Inuit infants need access to medication to prevent respiratory illness

“The Nunavut and Canadian governments must listen to health experts and make life-saving antibody drugs available to combat RSV”

Healthy, full-term Inuit babies in Nunavut are not eligible for palivizumab even though they have four to 10 times the rate of hospital admission compared to “high-risk” infants. (Philippe Put/flickr, CC BY-SA)

By Anna Banerji, David Suzuki and Faisal Moola
The Conversation

Inuit infants living in Arctic Canada have some of the highest rates of hospitalization and intensive care unit admission in the world due to a virus called respiratory syncytial virus (RSV).

Most children who get the virus come down with a cold, or mild respiratory illness, but RSV can also lead to pneumonia, inflammation and blockage of small airways in the lungs (bronchiolitis) and death.

The vulnerability of Inuit children to RSV is exacerbated by chronic poverty, overcrowding, poor indoor air quality as well as other social and environmental factors. The social and environmental determinants of Indigenous health are issues that we care about deeply and have worked on with communities, academics and governments.

In the Arctic, sick babies are often evacuated by air ambulance to regional hospitals and hospitals in southern Canada and can spend prolonged time in intensive care units.

These hospital stays stress families, which may be separated during the prolonged treatment, and comes at a great expense to the health-care system. Many children suffer from the long-term consequences from hospitalization, such as damage to the lungs, asthma, and some die.

Read more: More than one in 100 Nunavut infants have TB

The underlying social and environmental determinants of Inuit health are exacerbated by the legacy of colonialism, including forced relocation and extreme poverty. Yet these RSV hospital admissions are largely preventable with access to life-saving medication.

RSV admissions can be drastically reduced with an antibody drug called palivizumab, which is routinely given in other parts of Canada for infants considered at high risk for RSV, such as premature babies or those with significant heart conditions. A growing chorus of doctors and other medical experts are calling for the Nunavut and Canadian governments to make the antibody available to all Inuit infants living in rural communities in Nunavut.

High risk of hospitalization

Almost all children in Canada will get RSV before they are two years old, and only one per cent to three per cent of children in Canada are hospitalized in the first year of life.

But since the 1980s, several studies have documented extremely high rates of lower respiratory tract infections among Inuit infants, often requiring hospitalization. In some Baffin Island communities, as many as two-thirds of babies are hospitalized with lower respiratory tract infections, mostly due to RSV.

Hospital admissions from RSV infection are also extremely high in other regions of Nunavut. In Kitikmeot, the rate of hospital admissions for lower respiratory tract infections reached 590 per 1,000 live births in the first year of life between the beginning of January 2000 and the end of December 2004.

The reasons for the elevated rates of RSV and resulting lower respiratory tract infections among Inuit babies are not fully understood. Medical experts believe Inuit children have a number of genetic, social and environmental risks, including overcrowded housing, exposure to cigarette smoke, poverty, food insecurity and poor access to necessary health care, especially for those living in isolated Arctic communities.

High cost, but cost-effective

While palivizumab is effective at preventing RSV, it’s expensive ($6,500-$7,000 per child per season) and it must be administered monthly during the time of year when Inuit babies are at risk of exposure to the virus, usually between January and June.

Due to costs, the Government of Nunavut currently restricts the use of palivizumab to those traditionally considered to have a “high risk” of contracting the virus. Healthy, full-term Inuit babies are not eligible even though they have four to 10 times the rate of hospital admission compared to “high-risk” infants.

Research shows it’s less expensive to provide the antibody to full-term Inuit babies in rural communities in Nunavut as a preventative measure, than to incur the risks and astronomical costs of medical evacuations and prolonged hospitalizations resulting from RSV infection.

A recent review of the cost-effectiveness of palivizumab in different populations in North America supports this approach.

Inequity of care

Pediatricians and other doctors have been calling for better access to palivizumab in northern communities for more than a decade. In 2018, the Canadian Paediatric Society said doctors should consider administering palivziumab to term Inuit infants under six months old in communities with high RSV hospitalization rates.

Indigenous child advocates and Indigenous-led inquiries such as the Truth and Reconciliation Commission and the National Inquiry into Missing and Murdered Indigenous Women and Girls have shone a bright light on Canada’s horrific legacy of colonialism, including ongoing inequity of access and quality of health and social services for Indigenous children.

Read more:Indigenous knowledge is the solution to Canada’s health inequities

Inuit infants and families must have access to the same life-saving medication that other Canadians infants at lower risk of RSV receive, especially when those preventative treatments are effective and save the health-care system money.

The Nunavut and Canadian governments must listen to health experts and make life-saving antibody drugs available to combat RSV infections that devastate Inuit babies and their families.

Anna Banerji is Associate Professor of Pediatrics at the Dalla Lana School of Public Health at the University of Toronto, co-chair of the Indigenous Health Conference, and chair of the North American Refugee Health Conference; David Suzuki, is Emeritus Professor of Zoology, at the University of British Columbia; and Faisal Moola is Associate Professor at the Department of Geography, Environment and Geomatics at the University of Guelph

Read the article “Expand use of anti-RSV agent in Nunavut, thousands of petitioners say” published on Oct. 25, 2019 in Nunatsiaq News.

Disclosure statement

The Northern RSV Surveillance was the winner of an international call for proposals in 2008 from Abbott Laboratories. Abbott Laboratories was not involved in the study design, implementation or interpretation. Winner of a research grant through the Government of Nunavut in 2002/2003 for Respiratory surveillance.

David Suzuki is the co-founder of the David Suzuki Foundation and board member of the Japan Renewable Energy Institute.

Faisal Moola receives funding from the Social Sciences and Humanities Research Council and the Metcalf Foundation.

