Manitoba plans to move its respiratory syncytial virus (RSV) immunoprophylaxis program from palivizumab to nirsevimab, effective October 1. This amendment has significant effects on preventing severe RSV disease in infants and young children. The province hasn’t agreed to ensure universal access to this treatment—that’s what the fight is about. Right now, Manitoba’s program only protects about 300 high-risk infants and children each year, putting thousands of vulnerable newborns at risk.
Nirsevimab is a single-dose, injectable monoclonal antibody that prevents severe RSV infections. Quebec, Ontario, and Nunavut provinces have eagerly adopted this new treatment. Since last fall, they have made it available to all infants. We were disappointed to hear that Manitoba is not proceeding with their commitment to expand coverage to all newborns and young children under the age of 18. Given that RSV infections mostly affect babies less than one-year-old, this decision has sparked fear among parents and healthcare providers.
The Impact of RSV on Manitoba’s Healthcare System
RSV can be a severe health danger, particularly in the winter months. Each RSV season, hospitalizations of newborns and infants who contract this dangerous virus surge. As a pediatric specialty provider, Barbara Porto outlined the pressure this adds to our already overburdened healthcare system.
“During the winter, we see a huge spike in hospital admissions caused by RSV in babies and infants. This will keep causing a huge burden in our health-care system,” – Barbara Porto.
Almost all children will have an RSV infection by the time they are three, and the consequences can be dire. Clinical trials found that nirsevimab reduces medically attended RSV respiratory tract infections in healthy infants by 80 percent. This 92 percent decrease makes it clear there are major benefits to expanding access to this lifesaving treatment.
Parents such as Ashton Kehler have made their disappointment with Manitoba’s restrictive coverage known. Kehler’s daughter, Lilly, was a warrior against all odds. Due to complications from RSV, she spent 77 days in the neonatal intensive care unit at Winnipeg’s Children’s Hospital. health obstacles from the day that she was born. Yet because of that, she wasn’t vulnerable enough, in her doctors’ eyes, to be given the preventative treatment.
“It was really scary. We had already gone through so much … and then finding out after that, something they refused to give her could have prevented it, just made the whole situation a lot worse,” – Ashton Kehler.
Kehler is sure that if nirsevimab had been available, Lilly’s experience with RSV would have been very different.
“I think that the shot definitely would have made a difference,” – Ashton Kehler.
Provincial Responses and Variability in Treatment Access
Other provinces have seen the value in offering this preventive treatment more widely. For example, Yukon provides nirsevimab to all children under eight months of age during RSV season. The Northwest Territories distributes it to every infant born in RSV season. They administer it to children under three months old in that same year. Nova Scotia is looking to increase the number of children covered by their program, as all infants under eight months old should be covered in RSV season.
Saskatchewan is in the process of expanding its program to cover all babies born during the RSV season. This variability in access across provinces highlights a growing concern among parents regarding why Manitoba has not followed suit despite recommendations from Canada’s National Advisory Committee on Immunization over a year ago.
“Knowing that it is an option in other places, it’s actually really disappointing,” – Ashton Kehler.
Healthcare providers are pushing for wider access to nirsevimab. They stress the difficulty in terms of knowing ahead of time which infants are at most risk of severe RSV disease. Porto noted the unpredictability associated with the virus:
“We actually don’t know which babies will go on to develop a severe disease, or which babies will have only a mild disease and recover soon after getting infected,” – Barbara Porto.
Parental Concerns Over Limited Coverage
The shortcomings of Manitoba’s immunization program have led to outcry from parents concerned for the well-being of their newborns. Samantha Gould, Access Strategy Lead for Infectious Diseases at Sanofi noted the burden posed by severe RSV infections and the impact it can have if not addressed.
“If it’s a simple cold that can be turned into literally a life-or-death situation, I think parents would want to have their kid maybe vaccinated,” – Samantha Gould.
With Manitoba’s decision pending on expanding its immunization program, many parents remain anxious about their infants’ vulnerability to RSV. The lack of universal coverage for nirsevimab makes me ponder the depth of our public health priorities. It’s time we do the right thing and act to protect our most vulnerable – our children.
