSV Prevention

Economic evaluations suggest that universal immunization with nirsevimab could be a cost-effective strategy for the Canadian healthcare system. The antibody is projected to prevent a significant number of RSV-related hospitalizations and other healthcare events, leading to substantial cost savings.

However, the high cost of nirsevimab – approximately $952 per dose – remains a concern. While the long-term cost-effectiveness is promising, the initial financial burden could be substantial, particularly for provinces with limited healthcare budgets.

The price of Abrysvo, approximately $230 per dose, is significantly lower, but the vaccine is not universally funded and may require out-of-pocket expenses for some families.

“Finding a balance between cost and access is crucial,” says a healthcare economist. “We need to ensure that all infants have access to effective RSV prevention, regardless of their socioeconomic status.”

The future of RSV prevention in Canada likely involves a combination of strategies, including universal immunization with nirsevimab, maternal vaccination with Abrysvo, and continued public health education about RSV prevention measures, such as hand hygiene and respiratory etiquette.

“The introduction of these new tools represents a major step forward in protecting our children from RSV,” says a public health official. “However, it’s important to remember that RSV prevention is a team effort, requiring collaboration between healthcare providers, parents, and public health officials.”

The ongoing monitoring of RSV incidence and the evaluation of the long-term impact of nirsevimab and Abrysvo will be essential to refine prevention strategies and ensure that all Canadian infants receive the best possible protection from this common respiratory virus.