This article is republished from The Conversation under a Creative Commons license. Read the original article.
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(11) Comments:

  1. Posted by Yound About on

    “as well as other social and environmental factors” … such as living in a filthy unkept home. I’ve seen it a thousand times. Too many people don’t look after basic upkeep and hygiene in their homes, which harbours pathogens and allows them to thrive.

  2. Posted by In the know on

    Hmmm.
    I wonder why there is no input from anyone in the territory or from any of the Inuit organisations?
    Why is someone from Toronto pushing data that is over a decade old. Why is there not newer data? Why are these people who dont work in Nunavut or with Inuit populations making these statements?
    How about nunatsiaq, you get information from a local source, it at least a reputable source (like the Canadian Pediatric Society)
    Nunavut gives the same access as every other child in Canada to these needles.
    This smells of ivory tower stink.

    • Posted by Reader on

      Quote: “Why is someone from Toronto pushing data that is over a decade old”
      Apparently you have not read the article. Most of the links are to journal articles published between 2016 and 2019.

      Quote: “I wonder why there is no input from anyone in the territory or from any of the Inuit organisations?”

      How many university educated physicians and medical specialists work for Nunavut Tunngavik? The answer is zero. It’s pretty obvious the Inuit organizations in Nunavut do not have the ability to take on issues like. Pretty much all medical knowledge related to Nunavut is held by southern-based physicians like Doctor Banerji. She obviously holds more medical knowledge about these respiratory diseases than anyone residing in Nunavut at the moment.
      Of course, anything the GN says will be self-serving, defensive and untrustworthy.

      • Posted by In the know on

        Wow. Hit a sore spot, did I?
        Papers published with old data in more recent publications doesnt make it better. Its the same data.
        Are you really suggesting that the only Toronto specialists have medical knowledge? And that doctors in Nunavut dont know about respiratory disease? Are you suggesting that Nunavut can not make decisions without southern doctors?? I as a patient and parent am not buying what this toronto doctor is selling. Thanks but no thanks!!
        And yes, i actually do believe that NTI and other inuit organisations, as well as people of this territory are capable of making their own decisions, by consulting with those that are reputable and trustworthy.
        NTI is not the GN, but they dont seem to be buying what you are selling either. Just wondering why??
        Smells of something funny still.

        • Posted by sicko on

          You realize doctors in Nunavut are southern doctors, right? Not sure why you’re so defensive of them. It seems like this particular southern doctor is quite knowledgeable about respiratory illnesses in infants, and cares about childrens’ suffering more than she cares about the bottom line. Sometimes it’s good when outside eyes take a fresh look at serious matters. It keeps us from becoming insular and ignorant to new (sometimes better, sometimes worse) ideas.

        • Posted by iRoll on

          In the know asks: “Are you really suggesting that the only Toronto specialists have medical knowledge?” – This is a strawman.
          .
          Obviously there are specialists all over the world who have medical knowledge. How many of those are in Nunavut and how many who are in Nunavut are from Nunavut (zero?), and if there were any, would their ‘knowledge’ somehow be different because they were from Nunavut? (Genetic fallacy). Answer is also no.
          .
          Funny, i was just reading an article on indigenous science (IS), filled with pointless comparisons between IS and western science (WS), crafted with the sole purpose, in my opinion that is, of enhancing the prestige of IS.
          .
          Still, most scientists are unlikely to challenge such assertions because scientists aren’t typically in the business of endorsing, let alone paying attention to alternative epistemologies for the purpose of ameliorating people’s feelings and sense of worth. That’s what social justice is all about, we will leave that work to activists, journalists and other members of the cultural establishment who are less concerned with science than fostering illusions around equality.

          • Posted by Poser Alert on

            Nice way to hijack a discussion with a completely off-topic post about an anal retentive personal obsession.

            This article makes two arguments:

            1. Palivizumab should be administered to all Inuit infants because it is cost-effective when compare with the cost of medevacs.

            2. Palivizumab should be administered to all Inuit infants for moral and humanitarian reasons, to put Inuit infants on the same footing as infants in the south.

            You can agree or disagree based on how you interpret the evidence on the use of Palivizumab. But what does this have to do with “epistemology” or “genetic fallacy” or all the other pretentious pseudo-intellectual fecal matter that you just posted?

            • Posted by iRoll on

              Sorry you don’t know what those terms mean, that’s a huge bummer for you and it saddens me deeply. Still, that fact doesn’t make them meaningless. Though it may be hard to accept, it’s important that you know that.

            • Posted by Upon Reflection on

              My hypothesis is that you must work for Nunatsiaq, there’s no other explanation for such vitriol getting past the typically hyper-sensitive censors in the newsroom. Granted it can be inexplicably arbitrary, but this is always to serve some end. Case in point…

  3. Posted by Critical Reading Skills on

    How strange is it to blame colonialism while noting that the Government of Nunavut is responsible for the decision to not deliver palivizumab?

    This to me seems like narrative building.
    .
    Any critical reading of the above piece should raise questions as to the motives of our local media. Though they are probably obvious.
    .
    What ever became of Thomas Rohner’s ‘behind the media’ (or something like that) project? I would say we need it now as much as ever.

  4. Posted by Because… on

    It stinks because one of the researchers has been advocating for GN health to purchase and administer the palimizumab vaccine, the Synagis drug produced by Abbot Industries, for a very long time. Way back in 2008-2011, the GN turned down access to health records for research, and Ministers also declined the repetative pleas to purchase and administer, yet the researcher was relentless with petitions and lobbying. And now David Suzuki is on the band wagon, to use his referent power. Saviourism for the sake of research accolades, based on the dumb, poor Inuit.

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