Increased Development of RSV Immunoprophylaxis Inhibited by Cost and Acquisition Barriers

Respiratory syncytial virus (RSV) affects nearly 64 million individuals annually around the world, many of whom may require hospitalization in severe cases.^1,2 Data suggest that prognoses for RSV in vulnerable populations are currently more severe than influenza and COVID-19, making the development of readily available immunoprophylaxis an overdue necessity. Unfortunately, the significant cost burden associated with such measures may inhibit the overarching goal of protecting the public, particularly those in low-middle income countries (LMIC), from such virulence.

A review in the Journal of Medical Virology this past January provides an overview of available vaccines and monoclonal antibodies and recommends a strategy to ensure equal access globally.³ The Table³ reviews current agents, including vaccines and antibodies.

Table.

Although these agents have been deemed effective, they pose significant cost restraints and acquisition barriers, particularly the monoclonal antibodies. Nirsevimab is the newest agent to the market meant to provide novel protection directly to otherwise healthy infants, but the CDC has announced a shortage a mere 3 months after it came to the market.⁴ This has resulted in a dynamic change to guidance and narrower criteria for use.

The authors suggest multiple strategies aimed to minimize monopolizing these therapies and ensure global immunoprophylaxis equity. Public health leaders must commit to worldwide collaboration to ensure that the most vulnerable populations and LMICs are able to attain the same protection as wealthier nations. This includes coming together to negotiate with pharmaceutical companies regarding subsidized costs, increasing the availability of skilled health care teams, improving fair allocation of immunoprophylaxis distribution, and identifying opportunities for more local manufacturing and finishing of products.

The development of strategies to prevent and combat RSV has been long awaited. Utilizing lessons learned from recent pandemic history will allow for a better chance of immunizing and protecting the global population.

References

1. RSV Surveillance and Research. CDC. February 1, 2023. Accessed February 7, 2024. https://www.cdc.gov/rsv/research/index.html#ref11

2. Respiratory Syncytial Virus (RSV). NIH: National Institute of Allergy and Infectious Diseases. December 12, 2008. Accessed February 7, 2024. https://www.niaid.nih.gov/diseases-conditions/respiratory-syncytial-virus-rsv

3. Piotr Rzymski, Gwenzi W. Respiratory syncytial virus immunoprophylaxis: Novel opportunities and a call for equity. Journal of Medical Virology. 2024;96(2). doi:https://doi.org/10.1002/jmv.29453

4. Health Alert Network (HAN) – 00499. Limited Availability of Nirsevimab in the United States—Interim CDC Recommendations to Protect Infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 Respiratory Virus Season. October 23, 2023. Accessed February 7, 2024 https://emergency.cdc.gov/han/2023/han00499.asp