Opportunities and Challenges Facing RSV Vaccination Rollouts


Dr Filer highlights the considerations for the rollout of new RSV vaccines.

Wanda Filer, MD, MBA, FAAFP: RSV [respiratory syncytial virus] is highly contagious. A couple of things [can be done to prevent the spread of illness]. Make sure you wash your hands for at least 20 seconds at a time with soap and warm water. Make sure that, if you have symptoms—a cough or sneezing—you stay home from work and keep away from others around you who might be very susceptible. Also, cover your sneeze and cough. But the biggest thing is that hopefully we’ll have a vaccine soon. That will be the primary prevention: to get immunized.

One thing that’s important to know about RSV is that even as patients are recovering, if they’re immunocompromised, they may be shedding the virus for up to 4 weeks. In public, you might not even realize that you’ve been exposed to RSV.

There are RSV vaccines. We have 1 that’s been approved and possibly another 1 very shortly. We also have a maternal RSV vaccine. The goal of that is in the pipeline. It hasn’t been approved, but it’s much closer to approval. The hope is that you immunize a pregnant mother so that passive immunity transfers to her newborn and protects not only her but that baby during its most vulnerable time frame. Other forms of RSV vaccines are under development. If they continue with their clinical trials, they probably won’t be available till 2024 or 2025.

There are immense opportunities for the RSV vaccine. This is an incredibly common infection for young children and adults. It has huge morbidity and mortality. There’s a need to immunize. The expectation is that we will probably be recommending an immunization once a year. Those guidelines haven’t been formalized as of this recording. Hopefully we’ll know within the next few weeks exactly what the recommendation is and how long the duration will be. The pediatric vaccine is actually a monoclonal antibody that lasts for several months. It can protect that child and give them instant immunity, lowering their chance of having severe infection and hospitalization. The adult vaccine is a more traditional vaccine, and it’s the first time these vaccines have been in the works for over 60 years. This is a very exciting time in terms of prevention and beginning to save lives against this virus.

There are different strategies for protecting young children. One is maternal immunization. That’s where you immunize the mother and give her passive immunity. That passive immunity transfers to the newborn at the time of birth and protects that infant through the first several months of life when they’re most vulnerable. Then there’s the infant immunization, where we give that monoclonal antibody directly to the baby. The goal is to protect that child through that vulnerable time, for several months. With the infant strategy, you’re thinking about what month you’re going to be administering this dose. There are going to be targeted months, and we’re waiting for the final recommendations. It will be interesting to see. I don’t think anyone is completely clear on how these will possibly marry together or if it will be 1 or the other. We’re going to have to wait for ACIP [Advisory Committee on Immunization Practices] to make its decisions.

There will be challenges with deploying the RSV vaccine. First, we’ve got a lot of vaccine fatigue among patients and clinicians. What I’m hearing from medical practices is that many of them are short staffed. Pharmacies have been slammed during the pandemic. Nevertheless, we have an opportunity to save lives with this vaccine. The other thing we’re going to see is in the fall. Because this is hitting in respiratory virus season, individuals will also be getting the flu vaccine, and there’s probably going to be an updated COVID-19 vaccine this fall. Now we’re going to add an RSV vaccine. We don’t know whether, in the adult world, they can be coadministered. That information isn’t clear, so we’re going to need guidance on that. Individuals only have 2 arms, and I don’t think they’re going to want to drop their drawers for that third shot. We’re going to need to wait and see. How do we prioritize this? How do we time these? Do they need to be separated by several weeks?

In reality, that creates a challenge for the patient it creates. It creates a challenge for the clinical staff in terms of getting individuals in [for a vaccine] in a timely fashion. On the pediatric front, there’s some thinking that the first dose of a vaccine in certain months will be given in the newborn nursery. I have a lot of medical directors in my role. I’ve interviewed about 20 of them in the last few weeks, and 5 were pediatricians. Every pediatrician doubted that their hospital would give it in the newborn nursery. They felt that it would require some change in their clinical practice. Those babies would need to be seen at 1 or 2 days of age.

A lot of it is going to depend on the payment and the reimbursement. If the cost of that newborn vaccine is lumped into routine newborn care, hospitals may not be able to afford it. If it’s a carve-out strategy, possibly the hospitals will go forward and do it. But we’re going to need to make sure we get all these children immunized. The timing of it will be required. The other part of it that I want to add for the adult world is that patients don’t know about RSV in the adult space. They know about it for kids, but the adult space is going to require a lot of public and clinician education. There’s finally something we’ll be able to do about RSV. That’s good news, but it’s going to require a lot of individuals to carry that message.

Transcript edited for clarity.

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