The decision on whether to immunize all infants under 6 months of age with the monoclonal antibody nirsevimab (Beyfortus) to protect against Respiratory Syncytial Virus (RSV) has sparked a debate among autonomous communities. RSV is the main cause of lower respiratory tract infections, such as bronchiolitis and pneumonia. Some regions initially planned to immunize only high-risk babies with underlying health conditions, but their stance may change.
Several regions, including the Balearic Islands, Cantabria, Castilla-La Mancha, the Valencian Community, Extremadura, the Basque Country, Navarra, La Rioja, Ceuta, and Melilla, voted against extending immunization to all babies. They cited the need for more evidence on the drug’s effectiveness and uncertainty about the total cost of the immunization campaign. However, experts from the Vaccine Report unanimously recommended immunizing all infants, and the Ministry of Health has approved the financing without disclosing the price.
On the other hand, regions such as Madrid, Catalonia, Andalusia, Castilla y León, Murcia, Galicia, the Canary Islands, and Asturias advocate for immunizing all babies without distinction. They argue that bronchiolitis has a significant impact on the healthcare system, with one in ten hospital admissions for children under 5 years of age attributed to this condition in Spain. Moreover, 95% of cases in children under 2 years of age occur in previously healthy children.
A Middle Ground
The Ministry of Health has taken a middle-ground approach due to the divided opinions. Instead of mediating and coordinating the Interterritorial Council of the National Health System, the ministry decided to postpone the decision until after the recent elections on May 28.
This delay could have consequences as regions previously governed by the Socialists, including the Balearic Islands, the Valencian Community, La Rioja, and Extremadura, may change their stance. While political affiliation has not typically influenced regions’ positions on public health matters, a shift in sides is expected this time.
During this waiting period, the Community of Madrid (CAM) has taken the initiative to announce its decision to start immunizing all infants under 6 months of age born after April 2023. The immunization campaign will begin in October and will be conducted in public hospitals through a specific appointment system. This makes CAM one of the first regions, following Galicia’s announcement in March, to facilitate RSV immunization ahead of the next epidemic season. The General Directorate of Community Public Health is already procuring doses of the monoclonal antibody niservimab and finalizing the Surveillance and Control Protocol for RSV bronchiolitis.
A New Consensus Opportunity
A new meeting of the Public Health Commission (CSP) has been scheduled for June 22. The agenda includes discussions on immunization against RSV, as well as the presentation of reports on vaccines. Experts believe that all babies should be protected seasonally, starting in October, as the drug’s effect lasts for five months. Infants with risk factors would require two vaccinations in their first year, while those without risk factors would only need one. Failing to extend protection to all babies is considered a mistake, as even healthy infants face the same risk of serious prognosis if infected with RSV. Additionally, prevention is more cost-effective than treatment.