Inuit babies deserve drugs to protect from respiratory illness
Inuit infants in Canada’s far North have the highest rate of hospital admissions in Canada, for Respiratory Syncytial Virus ( RSV), an illness that can lead to pneumonia or bronchiolitis, sometimes requiring hospitalization and life support.
Many infants especially in remote communities in Nunavut, wait days for air ambulances to transport them and often end up on life support. Many have long- term health issues and a number even die of this dreaded virus.
In the North, RSV season runs from January to June and during this time many Inuit babies end up on life support. The stress this puts on the families is incalculable. And the hospital admission charges for Inuit babies with RSV are estimated to cost the government at least $8 million a year.
Dr. Anna Banerji is trying to change the odds for these Inuit infants. A professor at the University of Toronto’s faculty of medicine and an infectious disease specialist, she’s dedicated her medical career to bringing decent and much- needed health care to Indigenous children and youth.
With years of research behind her, Dr. Banerji has shown that too many Inuit infants become seriously ill, some succumbing to the virus even though there may be ways to curtail the disease. Although there’s not a lot of data available, she noted a 2009 study, which found 205 of the 728 babies born in the communities of Nunavut were admitted to the hospital with a respiratory infection in the first year of life. In the Kitikmeot region, the westernmost of the three regions of Nunavut, 35 per cent of the babies less than six months of age were admitted with RSV.
Palivizumab, a highly effective antibody for RSV, was licensed in Canada a number of years ago. And Dr. Banerji has shown it’s highly effective in preventing RSV hospital admissions in Inuit babies. But, it comes with a catch; it needs to be administered monthly during the RSV season and costs about $ 7,000 per baby for the season.
It is therefore presently restricted to babies who are known to be at high risk, mainly those born prematurely and those with cardiac and chronic respiratory disease. Shockingly, Inuit babies are not classified as high risk, despite evidence to the contrary. And so they are not eligible for the medicine that would clearly protect and prevent RSV admissions.
Many of Dr. Banerji’s medical colleagues, including Dr. Sohail Gandhi, president of the Ontario Medical Association, agree that Inuit babies should receive the vaccine.
Dr. Gandhi noted in his endorsement that Inuit infants have 10 times the rates of hospital admissions with RSV than the high- risk infants in the rest of North America and the symptoms are often more severe. “Despite this disparity, Inuit infants in Nunavut do not get the antibody.”
Dr. Gandhi has support to make the injections available to Inuit babies in the rural Arctic from the Northern School of Medicine, the Canadian Medical Association and the Canadian Institute of Health Research Institute of Indigenous Peoples’ Health.
However, some people claim there is still not enough proof that the vaccine is effective. George Hicks, health minister in Nunavut, said in October that he was following the progress of an ongoing immunization program in the northern Quebec community of Nunavik, but that at this point he is just adhering to “best medical practices.”
Some people have argued that the territorial government is trying to save money by refusing to vaccinate high- risk Inuit infants. Yet even this callous argument fails.
According to Dr. Banerji there have been a number of studies in North America showing the cost effectiveness of administering palivizumab. These make it clear that in Northern regions the government could actually save money with it, she said.
In the Kitikmeot region, which is about 1,200 kilometres northwest of the capital Iqaluit, RSV admissions cost about $1.5 million a year. Protecting the estimated 50 babies a year there until they reach six months of age would cost about $ 365,000 and would save the territorial government more than $1.14 million, she said.
Similar results could be found in the Kivalliq region, west of Hudson Bay and home to the regional centre Rankin Inlet, she said.
Our history of neglect on Indigenous matters in this country is legendary. The recent Truth and Reconciliation Commission Report documented 94 calls to action. Many have yet to be implemented.
Surely each Inuit infant should have the same chance at life as any other Canadian-born baby.
By choosing to speak out, we can help bring some hope for health in a place where out- of- sight is not only outof-mind, but often a sentence for a lower quality of life than in the rest of the country and brings with it the risk of premature infant deaths, which can be avoided.
Dr. Banerji’s colleagues have started a petition, which currently has more than 70,000 signatures, asking the government to implement palivizumab injections for babies in Nunavut this season.