A group of doctors is urging officials in Nunavut to offer an effective but costly drug to all Inuit babies living in remote communities in the territory to protect them against a respiratory virus that disproportionately leads to their hospitalization.
A petition, started by members of the 1989 graduating class of University of Toronto’s faculty of medicine, says giving the prophylaxis palivizumab to Inuit infants would reduce their rates of serious complications from respiratory syncytial virus (RSV) and would also save the government money it currently spends on air-ambulance services and hospital stays.
But Nunavut’s chief medical officer disagrees, saying there isn’t enough evidence to support such an approach.
For most people, symptoms of RSV infection are indistinguishable from the common cold, although an estimated 1 per cent to 3 per cent of infants in developing countries experience complications requiring hospitalization.
Inuit babies in Canada, however, have an exceptionally high rate of RSV complications.
Among some Inuit communities on Baffin Island, as many as half to two-thirds of babies are hospitalized with lower respiratory lung infections, mostly owing to RSV, according to Anna Banerji, an expert on Indigenous and refugee health and associate professor of pediatrics at the University of Toronto who helped start the petition. Although it is not entirely understood why, experts believe Inuit infants are disproportionately affected because of a combination of genetic and environmental factors, including food insecurity and a lack of adequate housing arising from a history of forced settlement.
Palivizumab, the only available prophylactic treatment for RSV, is currently given to infants in Canada who are considered at high risk of complications, such as those born prematurely or who have underlying heart or lung conditions. But it is not routinely administered in Nunavut to healthy Inuit infants who are born at full term.
At the cost of roughly $6,500 a child for each season, the drug is expensive, Dr. Banerji says. Yet, according to her analyses, giving it to all Inuit babies in remote communities can cost less than the alternative.
The petition had more than 21,600 signees as of late last week and has the support of the Ontario Medical Association.
Nunavut’s chief medical officer of health, Michael Patterson, said while the high rates of RSV complications are a problem, there is not enough evidence to show universal administration of palivizumab is the best solution.
The number of RSV hospitalizations and the costs involved vary from year to year, and from community to community, Dr. Patterson said. This makes it difficult to predict just how cost effective the drug would be each year.
Moreover, RSV is only part of the problem; a number of different viruses can lead to the same respiratory complications, Dr. Patterson said. “You get rid of one virus and there’s others that children will be exposed to at the same time,” he said.
The Canadian Paediatric Society issued a position statement in 2015, stating health professionals may consider giving palivizumab to term infants in remote northern communities. It said other measures, such as improved housing, prevention of exposure to smoke and the use of influenza and other vaccines, appear to be more cost effective than palivizumab in the long term.
Joan Robinson, the principal author of that statement, said she is not opposed to offering the drug to term Inuit babies. But she said it is a question of whether this approach is a priority for a territory with limited health resources, and whether it is worth giving babies injections every month. (Palivizumab is an antibody, not a vaccine. Injections are given monthly over the course of an RSV season, which typically lasts about five months between fall and spring.)
Dr. Robinson said she expects more answers to help guide this decision will come from the Quebec region of Nunavik.
Quebec’s criteria for palivizumab expanded in 2016 to include babies in Nunavik born at term and less than three months old at the start of RSV season. A report on the impact of this change on RSV infections and hospitalizations in Nunavik is expected to be released in 2020.
Sheila Ningiuruvik, a board member of the Nunavik Regional Board of Health and Social Services who lives in the Northern village of Quaqtaq, said she was not aware of palivizumab being administered to Inuit babies in her region.
Ms. Ningiuruvik’s son, Aggaajuk, now 6, suffered from recurring lung infections as a baby. He was once transported by air ambulance to a hospital in Kuujjuaq, an hour and 45 minutes away by air, with severe pneumonia. She said she was not told whether RSV was the cause of his respiratory issues.
She said that as a parent, she feels as long as palivizumab is safe, it would be good for babies to have the drug.
She said there are other problems that may hamper the health of infants in her region. The clinic that serves her village of 400 people has a frequently changing team of nurses and a doctor who visits only once a month, making it difficult to receive consistent medical care.
In addition, she said, mould is widespread in social housing.
“Things [like] that could increase the respiratory problems in children. Maybe they need to research on that,” she said.
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