A healthcare worker dons a gown as they prepare to see a patient in the intensive care unit at Hospital for Sick Children in Toronto on Nov. 30, 2022. A new RSV vaccine will help protect babies from serious illness caused by respiratory syncytial virus, or RSV this fall.Chris Young/The Canadian Press
This fall, all newborns in Ontario and Quebec will for the first time be offered a shot that can cut their risk of getting seriously sick with respiratory syncytial virus, a pathogen that is the top reason infants are admitted to hospital in Canada.
The launch of universal programs covering nirsevimab, a long-acting antibody that provides passive immunity to infants, in the country’s two largest provinces is part of a significant expansion in tools to combat RSV.
New vaccines for seniors and expectant mothers, who can now receive a jab late in pregnancy to pass antibodies on to their babies, are also expected to reduce the burden from a virus that sends thousands of babies and elderly people to hospital every year.
“The monoclonal antibody and the RSV vaccine for pregnant patients are a game changer,” said Yenge Diambomba, a staff neonatologist and co-chair of the RSV prevention working group at Mount Sinai Hospital in Toronto.
But the cost and availability of the new RSV immunizations is emerging as a challenge and none of the Western provinces will provide nirsevimab this season.
Health spokespeople in British Columbia, Saskatchewan and Manitoba all confirmed to The Globe that their provinces would be sticking with their current programs. That means offering palivizumab – an older, more expensive antibody taken monthly during RSV season – to high-risk infants only, including babies born prematurely or with chronic lung and cardiac diseases.
Alberta Health declined to comment, but a source with that province’s RSV prophylaxis program said Alberta was taking the same approach as its Western neighbours.
“It’s unfortunate,” said Darryl Adamko, a pediatric respirologist and director of the RSV prevention program in Saskatchewan. He said he expects Ontario and Quebec will see “great benefits” from offering all infants nirsevimab, which is sold under the brand name Beyfortus. “It’s too bad the rest of Canada couldn’t get in on it at the same time. We’re supposed to be one country.”
RSV is a highly contagious seasonal respiratory virus that is most dangerous to the very old and the very young, especially children younger than six months old who develop bronchiolitis or pneumonia owing to RSV.
RSV made headlines in the fall and winter of 2022-2023 when it was one of three viruses that rebounded as pandemic-era restrictions were eased, overwhelming children’s hospitals.
But unlike influenza and COVID, there were at that time no Health Canada-approved immunization options for RSV, except for the more expensive and frequently injected palivizumab. For that reason, provinces and territories covered palivizumab only for the most vulnerable babies. Health Canada approved nirsevimab last year.
Three sources involved in RSV implementation programs said the provinces that aren’t offering nirsevimab for the 2024-2025 season struggled to get doses in part because Sanofi, the French pharmaceutical company that makes the antibody, prioritized their limited global supply for jurisdictions that agreed to cover it for all babies, as Ontario and Quebec did.
Some other provinces balked at the cost of giving every baby an immunization with a Canadian list price of $952 a dose. They preferred to start with smaller programs targeting high-risk infants and those living in remote communities where serious RSV infections sometimes lead to babies being airlifted to urban hospitals.
The sources said their provinces felt that if Sanofi wouldn’t promise them doses of nirsevimab for a smaller program, they had little choice but to place orders for palivizumab to ensure they had something to offer high-risk babies this RSV season.
The Globe and Mail is not naming the sources because they were not authorized to speak publicly about provincial immunization policies.
Delphine Lansac, Sanofi’s general manager of vaccines for Canada, said that was “not accurate,” although she also stressed that it was always the company’s goal to ensure nirsevimab was publicly covered for all infants.
“I think in this first year of implementation we’ve all been working against tight timelines,” Ms. Lansac said. “Some provinces were expecting to have early confirmation on doses and programs. I think that’s also why some of them probably decided to opt for other options. But for sure our objective as Sanofi is to make sure that all newborns, all Canadian infants, can access protection, can access Beyfortus.”
Ms. Lansac said she couldn’t speak about provinces that had not publicly announced RSV programs for this season.
Nunavut officials told The Globe and Mail they were planning a universal nirsevimab program, while spokespeople with Newfoundland and Labrador’s and Prince Edward Island’s health departments said they are planning to offer nirsevimab to high-risk babies. Nova Scotia isn’t planning a universal nirsevimab program this season, but is still in talks with Sanofi about securing nirsevimab for high-risk infants.
New Brunswick, Yukon and the Northwest Territories did not respond to The Globe.
In May, the National Advisory Committee on Immunization published new guidelines recommending nirsevimab over palivizumab or the maternal vaccine because clinical trial results suggested nirsevimab would keep more babies out of hospital.
However, NACI also commissioned a study that concluded giving nirsevimab to all infants would not be cost-effective unless Sanofi cut the price to between $110 and $190 a dose, down from the Canadian list price of $952. Confidential discounts off the list price are common, but Ms. Lansac of Sanofi said she couldn’t comment on the real price provinces are paying for nirsevimab.
Dr. Diambomba of Mount Sinai said she and her colleagues have been working hard to educate expectant parents early in their pregnancies about the new options for protecting babies against RSV. Mount Sinai and other hospitals in Ontario and Quebec will be offering injections of nirsevimab to all newborns before they leave the hospital beginning as early as next month.