RSV Jabs

Photo by gratuit at Free Images Live under Creative Commons license

(Photo by gratuit at Free Images Live under Creative Commons license)

Most people who catch respiratory syncytial virus (RSV) just feel like they’ve got a common cold, but it can lead to pneumonia, hospitalization and death. It’s most inclined to do that to infants and the elderly. For the littlest kids, RSV is the leading cause of hospitalization.

In a typical year, in the UK it sends about 175,000 people to their doctor, puts 14,000 in the hospital and kills about 8,000. Influenza is more deadly in general, causing about 13,500 deaths in the UK in a typical pre-pandemic year, but from these figures it’s clear that RSV is close behind flu as a danger to vulnerable people. Both RSV and flu are seasonal, peaking in winter.

RSV is highly contagious as an airborne pathogen. Researchers believe practically all children catch it at least once by the age of two years. The only ways to prevent its spread have been the same measures being rejected by most people and places against the pandemic.

That is about to change. Exactly how it will change is slightly different for the littlest children versus adults.

For little tykes up to two years old, a few days ago the USA’s Food and Drug Administration (FDA) announced approval of a monoclonal antibody as a preventive treatment. It’s called Beyfortus (nirsevimab-alip). AstraZeneca was granted fast track approval, which the FDA sometimes gives when the need for a new drug is urgent.

For adults, two vaccines have been approved this year by the FDA. GlaxoSmithKline’s vaccine Arexvy was first through the gate. Pfizer’s vaccine Abrysvo was approved next. The Centers for Disease Control must issue recommendations about use of these vaccines. Americans should be able to get these as early as the third quarter of this year. The EU has also granted marketing approval to both vaccines.

In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) has approved GSK’s Arexvy. Pfizer’s Abrysvo will probably follow. After MHRA approves an immunization, the Joint Committee on Vaccination and Immunisation (JCVI) provides advice to the government. Trade-off decisions about cost effectiveness happen at that point. Those decisions affect whether and how patients can access the vaccination.

Here are some examples of what could happen now that MHRA approval has been granted:

• Annual flu jabs are offered by the NHS to a targeted subset of the population, especially the elderly and NHS staff. Most people must get theirs privately, usually at a pharmacy for a low price.

• The NHS does not vaccinate against chickenpox, but that jab is approved so it can be bought at a private clinic.

• The NHS vaccinates against shingles, but only when people reach age 70 and only with an older single-jab vaccine. A newer vaccine is more effective and lasts longer, but requires two jabs several weeks apart. It costs more in both money and clinical time. It can be obtained an earlier age by paying to get it at one of the few private clinics that offer it.

Every vaccine has some potential risks. So far the new vaccines against RSV do not carry unusual levels or types of risks. Considering how bad (even deadly) catching RSV can be, being able to get a strong vaccine against it is great news.

Those of us who have universal access to health care probably won’t all be offered the vaccine. It’s likely to be offered to people above a threshold age while the monoclonal antibody goes to babies. In the UK, I hope we somehow find the resources to do this. It would protect the two demographics most severely affected by the disease.

If you are grey-haired like me or especially vulnerable to pneumonia and have a chance to get one of the new RSV vaccines, it’s worth considering. If I can get one of those vaccines, I will. And if you have a baby, maybe your baby can have the monoclonal antibody.