Anticipating Needs of Patients Diagnosed with RSV


Experts discuss strategies to prepare for the oncoming respiratory diseases season.

Laurene Mascola, MD, MPH: The Advisory Committee on Immunization Practices [ACIP] isn’t a governmental agency, but it sets the standard for how vaccines are given with respect to timing, dosing, and age. That comes months before the MMWR [Morbidity and Mortality Weekly Report], which is produced by the Centers for Disease Control and Prevention [CDC]. I was wondering how the ACIP recommendations help payers get ready to pay for these vaccines, as opposed to waiting for the MMWR, which could be weeks down the line and miss the peak timing when vaccines are needed.

Abby Lynne Singleton, PharmD, BCPS: That information from the ACIP will be really valuable. I can tell you that payers, typically as soon as new medications or vaccines are approved, will review those data right away. We’ll be looking at the package inserts and the trials and taking all that information into account.

Adam C. Welch, PharmD, MBA, FAPhA: For the 2023-24 season, the timing seems to be of utmost importance because we’re going to have a couple of vaccine candidates that will be indicated, approved, and recommended. But before the official publication comes out, we’re going to have this time window when we’ll be waiting for this publication in MMWR. At the same time, RSV [respiratory syncytial virus] will start to peak in the community. We may have this overlap where we’ll need the payers to come on board as fast as possible, and we’ll need the providers to be ready to go as quickly as possible.

Laurene Mascola, MD, MPH: And educated.

Adam C. Welch, PharmD, MBA, FAPhA: And we’ll need vaccine products available on the market as quickly as possible so that we can get patients educated and vaccinated this RSV season.

Wanda Filer, MD, MBA, FAAFP: The last thing we want is any hiccups in this process because there’s already anxiety and skepticism around vaccines. We don’t need to play into that. We need to make sure everybody is doing their part so this comes off as flawlessly as possible.

Laurene Mascola, MD, MPH: The public doesn’t need any more anxiety. We don’t need a problem with the vaccine to cause more anxiety about a vaccine that, hopefully, is going to prevent them from getting the disease and being hospitalized.

Wanda Filer, MD, MBA, FAAFP: I’ve had the privilege over the last couple of years of auditing the ACIP meetings. Laurene, you’ve probably done it as well.

Laurene Mascola, MD, MPH: Yes.

Wanda Filer, MD, MBA, FAAFP: I’m unbelievably impressed by the amount of data, the work, and the approach they take.

Laurene Mascola, MD, MPH: The depth.

Wanda Filer, MD, MBA, FAAFP: They use the grade’s criteria, the depth, the knowledge, and the debate. This is not a slam dunk—“Hey, somebody. We’re going to approve this.” It’s an incredibly thoughtful scientific- and economic-driven conversation. I wish I’d realized that earlier in my career. I share that with my colleagues because I’m really impressed with the work they’ve done. It’s been under a lot of heat in the last few years, but it’s incredibly reassuring to me as a physician when I watch the work they do.

Marty J. Feltner, PharmD: They’ve done a remarkable job during the COVID-19 pandemic.

Abby Lynne Singleton, PharmD, BCPS: I appreciate that their forums are public. The public can go and talk about their concerns. It’s great to involve those opinions also.

Laurene Mascola, MD, MPH: Yes, everybody is invited. It’s online. It’s all their data, and everything is available for anyone who’s interested in seeing it ahead of time and to be part of the discussion as well as other scientific advisers.

Adam C. Welch, PharmD, MBA, FAPhA: The timing will be tight from when a vaccine becomes indicated, when it becomes recommended, and when RSV season tends to peak. What can providers and payers do in the meantime, knowing this is all coming, to help get us ready for the upcoming season?

Marty J. Feltner, PharmD: We all need to get prepared now. We know it’s coming, so let’s start our education process. We have to wait for the formal recommendations from ACIP, but have a plan. We need to implement it and have a strategy. How are we going to approach this new vaccine coming down the pipeline during flu season?

Laurene Mascola, MD, MPH: The public health sector has to get on board and plan on how its going to do surveillance, or have the Centers for Disease Control populate certain areas with some money to have them do extra surveillance for RSV. Then we can start seeing when it comes, as we do for flu surveillance. We always make a big announcement after the first case of flu is found in our community. The same thing should be done for RSV, and we should count on that.

Let’s say the public is hearing about RSV the way they hear about the flu, and they make those 2 synonymous with respiratory disease season. That’s what we need to look at in addition to COVID-19, which might peak in the fall. We don’t know whether there’s seasonality with COVID-19. But all these things have to be brought to mind when we’re looking at respiratory infections, especially in older patients.

Wanda Filer, MD, MBA, FAAFP: I expect to see a lot of educational campaigns. Hopefully, in my CMO [chief medical officer] role, we’ll be doing some of those as well. I like to look at things like NFID, [National Foundation for Infectious Diseases]. They’ve got campaigns, and the CDC has programs. There are a lot of thoughtful individuals coming to bear to explain—to those of us who haven’t paid attention to RSV as we should have or don’t realize the burden of illnesses out there—why we need to pay attention. Most important, for our patients to understand and have faith and an expectation that we’re going to have a safe, efficacious vaccine that’s going to be affordable for you. It’s critical that you do this to protect yourselves and your loved ones.

Laurene Mascola, MD, MPH: We also don’t have to forget about nursing homes and congregate care facilities, where we see a significant burden of all respiratory diseases, especially RSV. This can be very helpful for those individuals who are in these settings. We don’t want to propagate disease outbreaks. We have to make educate those populations, which are very different from other populations, about this new disease and potential vaccine.

Adam C. Welch, PharmD, MBA, FAPhA: Dr Singleton, what can insurance payers do to get ready for the 2023-24 RSV season?

Abby Lynne Singleton, PharmD, BCPS: We’re definitely looking at the pipeline of vaccines that are in development. We’ve been meeting with some of the payers to get that early information exchange and learn about the data they already have. We’re already thinking about those things, and we’ll be as proactive as we can be when they come out.

Adam C. Welch, PharmD, MBA, FAPhA: Dr Mascola, what patient population would benefit the most from an RSV vaccine?

Laurene Mascola, MD, MPH: The patient population that will benefit the most from this vaccine are those that we’ve been talking about before. All adults over age 65, healthy or not, have waning immune senescence. They would benefit greatly from this vaccine. Individuals living in congregate settings, where outbreaks can run rampant. And all those patients with underlying comorbidities where any infection will tip them over, including those with underlying heart disease, lung disease, asthma, and stroke and individuals who are frail and can’t do their daily life activities. All these groups would greatly benefit from this vaccine. So would those living in congregate settings. A lot of groups would benefit from this vaccine.

Transcript edited for clarity.

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