Stop the needless hospitalizations and deaths due to RSV in Inuit babies.
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Canadian Inuit babies have the highest rate of hospitalizations with respiratory syncytial virus (RSV) in the world. Every winter intensive care units fill up with very young Inuit babies on life support due to RSV, a disease that can be prevented with a vaccine.
Many of these babies have long term consequences as a result of their hospital admission and some succumb due to RSV. This also causes great stress on the families who are separated during the hospitalizations. The costs of these RSV admissions are exceptionally high due to the combination of very high rates of admission, very expensive medical air evacuations and prolonged hospitalizations.
However, there exists an RSV antibody called palivizumab that could greatly reduce these RSV hospital admissions. Currently it is given to other babies across Canada who are considered at high-risk for RSV disease. TERM Inuit infants have ten times the rates of admission with RSV than the “high-risk” infants and the symptoms are often more severe. Despite this disparity, TERM Inuit infants in Nunavut do not get the antibody.
Palivizumab has been shown to be highly effective in reducing such admissions in preterm Inuit infants in Nunavut. What makes matters worse is that due to the exceptionally high rates of admission, very expensive medical evacuations and prolonged hospitalizations and ICU admissions, it is much cheaper to give the palivizumab than to have these babies admitted with RSV. In fact, by giving palivizumab the Government of Nunavut would save a lot of money.
In 2009, the Canadian Paediatric Society (CPS) issued the following statements:
"Consideration should be given to administering RSV prophylaxis to all full-term Inuit infants younger than six months of age at the onset of the RSV season in northern remote communities"
And again in 2018:
"Consideration may be given to administering palivizumab during RSV season to term Inuit infants until they reach six months of age only if they live in communities with documented persistent high rates of RSV hospitalization."
Despite 10 years of evidence there is a failure to give palivizumab to these babies. In the post Truth and Reconciliation era, this discrepancy in the way Indigenous and non-Indigenous peoples are treated, is no longer acceptable. Palivizumab prophylaxis needs to be implemented for this season.
We, as physicians, have taken the Hippocratic Oath. Please help us end this suffering and inequality. We can move forward by putting an end to health discrimination as one step towards reconciliation. We and all levels of government need to work together to put precious human lives first and make this change now.
Alumni of '89 University of Toronto Medicine
Dr. Famy Yim-Lee, Dr. Marilena Biscotti, Dr. Anna Banerji, Dr. Vivian Chow, and Dr. David Wong
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