New RSV Treatments For Infants Face Challenges In Oregon

Two groundbreaking therapies have emerged, promising to significantly reduce the risk of lung infections in infants caused by the respiratory syncytial virus (RSV). However, Oregon anticipates its rollout is fraught with challenges.

Beyfortus: A Game-Changer

Beyfortus, commercially known as nirsevimab, is a monoclonal antibody treatment akin to a vaccine. Approved for infants up to 8 months old, it has shown remarkable efficacy.

Clinical trials revealed that Beyfortus decreased RSV-related hospitalizations and healthcare visits in infants by nearly 80%. Chief of Infectious Disease for Kaiser Permanente Northwest, Katie Sharff, hailed it as groundbreaking.

Unlike traditional vaccines, Beyfortus offers passive immunity, similar to the protection infants receive from breastfeeding. This protection lasts approximately five months, covering infants during their most vulnerable RSV season.

The Pfizer RSV Vaccine

The CDC has also greenlit the Pfizer RSV vaccine for adults aged 60 and above and for pregnant individuals. This strategy aims to confer immunity to newborns post-birth.

However, the vaccine is recommended only during weeks 32 to 36 of pregnancy due to unproven concerns about potential preterm births. This narrow window might deter some from opting for the vaccine.

Challenges In Oregon

The American Academy of Pediatrics recommends that if a baby’s mother didn’t get the maternal shot, the baby should receive Beyfortus in the first week. However, Oregon is encountering challenges in distributing the treatment.

The steep price of Beyfortus, at $495 per dose, combined with strict federal regulations for distributing free shots to Medicaid-eligible children, has made the rollout uneven.

The Impact Of RSV

RSV might be mild for older children and healthy adults, but it can escalate to bronchiolitis or pneumonia in younger children. It’s the major cause of infant hospitalization in the U.S.

Last year, Oregon witnessed a surge in pediatric hospitalizations due to RSV, spurring a public health emergency declaration. The simultaneous exposure of many infants and toddlers led to a fierce revival of the virus.

Obstacles To A Smooth Rollout

While both Beyfortus and the Pfizer RSV vaccine hold immense promise, their distribution faces timing and supply challenges. RSV cases are already rising in some states, indicating the season’s onset. Sharff is still determining the quantity of the initial Beyfortus shipment and whether it will suffice for all those in need.

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Cost Concerns And Distribution Inequities

The high cost of Beyfortus is a significant barrier. Although intended to be accessible for patients, its price tag makes it the most expensive childhood vaccine recommended by the CDC. Sanofi, the manufacturer, has proposed a deferred payment option for healthcare providers to enhance accessibility.

However, the issue’s core lies in the distribution to children eligible for the Vaccines for Children (VFC) program, a federal initiative providing free vaccines to children on Medicaid and other qualifying groups. Most hospitals enroll in the VFC program, making it challenging to distribute Beyfortus equitably.

Mimi Luther, Oregon’s immunization program manager, highlighted the tough VFC regulations many hospitals find hard to comply with. Many health systems bear losses when administering Beyfortus to all newborns.

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The Way Forward

Oregon has appealed to the CDC for more flexible VFC regulations but failed. The current situation stresses the systemic issues in American healthcare, which often prioritizes procedures over holistic well-being.

Most babies bounce back from RSV, but with no treatment and the rare but real risk of fatalities, we can’t afford to be complacent. As Ben Hoffman, a professor of pediatrics, puts it the thought of kids suffering due to treatment delays or lack of access is a bitter pill for any pediatrician to swallow.

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