Shortage of new RSV shots could endanger Michigan babies

• A new RSV vaccine for babies is in short supply
• Meanwhile, the state is less than halfway to its flu goal of vaccinating 4 million Michiganders, and interest in the COVID vaccine is flagging, too
• There’s good news, too: Viral activity remains low going into another respiratory season

A national shortage of a new shot that protects against a deadly respiratory virus could put Michigan babies at risk.

Public health officials had cheered the arrival of the new nirsevimab shot, a monoclonal antibody immunization, when it was approved in July for babies up to 8 months old. The medication helps fight off the deadly respiratory syncytial virus (RSV), which each year sends more than 2 million young children to doctors’ offices and emergency rooms, and hospitalizes another 58,000.

But a shortage that drugmaker Sanofi Beyfortus attributes to high demand for the shots has made them so difficult to access that the U.S. Centers for Disease Control and Prevention last month called on doctors to ration the medication. The federal agency urged providers to reserve the 100 mg doses just for infants at the highest risk for severe RSV disease.

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• RSV vaccine available for older Michiganders, but many don’t know of it

But as RSV cases have begun to “inch up” in Michigan, even prioritization won’t be enough to cover the babies most at-risk, said Dr. Aarti Raheja, a pediatrician at University of Michigan’s C.S. Mott Children's Hospital and a member of the immunization task force of the Michigan Chapter of the American Academy of Pediatrics.

“The priority was for those most at risk, and we can’t even protect all of those babies,” she said.

That’s especially frustrating, given that the immunization was approved with such fanfare in July, said Dr. Joseph Fakhoury, vice president of the pediatricians’ group and a pediatrician for Bronson Healthcare.

In addition to the shortage, he said, there has been confusion over when the vaccine should be administered — in the hospital before a newborn goes home for the first time, or at a doctor’s office during a baby’s first appointment, for example. Also unclear is how insurers would cover the cost. Moreover, some medical assistants who usually administer vaccines may be unable to do so because the shot is technically a medication rather than a vaccine, Raheja in Ann Arbor said.

“It has been frustrating because the (health care) community was very, very excited to be able to protect our youngest patients against RSV,” Fakhoury said. “RSV is probably one of the most — in addition to influenza — harmful respiratory infections that infants can contract."

But Chelsea Wuth, a spokesperson for the Michigan Department of Health and Human Services, said what doctors have seen as a shortage really is a “misconception.”

Some of the RSV doses may have simply not arrived at doctors’ offices and some doctors have not purchased the vaccine — unsure about how much demand there will be for it, or whether they’ll be reimbursed by insurance companies, Wuth told Bridge in an email. 

While many infants will be able to fight the infection without medical intervention, children that require hospitalization are often among the sickest pediatric patients, requiring oxygen support or feeding tubes. Already this fall, about a dozen patients — mostly children under two years old — have been admitted to Bronson Children’s Hospital in Kalamazoo, which serves nine counties, Fakhoury said.

RSV is the leading cause of hospitalization among U.S. infants. 

The CDC estimates that between 58,000 and 80,000 children under 5 are hospitalized each year with RSV.

Also new this year is a vaccine against RSV for pregnant women at 32 to 36 weeks gestation during the RSV season — generally September to January. That protection from the mother could be passed on to babies who otherwise might not be able to get their own immunization because of the shortage, Raheja noted.

What could have been

The challenges with the RSV shot could undermine what doctors had hoped would be the healthiest winter that Michiganders had seen in years. 

It’s still early in the season, but Michigan and other Midwestern states are reporting “minimal” flu activity, according to the CDC and the most recent state flu surveillance report.  And confirmed weekly COVID-19 cases fell 4 percent to 2,319 — down from 2,408 the week before, Michigan health officials reported Tuesday. Of 1,710 COVID-19 deaths this year (down from 9,335 deaths last year), nine occurred in October. 

“I’m quite optimistic the way we look right now, said Dr. Paul Entler, regional chief medical officer at University of Michigan Health, which includes Sparrow and UM Health-West.

Still, vaccine rates for both flu and COVID have flagged dramatically — a “concern,” especially since flu’s peak is usually in January or February, he added.

As of Monday, fewer than 1.7 million Michiganders had received a flu vaccine, compared to more than 2 million Michiganders at the same time last year. That’s less than halfway to the state’s goal of 4 million vaccinated Michiganders.

Meanwhile, more than 391,000 Michiganders have received the reformulated COVID vaccine since the CDC recommended it in September for nearly all adults and children. That compares to about 688,000 Michiganders who rolled up their sleeves last year in the first seven weeks after the new, bivalent COVID shot booster was released.

With so many boosters, patients have lost sight of the changing nature of the virus, said Dr. Felix Valbuena, CEO of the Detroit-based Community Health and Social Services Center.

“We have to do more education,” he said. “They think that if they’ve had those other shots they are protected. They are not.”

Local retail pharmacies, health departments and some doctors' offices provide vaccines. The state offers a searchable vaccine provider map here, and this federal website provides a list of vaccine providers, searchable by zip code.