Low- and middle-income countries need vaccinations to prevent and control respiratory virology: Insights from first-principles and a global initiative
By 2022, when people began to socialize more often, however, RSV bounced back. Canada, Japan and several countries in the European Union reported a sharp rise in RSV cases. The same was probably true in low- and middle-income countries (LMICs) too, where RSV has the biggest affect. It is not known for sure because of the incomplete and missing systems for tracking the disease in those countries. Maria Zambon, head of respiratory virology at the UK Health Security Agency in London, says that 5% of deaths due to the disease are in low- and middle-income countries. In most LMICs, there is noRSV data.
In a commentary published earlier this year, Zar and Cunningham called for a concerted global initiative to fund and deliver RSV preventative treatments to all infants everywhere, particularly in underserved regions, where rates of RSV-related illness and death are greatest12. “It’s absolutely a key issue now to get these products out to low- and middle-income country settings,” Zar says. This is where the kids are dying.
Even in countries where there is some surveillance infrastructure, rural areas are not adequately represented. Eva says most of the hospitals are in urban areas.
Drug companies are helping to gather data about the disease. AstraZeneca, the developer of the RSV monoclonal antibody nirsevimab, for example, has funded an RSV surveillance dashboard run by the non-profit organization ReSViNET, based in the Netherlands, to collect data from 20 countries (see go.nature.com/3y8kkzr). “These companies can then make a case for nations to introduce their vaccines as part of their existing immunization programmes,” Barr says. In developing countries, it will be difficult to do that.
What will we learn from his experience with anti-rsv vaccinations? A case study for long-acting antibodies in high-income countries
Unless you have had cancer or experienced an inflammatory disorder, chances are you have never taken an antibody drug. But Oliver DeLong, a healthy baby from Chicago, Illinois, probably received his first antibody therapy before he was even four months old.
The arrival of these agents comes at a time when there are increased pharmaceutical options for defending againstRSV. The FDA approved two vaccines for older adults earlier this year. And the agency approved another for pregnant people in August as well, offering benefits to newborns accrued through the transfer of maternal antibodies across the placenta (see ‘Complementary care’). Young infants could get a vaccine in the next few years.
You can call it bad luck. He sees a valuable lesson that cannot be predicted by the experience. And for that reason, it will be important to have multiple RSV antibodies on the market, with a diverse range of binding specificities, to increase the likelihood of maintaining effective options for if and when new mutations arise. Even if one of them stop working, we will have alternatives, says Kyratsous.
This leaves many people contemplating the role that long-acting antibody drugs will assume amid this new array of prophylactic options. Implementation and parental acceptance of the vaccine are some of the challenges that arise.
Cunningham is a respiratory-disease specialist at the University of Edinburgh, UK. There is going to be a lot of debate over the next few years about which is the best coverage option.
Notably, pharmaceutical companies have committed to offering nirsevimab and other long-acting antibodies at the same price as conventional vaccines. In high-income countries, analysts estimate that the antibodies will be priced between $300 and $500 for newborns — not much higher than the $200 or so expected for RSV vaccines. Prices in resource-poor settings should be even lower.
Banerji has been advocating for access to palivizumab for Inuit babies born in remote northern communities for more than a decade. However, her appeals have gained limited traction.
Things should be different with nirsevimab. As a one-time, lower-cost option, nirsevimab should streamline the administration process, while also being “highly cost-effective or cost-saving as compared to the pilot strategy in Nunavik”, according to a 2021 modelling study led by researchers at York University in Toronto5.
Source: Antibody therapies set to transform respiratory syncytial virus prevention for babies
Clesrovimab vs. Nirsevimab: A Possible Alternative to Rivalry Vaccination and Disease Prevention
Maternal vaccination increases immunity for the mother and the baby. It would offer more protection if both approaches were put up with more vaccine and antibodies. With limited budgets, public-health officials may have to decide between giving vaccine to expectant mothers or giving synthetic antibodies to babies to prevent serious infections in the first few days of life.
The better option would be a shot for shot, because disease prevention was the only consideration, according to Louis Bont.
Notably, clesrovimab has several design features that make it distinct from, and complementary to, nirsevimab. One key distinction is its target location on the RSV fusion protein. Nirsevimab binds to a spot on the protein’s apex — one that is only present in the protein’s pre-activation state, before it undergoes a structural change necessary for viral entry into host cells. But, clesrovimab latches on to the protein’s flank, on an area that remains consistent across different conformations of the protein.
The few genes that have been observed have reduced nirsevimab11. Octavio Ramilo, a infectious-disease researcher at St. Jude Children’s Research Hospital, says that resistance is still an area of concern. He says they need to watch the outcome and look at what happens.
On a molecular level, the Adimab agent — called RSM01 — and nirsevimab are fairly similar. Laura Walker, who was head of the antibody sciences at Adimob, said the antibodies bind to adjacent sites on the fusion proteins and have comparable potency in laboratory experiments. The differences are not very significant, she says. An important potential advantage is found in RSM01. The Bill & Melinda Gates Foundation plans to advance the drug and make it available in low income countries for little or no manufacturing costs.
As with most medical interventions, however, the first beneficiaries of nirsevimab will invariably be in wealthier parts of the world — that is, children such as Oliver.
The Moderna Outlook: New Challenges in Preventing and Controlling Respiratory and Throat-related Diseases in the Era of Epidemics
We are pleased to acknowledge the financial support of Moderna in producing this Outlook. Nature is always responsible for all editorial content.
Research also suggests that the effects of RSV might linger long after the initial infection has been cleared; studies are beginning to uncover links between RSV infections and respiratory problems in later life, such as wheezing and asthma. Other research is looking at how other pathogens might compete withRSV in a host.
Efforts to prevent infections and keep vulnerable people out of hospital are beginning to pay off, but deploying these strategies presents new challenges.