In the midst of a persistent scarcity of nirsevimab, a paediatric RSV vaccine, the US Centres for Disease Control and Prevention have declared that over 77,000 extra doses will be provided “immediately.”
The release from Thursday states that these doses would be distributed to hospitals and physician offices via the CDC’s Vaccines for Children Programme as well as commercial outlets.
Beyfortus, also known as nersevimab, is a long-acting monoclonal antibody that is injected into newborns to guard against serious illness caused by respiratory syncytial virus (RSV) infections, which are the primary reason why babies end up in hospitals.
Dr. Patrizia Cavazzoni, director of the US Food and Drug Administration’s Centre for Drug Evaluation and Research, stated in the announcement that “helping to ensure the availability of this preventative option to reduce the impact of RSV disease on eligible babies and young children, families, and the health care system remains a priority.” “We will keep using all of the regulatory tools at our disposal to support the public’s access to safe, effective, and high-quality medicines.”
According to the notification, the FDA and the CDC will keep in “close contact” with manufacturers to guarantee that sufficient doses will be available to meet demand until the end of this year and the beginning of next year.
Public health officials are frustrated by the lack of nirsevimab, particularly as the country approaches winter, which is usually the busiest season for respiratory virus transmission.
The desire of moms to shield their children is a success. The desire of mothers to receive vaccinations is a success. The chief executive officer of the National Association of County and City Health Officials, Lori Tremmel Freeman, stated, “But we cannot celebrate that success if we do not have equal access everywhere and supply does not meet demand.”
The CDC suggested Beyfortus in July for children under 8 months old who are starting their first respiratory virus season, and the FDA authorised it in July as well. It is also advised that select high-risk toddlers under the age of two receive the vaccination. Single-dose prefilled syringes containing 50 or 100 milligrammes of nersevimab are available for purchase.
A shortage of nirsevimab has arisen due to strong demand; in October, the CDC advised doctors to give priority to infants who are most at risk of developing severe RSV sickness by prescribing 100-milligram doses of nirsevimab. The use of dosages of 50 milligrammes is still advised.
RSV infections result in mucus-filled lower lungs, and infants with the virus often have fluid buildup in their narrow airways, which makes it difficult for them to breathe and feed. Physicians were alerted by the CDC at the beginning of September that RSV cases were increasing in the Southeast and that these kinds of regional spikes usually signal the beginning of RSV season.
According to CDC data, the weekly national average percent of positive tests for RSV has been rising since September. Thus far in the 2023–24 respiratory virus season, there have been approximately 7 hospitalisations per 100,000 individuals as a result of RSV-related causes.
As of last week, there were 18.8 hospitalisations per 100,000 children aged 4 and under connected to RSV, which is an increase from the prior week when there were almost 16 hospitalisations per 100,000 children.
“We face a significant challenge,”
Although most birthing hospitals are not a part of the CDC’s Vaccines for Children programme, this monoclonal antibody is being administered through it, and it is ideal for newborns to receive it before they leave the hospital. According to Dr. Chris DeRienzo, a neonatologist and the chief medical executive for the American Hospital Association, there seems to be a “mismatch” there.
In the past, only 10% to 15% of hospitals that provide births have taken part in the programme. DeRienzo stated that his team has been in communication with the CDC over the issue since early fall. “So we definitely have a challenge and a mismatch there between the goal and the channel,” he added. States started informing the Hospital Association in early September about several difficulties seen during the nirsevimab rollout.
It’s crucial to keep in mind that, despite federal authorization, state governments carry out the Vaccines for Children programme. To carry it out, states essentially use a patchwork quilt of different strategies, he said. A state statute that specifies what qualifies as a vaccine for the VFC programme exists in one state, New Hampshire, for instance. Because nirsevimab is a monoclonal antibody and therefore an immunisation, there have been certain difficulties. It isn’t a vaccination.
The Vaccines for Children programme is a source of great concern for the American Hospital Association. While it is effective for paediatric primary care providers who see patients on an outpatient basis and require access to a wide range of routine immunisations, the program’s design makes it difficult for birthing hospitals to participate and administer a single or double dose of vaccines to newborns.
According to DeRienzo, “I haven’t heard of a state where even more than 50% of their birthing hospitals are participating in VFC.”
He declared, “I have a great deal of respect for the CDC and their efforts to spread vaccinations.” However, I believe that what we’ve discovered thus far is that the VFC programme truly isn’t a good fit for the objective of achieving that during the initial hospitalisation period. Hopefully, as this RSV season progresses, we’ll be able to create new avenues for immunisation access in the future, perhaps by changing certain aspects of the VFC programme.
The onboarding of more maternity hospitals into the programme and ensuring that states incorporate nirsevimab in their Vaccines for Children distribution channels are two possible examples of these new lanes of access. However, there’s also the financial barrier. DeRienzo stated, for example, that the cost of the hepatitis B vaccine, which is also administered to newborns, is just approximately $10 per patient as opposed to the almost $500 cost of nirsevimab every immunisation.
“We’re going to have to learn from all the challenges that we’re facing in this first season,” DeRienzo said. “We’ve seen some shortages on 100-milligram bottles, but not on the lower-dose bottles. We’ve seen problems with the distribution channel and the mismatch between the Vaccine for Children’s programmes and birthing hospitals. We also have supply issues and dosing issues.”
“As we move through this season, I hope that the medical community as a whole does everything within our power to try to get as much of this product into newborns as we can produce,” the speaker stated. “After that, we’ll be able to draw lessons from the difficulties we’ve had this year and create new routes for access in the upcoming season.