Protecting newborns

The expanded approval of Pfizer’s shot as a maternal immunization means expecting parents have two options to protect newborns.

Cleared for mothers between 32 and 36 weeks of gestation, Abrysvo is meant to, for a time, create passive immunity from RSV in young infants. The FDA limited the window in which the shot is administered due to concerns of a possibly higher risk for preterm birth.

CDC advisers are set to meet Sept. 22 to develop recommendations for maternal immunization. Their advice could affect how widely Abrysvo is used this way.

The CDC has already endorsed Beyfortus for infants younger than 8 months born during or entering their first RSV season. The shot is also recommended in children between 8 and 19 months who are at high risk of severe disease during their second RSV season.

It’s not yet clear whether Beyfortus can be used following maternal immunization with Abrysvo to improve an infant’s protection from RSV.

Navigating insurance

The RSV vaccines and Beyfortus aren’t cheap, and how they’re paid for and covered could affect their uptake.

GSK set the wholesale cost for a single dose of Arexvy at $280, while Pfizer will charge $295 per Abrysvo dose. Beyfortus has a higher price tag — either $495 or $990 depending on the dosage.

The CDC recommendations mean the vaccines should be covered, without a copay, for people with private insurance. However, some people on Medicare have been asked to pay hundreds of dollars out of pocket based on whether they have Part D coverage or not, according to an August report by The New York Times.

According to Pfizer, insurance coverage is available for RSV vaccination.

For Beyfortus, the CDC advisers voted to include the shot in the Vaccines for Children program, which will expand access to children who might not have coverage otherwise. Insurance plans must also cover the antibody shot in accordance with the Affordable Care Act, per Sanofi.

Both drugmakers expect their shots to become lucrative products. GSK anticipates sales of Arexvy will have a “steady build” over time, projecting sales to eventually top around 3 billion pounds, or about $3.7 billion, per year. Last December, Pfizer predicted U.S. revenue from Abrysvo will reach over $2 billion.

Meeting people where they are

Rollout of the RSV shots has just begun, but public health messaging is already in full swing.

Kanter, from Louisiana’s health agency, said they have doubled their communication efforts, and are leaning on churches and community centers to encourage immunization.

“One of the other lessons that we learned from COVID is that you can’t wait for people to come to you,” Kanter said. “You have to really make an effort to go meet them where they’re at.”

Drive-thrus and other similar vaccine events — widely used in the early days of the pandemic — could be another tool, members of ASTHO said at the August meeting. But the main focus for now will be on doctor education and awareness.

“My sense is that vaccine hesitancy will be a challenge to the uptake of the vaccine,” said Stucky, the Providence physician. “This is a complicated issue, and to address hesitancy, we need to maintain open communication with our community about both safety and efficacy of the vaccine.”