Manitoba not covering RSV treatments for newborns, pregnant people now recommended by federal agency

Manitoba is falling behind on recommendations from a federal public health body to extend an RSV immunization program to help protect newborns and young children from the respiratory virus. 

This spring, Canada's National Advisory Committee on Immunization updated its guidance on preventing respiratory syncytial virus, or RSV, in infants. The respiratory virus can affect breathing, and in severe cases, can lead to hospitalization.

NACI is recommending provinces prioritize vaccinating children at severe risk, but work toward "a universal RSV immunization program for all infants."

But Manitoba is lagging in implementing some of those recommendations for this RSV season.

Two treatments recently approved by Health Canada and recommended by NACI are not listed under the province's free-of-charge immunization program.

Manitoba currently offers palivizumab, a monthly RSV antibody treatment, to young children identified at the highest risk from the illness, through the Health Sciences Centre's RSV prophylaxis program, a provincial spokesperson said.

According to NACI, palivizumab, approved by Health Canada for RSV prevention in infants in 2002, is a relatively expensive treatment.

The agency recommended in the spring that two new RSV immunizations authorized by Health Canada last year be used over palivizumab for infants: nirsevimab, an injectable monoclonal antibody treatment designed to protect children under 24 months from the virus, and RSVpreF, a vaccine for pregnant people starting their third trimester.

When the vaccine is given to pregnant people, the antibodies against RSV are transferred through placenta to the fetus, giving the infant "temporary protection" against the virus and preventing severe RSV in infants during their first months of life, NACI said.

The advisory committee said nirsevimab is the preferred RSV immunization option, based on its efficacy, duration and good safety profile.

The Canadian list prices for the nirsevimab and RSVpreF are $952 and $230 per dose, respectively.

Province says it 'continually reviews' vaccines

Dr. Philippe Lagacé-Wiens, a medical microbiologist at Winnipeg's St. Boniface Hospital, said the recommended immunization against RSV is an "excellent strategy" to reduce the disease's severity.

"Focusing vaccination on those groups has had a significant impact in reducing the incidence of RSV-related hospitalizations … by more than half," he said.

The province told CBC News it "continually reviews" vaccines, including the RSV vaccine, offered under its publicly funded immunization program.

The recommendations from NACI are "an important consideration" for the province, the spokesperson said, but other factors are also considered when determining whether a program is implemented in Manitoba.

Lagacé-Wiens said a shortage of health-care providers, physicians and nurses, paired with disease outbreaks, has likely forced the government to do "careful analysis" and prioritize strained resources.

He says universal RSV immunization campaigns for children, newborns,and pregnant people are a priority, but acknowledges Manitoba's health-care system is dealing with other "critically important problems" that demand funding.

But offering RSV immunization more broadly, especially in those groups at higher risk, might actually lead to "a substantial savings to the health system as a whole," by curbing ER admissions and other expenses related to treating RSV, he said.

"It may not need to be a universal vaccine" program, Lagacé-Wiens said, but "these vaccines should be, at a minimum, offered to appropriate populations." 

Ontario, Quebec make changes

Following Health Canada's approvals, Quebec will start offering nirsevimab injections to babies including those born after April 2 of the current year, as well as some older babies at greater risk of serious complications.

Ontario has also expanded its prevention program for this RSV season by opening free coverage to all infants and high-risk children up to 24 months of age. It's also switched to nirsevimab after previously using palivizumab.

It will also make RSV vaccination available to pregnant residents who are expected to have their babies near or during the 2024–25 RSV season.

Lagacé-Wiens said the immunization programs in those provinces will likely bring hospital admissions down.

After COVID-19 pandemic restrictions eased, Manitoba saw a spike in serious childhood respiratory virus cases.

Lagacé-Wiens said that while the symptoms of the virus in adults are similar to a mild illness, it carries a "very high risk" of severe complications for babies under six months old, because their immune systems are not mature.

"RSV is a big problem," Lagacé-Wiens said. "It really behooves us to do everything we can to try to reduce the strain on the health-care system, and it would include getting those vaccines."