NEWS: Nunavut January 08, 2009 - 2:00 pm

'I don't think it would be extra information or added value for us.'

RSV study not needed in Nunavut: GN


There's nothing to be gained for the government or people of Nunavut from Dr. Anna Banerji's current research project on respiratory syncytial virus, Nunavut's chief medical officer of health said.

"I don't think it would be extra information or added value for us. It would be duplicative," Dr. Isaac Sobol told Nunatsiaq News, responding to an article published Dec. 12 that questioned why the Nunavut health department turned down an offer of free research on RSV.

But Banerji and her colleagues, who include Dr. Michael Young, a pediatrician at Stanton Hospital in Yellowknife, Dr. David Goldfarb of the Qikiqtani General Hospital, and 18 other health professionals, are not giving up.

A Dec. 15 letter to Sobol and Dr. Geraldine Osborne, signed by all 21 health-care workers - mainly pediatricians and researchers from "all the northern and tertiary centres who receive sick children from Nunavut" - asks Nunavut to reconsider and allow the study.

"It is a non-interventional, non-intrusive prospective data collection that has no patient impact and does not require any financial or human resources from H&SS," says Banerji's letter.

"We have had ongoing consultations with ITK, NTI, Pauktuutit, the First Nations and Inuit Health Branch, Health Canada, and numerous other organizations, and we have received nothing but support for this initiative."

RSV is a virus that often leads to lower respiratory tract infection, or bronchiolitis. It can mean hospitalization for nearly a third of Nunavut children outside of Iqaluit less than six months old.

All have to be flown out of their communities, causing stress for children and parents, and great expense to the government.

Sobol said Nunavut's health department already has its own research on lung infections in the works, with a master's student who will work under the direction of Dr. Geraldine Osborne, the territory's associate chief medical officer of health.

It will be a comprehensive review of the effectiveness of the use of palivizumab, he said, referring to the expensive antibody that boosts the immune system, but whose effects only last a month.

At up to $1,500 per single injection, which may have to be repeated six or more times in a year, Nunavut can only afford to provide the antibody to children at the highest risk of contracting the virus.

Sobol said a one-year study like Banerji's isn't that helpful as "RSV numbers can change dramatically from year to year" and from community to community. He noted that in 2001, there was virtually no RSV activity in Nunavut.

For other jurisdictions with little data of their own, such as Nunavik, the NWT and Greenland, where Banerji's study has been given the green light, the research will no doubt be helpful.

"But that is not the case for us. We are happy and capable, and already engaged in doing our own work." He added: "We think we are being very responsible. We care about bronchiolitis in kids."

Banerji noted in her letter that lower respiratory tract infections in Nunavut are estimated to be 30 to 50 times higher than the Canadian average.

And the rate of children under six months who end up having breathing tubes inserted down into their lungs to survive the infections is several hundred times higher than the Canadian average, Banerji said.

The Nunavut health department blocked the study by refusing to allow Banerji's researchers access to Qikiqtani Regional Hospital records.

In an email to Nunatsiaq News, Banerji said Nunavut's "proposed study is retrospective and only gets data from the Qikiqtani region."

An earlier letter to Banerji from Cindy Roache, chair of Nunavut's Health and Social Research Review Committee, said the committee's biggest concern is that the multinational pharmaceutical company, Abbott Laboratories Ltd, was funding the research project.

Abbott manufactures palivizumab under the trade name Synagis.

But Sobol said that drug company funding is not the GN's major concern.

Despite their differences over the value of the research, Sobol and Banerji seem to be in complete agreement on one thing. Overcrowded housing, high smoking rates, premature births, and lower breast-feeding rates, all contribute to RSV and lower respiratory tract infections.

And all these conditions are linked to poverty, and all are problems in Nunavut. And all, Sobol said, are matters of concern for public health policy.

Children and families, and addiction reduction, are two focuses of Nunavut's strategic plan for public health, he explained.