‘Disappointing’: PBAC rejects national RSV vaccine push

Efforts to roll out a national respiratory syncytial virus (RSV) immunisation program for infants and older Australians have been rejected.
 
The Pharmaceutical Benefits Advisory Committee (PBAC) has knocked back applications for nirsevimab (sold as Beyfortus) for infants and AREXVY for seniors to be made freely available to eligible patients at its July meeting.
 
The two decisions have left many GPs, advocates, and parents concerned about vulnerable Australians at both ends of the age spectrum who will not be able to afford the expensive vaccines.
 
One of those advocates is New South Wales GP Dr Rochelle Oei.
 
As a rural doctor, RSV is something she was all too familiar with, but when the virus struck down her newborn baby the consequences left her feeling ‘helpless’.
 
At just 12 days old, her son Zach began showing symptoms of RSV, starting with a runny nose, and overnight his condition deteriorated.
 
Dr Oei rushed Zach to the emergency department, two days later he was flown to Sydney Children’s Hospital where he was placed into intensive care – ultimately spending 15 days in hospital.
 
‘It definitely gave me a whole new perspective of the healthcare system … Zach had a nasogastric tube for feeding and one of the hardest parts was seeing him rely on a machine to breathe,’ she told newsGP.
 
The application to the PBAC for AREXVY was for it to be added to the National Immunisation Program for patients 60 years old and above, but the committee said its incremental cost-effectiveness ratio was unacceptably high and uncertain.
 
For nirsevimab, a General Schedule Restricted Benefit listing was requested for neonates and infants born during or entering their first RSV season, and children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.
 
However, the PBAC said ‘the incremental cost-effectiveness ratio for nirsevimab for the first RSV season to be substantially underestimated and highly uncertain’.
 
It is a decision which has left Dr Oei calling for change, saying many patients are going without the potentially lifesaving vaccines.
 
‘We’ve seen evidence in clinical trials and in the programs in WA and Queensland that there’s been a reduction in cases and hospitalisations with RSV,’ she said.
 
‘[A vaccine] definitely makes sense – less GP visits, less ED presentations, less hospital and ICU stays, and less overworking the medical and nursing workforce, less sick days and days off daycare for parents and families.
 
‘Some of the states have obviously felt that it would be worthwhile, and I think this is where we probably see a bit of a fragmentation of the medical system in state versus federal.’
 
Several states introduced free vaccination schemes earlier this year amid skyrocketing RSV case numbers.
 
More than 145,000 cases of RSV have been reported across Australia so far in 2024, compared to 128,000 in the entirety of 2023, and 96,000 in 2022.
 
New South Wales has been hardest hit by the virus with more than 63,000 cases this year, followed by 33,000 cases in Queensland, and 27,000 cases in Victoria.
 
In the wake of this, Dr Leanne Jones, a Tasmanian-based GP and Immunisation Coalition Board Member, described the PBAC’s decision as ‘disappointing’.
 
‘I really was hoping that we were going to get a listing for both ends of the spectrum, because we’ve seen lots of cases of RSV,’ she told newsGP.
 
‘At the moment we’ve got this postcode lottery where some states have agreed to fund it.
 
‘As a GP, you’ve got to raise these vaccines with your patients … but the majority of my patients probably can’t afford a vaccine, so it makes it really hard, but we have to talk to them about them and give them their choices.’
 
Currently, RSV vaccines cost hundreds of dollars, putting them out of reach of many, despite being recommended by the Australian Government for vulnerable cohorts.
 
In June, the PBAC recommended subsidised RSV vaccine for pregnant women and backed Abrysvo being added to the National Immunisation Program.
 
Immunisation Foundation of Australia Director Catherine Hughes said a national program is needed urgently.
 
‘The success of RSV immunisation programs internationally, and now in Queensland and Western Australia, provides compelling evidence that we can dramatically reduce the number of babies admitted to hospital each winter,’ she said.
 
‘The impact of these state-based programs should serve as a catalyst for the Australian Government to commit to a national program to ensure every baby in every postcode has access to RSV protection in 2025.
 
‘Protection against RSV should not be determined by where you live, nor how much money you have.’
 
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immunisation respiratory syncytial virus RSV vaccination