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Yet even a pediatric phase III vaccine is lacking study for RSV feels like a missed opportunity in the midst of an outbreak of the disease, born out of a tendency not only among medical researchers but also in society as a whole to put young children last.
To those not caring about young children or elderly parents, RSV may sound as foreign as Covid-19 did in January 2020. That’s true, although most people have had RSV and experienced it as a mild cold that likely never needed a doctor’s diagnosis .
But for children under the age of 5 and adults over the age of 65, the virus is a feared antagonist that can cause serious lung infections. According to the Centers for Disease Control and Prevention, RSV results in 58,000 hospitalizations of children under the age of 5 and 177,000 hospitalizations of adults 65 and older each year, and kills between 100 and 300 infants and 14,000 elderly annually. Compare that to the 369 infants and 196 children aged 1 to 4 who have died from Covid-19 over the course of the pandemic. The CDC notes that up to 2 percent of infants younger than 6 months who contract RSV may require hospitalization.
RSV infections not only harm the children who contract them. This fall, more and more RSV cases are filling children’s hospitals from Connecticut to DC to Texas — meaning both children with RSV and those who need treatment for other serious medical conditions may be treated at home or in distant hospitals for inpatient treatment facilities need to be relocated.
This situation that accompanies the transition of Covid-19 from pandemic to endemic is terrifying for children and driving crazy the adults trying to treat and care for them.
During the worst of the pandemic, young children lived in secluded worlds to protect everyone else. They were the last to gain access to coronavirus vaccines, meaning they were the last Americans left to be told to wear masks. The vaccines they received were based on earlier virus strains rather than the omicron variations that now predominate.
Given the willingness of young children to make sacrifices on behalf of their communities, an increased focus on treating and preventing disease seems a fitting reward for the medical establishment does affect them disproportionately.
Instead, RSV is making a nasty comeback at a time when hospitals are cutting beds for children because they can make more money treating adult patients. In addition, the encouraging results from the Phase III clinical trials for RSV vaccine candidates are exclusively involving seniors, not pediatric subjects.
Of course, older Americans deserve protection from disease just as much as children do, and there is a tradition of testing drugs on adults first. And based on the study results for older adults, there is reason for hope regarding the early studies of pediatric RSV vaccines, as well as vaccines that could be given to pregnant people to help protect the youngest babies.
Still, it’s agonizing to see pediatric hospital admissions for RSV ticking up and to think about what might be possible if only vaccines for children were more developed.
RSV studies in children and adults have been delayed by the pandemic, as measures to contain the spread of Covid-19 have resulted in unusually mild flu and RSV seasons. (If no one is exposed to the disease that a vaccine is trying to prevent, people conducting studies can’t compare placebo and vaccine groups to see if the vaccine is working.) Now that RSV is roaring back for the second year in a row is , conditions would be ideal for large-scale trials of pediatric vaccines.
If trials were underway, at least parents of young children would know that something promising could come out of this scary season. Instead, we can at best hope for the holidays that the RSV spares our children.
