Opinion: Pharmac’s funding gap leaves New Zealand babies vulnerable to RSV

Winter is coming, and with it the spectre of respiratory syncytial virus (RSV) looms large for our youngest and most vulnerable children. Yet despite the availability of preventive measures, New Zealand’s Pharmac has fallen short in adequately safeguarding our babies against this potentially devastating illness. The recent decision not to fund palivizumab, coupled with the absence of nirsevimab, leaves our infants exposed to unnecessary risks. Meanwhile, Western Australia, following the US and Europe, has taken a proactive stance, providing nirsevimab to all babies. It’s time for New Zealand to also prioritise the health of its youngest population.

RSV is no ordinary virus. It causes bronchiolitis, which is responsible for 40 per cent of all hospitalisations in children under 5 years old. Babies born very preterm or with congenital heart disease face even graver consequences, often requiring prolonged stays in intensive care units. Māori or Pasifika children are more likely to be affected, worsening health inequities.

There are several options to protect babies against RSV, including palivizumab, a monoclonal antibody that has been a stalwart defence against severe RSV illness in other high-income countries. Routinely used in Australia, Europe and the US, it has been licenced in New Zealand since 2000. Having funded palivizumab from 2021 to 2023, Pharmac has now decided to stop funding it due to budgetary constraints, a move that will increase the number of vulnerable babies admitted to intensive care. The newer option of nirsevimab, a promising long-acting monoclonal antibody, remains conspicuously absent from our arsenal. While Western Australia is taking a proactive approach by providing nirsevimab to all babies, not just those at a high level of risk, New Zealand lags behind. Maternal vaccines against RSV are also available in the US and Europe and need to be available in New Zealand. The fast-track licencing of medications for NZ when approved by overseas regulatory bodies such as the FDA and TGA is a priority. The availability of these measures could significantly reduce RSV-related hospitalisations and complications.

RSV primarily strikes during winter, causing respiratory infections in children, especially those under 2 years old. Unfortunately, there is no specific medication to treat RSV - supportive care, hydration, oxygen, and sometimes intensive respiratory support are the best countermeasures we can offer. But for high-risk groups, who have already had a huge investment in their neonatal care, such as pre-term infants and those with congenital heart disease, severe or repeated RSV infections can lead to long-term lung damage and chronic conditions such as asthma and bronchiectasis. They often face rehospitalisation within their first year of life due to RSV-related respiratory illnesses. Intensive care admissions, sometimes spanning weeks, become a grim reality.

Pharmac must urgently reconsider its stance on protecting our infants from RSV. The recent temporary funding during the 2021 RSV season was a step in the right direction, but it falls short. We need sustained funding to protect our high-risk infants for this winter and beyond. New Zealand should follow Western Australia’s lead and explore funding nirsevimab, and explore future vaccine options as they become available. By doing so, we can enhance our defence against RSV and reduce the burden on our healthcare system.

As winter approaches, let us prioritise our babies’ health. Pharmac’s decisions today will shape their tomorrows. By bridging the funding gap and embracing innovative solutions, we can shield our youngest citizens from the harsh grip of RSV. It’s time to act, for their sake and for New Zealand’s future.

Associate Professor Jane Alsweiler is the deputy head of the School of Medicine at the University of Auckland.