Opportunities and challenges facing RSV vaccination deployments

Wanda Filer, MD, MBA, FAAFP: RSV [respiratory syncytial virus] is very contagious. A number of things [can be done to prevent the spread of illness]. Be sure to wash your hands for at least 20 seconds at a time with soap and warm water. Make sure that if you have symptoms (coughing or sneezing) stay home and avoid people around you who may be very sensitive. Also cover your sneezes and coughs. But the most important thing is that hopefully we will have a vaccine soon. This will be the first prevention: get vaccinated.

One thing that is important to know about RSV is that even while patients are recovering, if they are immunocompromised, they can shed the virus for up to 4 weeks. In public, you may not even realize that you have been exposed to RSV.

There are vaccines against RSV. We have 1 that has been approved and maybe another very soon. We also have a maternal RSV vaccine. The target 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 the passive immunity will transfer to her newborn and protect not only her, but that baby during her most vulnerable time. Other forms of RSV vaccines are under development. If they continue with their clinical trials, they probably won’t be available until 2024 or 2025.

There are huge opportunities for the RSV vaccine. It is an extremely common infection in young children and adults. It has enormous morbidity and mortality. You have to get vaccinated. It is expected that we will probably recommend vaccination once a year. These guidelines have not been formalized from this recording. Hopefully we will find out in the next few weeks exactly what the recommendation is and how long it will last. The pediatric vaccine is actually a monoclonal antibody that lasts for several months. It can protect that child and give them instant immunity, reducing their risk of serious infection and hospitalization. The adult vaccine is a more traditional vaccine, and this is the first time such vaccines have been in the pipeline for more than 60 years. It’s a very exciting time in terms of prevention and starting to save lives from this virus.

There are different strategies to protect young children. One is maternal vaccination. This is where you immunize the mother and give her passive immunity. This passive immunity is transferred to the newborn at the time of birth and protects this infant during the first months of its life, when it is most vulnerable. Then there’s infant vaccination, where we give that monoclonal antibody directly to the baby. The objective is to protect this child during this period of vulnerability, for several months. With the infant strategy, you think about what month you are going to give that dose. There will be targeted months, and we await final recommendations. It will be interesting to see. I don’t think anyone is completely clear on how these will eventually marry together or if it will be one or the other. We’ll have to wait for the ACIP [Advisory Committee on Immunization Practices] to make his decisions.

There will be challenges with the deployment of the RSV vaccine. First, we have a lot of vaccine fatigue among patients and clinicians. What I hear from medical practices is that many of them are understaffed. Pharmacies have been closed during the pandemic. Nevertheless, we have the opportunity to save lives through this vaccine. The other thing we’re going to see is in the fall. Because it strikes during respiratory virus season, individuals will also receive the flu vaccine, and there will likely be an updated COVID-19 vaccine this fall. Now we are going to add an RSV vaccine. We do not know if, in the adult world, they can be co-administered. This information is unclear, so we are going to need guidance on this. Individuals only have 2 arms, and I don’t think they’ll want to drop their drawers for that third hit. We’ll have to wait and see. How do we prioritize this? How do we time them? Should they be separated by several weeks?

In reality, it creates a challenge for the patient it creates. This creates a challenge for clinical staff in terms of getting individuals to [for a vaccine] in right time. On the pediatric side, some believe that the first dose of a vaccine some months will be administered in the nursery. I have a lot of medical directors in my role. I interviewed about 20 of them over the past few weeks, and 5 were pediatricians. Every pediatrician doubted their hospital would give it in the newborn nursery. They felt this would require changes in their clinical practice. These babies should be seen when they are 1 or 2 days old.

Much will depend on payment and refund. If the cost of this neonatal vaccine is lumped into routine neonatal care, hospitals may not be able to afford it. If it’s an exclusionary strategy, maybe hospitals will go ahead and do it. But we will have to make sure to get all those children vaccinated. The timing of this one will be necessary. The other part I want to add for the adult world is that patients don’t experience RSV in the adult space. They know this for children, but the adult space is going to require a lot of public and clinician education. Finally, there is something we can do about RSV. This is good news, but it will take a lot of people to deliver this message.

Transcript edited for clarity.