RSV vaccine for older Canadians comes at a cost. Why experts are worried

Although a vaccine for respiratory syncytial virus (RSV) is now available for older Canadians, experts worry that because many have to pay out of pocket for the shot, it’s a barrier that could lead to otherwise preventable hospitalization — and even death — this cold and flu season.

RSV is a severe and highly-contagious respiratory virus, especially for younger children and older adults. The virus typically surges in the late fall and lasts until spring, and in order to reduce the spread, proper access to vaccination paired with public awareness about the virus may help, according to a report published Wednesday by the National Institute on Aging (NIA).

“Respiratory syncytial virus is actually a very common virus. Whenever we have cold and flu season, it’s one of the main causes why people end up in hospital and it causes a significant number of deaths every year,” warned Dr. Samir Sinha, co-author of the report and the director of geriatrics at Sinai Health and the University Health Network in Toronto.

“So, while RSV certainly can cause hospitalizations in younger people, it really is older Canadians that actually bear the real brunt of this and represent over 80 per cent of the deaths that happen from this virus every year,” he added.

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On Aug. 4, Health Canada approved the first vaccine for RSV for adults aged 60 and over. The vaccine called Arexvy, made by drug company GSK, has been shown to be 82-per cent effective at preventing lower respiratory tract disease caused by RSV.

The vaccine has already started rolling out across the country. It is not publicly funded (in most provinces), meaning most older Canadians may have to pay out of pocket for it.

“The problem is that if it’s not a vaccine that’s covered, then we know that it becomes very difficult for many Canadians to access this vaccine if they don’t have the funds to pay for it,” Sinha said.

“We know that Canadians will be more reluctant to get a vaccine that they have to pay for out of pocket because sometimes they might think, ‘Well if it’s important, the government will cover it’.”

Despite the barriers, the RSV vaccine available in Canada can lower the risk of severe outcomes in a person such as hospitalization and death, he said, particularly for older adults, stressing the importance of getting the shot this respiratory season.

The report found that adults aged 65 years and older experience more complications from RSV infections. And a ” sizeable proportion that are hospitalized” also require mechanical ventilation and admission to an intensive care unit.

This age group also has the highest mortality rate linked to RSV infections, more than six times higher than the mortality rate among children younger than one year of age (who also experience high rates of hospitalization), the researchers stated.

“So I’ve seen a number of patients adversely die in our hospitals every year. We know that thousands of people are dying every year, mostly older people from this virus,” Sinha said.

An issue with RSV, unlike other respiratory diseases such as COVID-19, is the absence of a dedicated treatment for the infection, he added.

“Like many of my colleagues, we’ve unfortunately seen a lot of older people where we feel quite helpless because all we can do is try and support them the best we can,” he said.

“We still don’t actually have any effective treatments against RSV. What we do have is a vaccine that can prevent it in the first place.”

There are numerous types of RSV vaccines that are currently being developed, one of which is approved by Health Canada (approved as a single dose).

Once the federal government approves a vaccine, it is then up to the provinces to determine whether it will cover the costs of the shot and how they will administer it, explained Sinha, adding this causes a lot of variation across the country.

For example, the province of Ontario agreed to cover this vaccine, but only for people 60 and older who are living in long-term care and some retirement homes.

The RSV will be available in Quebec at private clinics or community pharmacies but it is not funded by the province, a government spokesperson told Global News Wednesday.

In British Columbia, the RSV vaccine is available by prescription for private purchase at select pharmacies, a government spokesperson told Global News in an email on Tuesday. It costs around $230 per dose.

A spokesperson from Manitoba Health told Global News in an email that the province does not have a publicly-funded RSV vaccine program “at this time.” They added that any product available will be through pharmacies.

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And on the East Coast, Nova Scotia, New Brunswick Prince Edward Island are also not providing the RSV vaccine free of charge to the public.

Global News reached out to other provinces asking about their RSV vaccine cost but did not hear back at the time of publication.

“Since the RSV vaccine is not currently part of the public programming, patients would have to pay out of pocket or cover the cost through private insurance,” a spokesperson from P.E.I. told Global News.

Although some Canadians are going to have to pay for this out of pocket for the vaccine,  Sinha said many private drug insurers will cover the shot.

“Which is really good news so that at least some people will not have to pay out of pocket for it. But unfortunately, other people who want this vaccine will have to pay upwards of $300 to get this one-dose vaccine administered either by their pharmacist or by a primary care provider,” he said.

The NIA report put out recommendations for governments and health authorities in order to better support RSV vaccination efforts and reduce the impact of infections across Canada. One of the recommendations was to provide RSV vaccinations free of cost to populations for which, “RSV vaccination is cost-effective.”

This is because cost plays an important role in whether Canadians choose to get vaccinated.

As an example, the authors pointed to the shingles vaccine, which is offered at no cost to older adults in some Canadian regions, while in others, it is priced at around $400.

“Research has shown that uptake of shingles and pneumococcal vaccination is more likely to happen when funded,” the report states.

RSV can cause a mild illness with cold-like symptoms, such as a runny nose, coughing, wheezing, sneezing and a fever, which begin two to eight days after being exposed to the virus, the report said.

“Influenza tends to become more apparent in terms of its symptoms within a day or two. RSV is one of those respiratory viruses that can take up to four days before you develop symptoms. And it doesn’t usually always present with a fever. And that’s why it’s a bit more of a tricky virus that can be more contagious,” Sinha said.

But complications can arise, especially for younger children, people who are immunocompromised and older adults.

A common complication linked with RSV infections is the worsening of pre-existing health conditions, the report said, which includes asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). Across age groups, both in infants and older adults, RSV infections can also cause pneumonia.

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Laura Tamblyn Watts, CEO of CanAge, Canada’s National Seniors Advocacy Organization, warned respiratory viruses such as RSV can be extremely dangerous for older Canadians.

“If you get one of these viruses — influenza, pneumonia, RSV or COVID — the chances are if you are a vulnerable person that you’re probably never going to fully recover again. That’s a harsh reality,” she said.

Given that this virus tends to circulate within long-term care facilities and schools, it becomes particularly vital to receive the RSV vaccine this season, especially if you are in close contact with your grandchildren, she emphasized.

“If the grandkids are coming home when you want to be able to give them a big hug. It’s important to find out whether or not there are outbreaks,” she said.

“If you don’t have coverage by the provincial health plan that you’re in, then start talking about whether or not that’s something that you might be able to afford, particularly since so much of RSV is found in schools.”