Feasibility and ethical issues: experiences and concerns of healthcare workers regarding a new RSV prophylaxis programme in Nunavik, Quebec

Abstract

Background: The respiratory syncytial virus (RSV) is a major cause of hospitalisation in young Inuit children. Prophylaxis with palivizumab is routinely recommended for premature infants and those with severe pulmonary or cardiac diseases. In the fall 2016, the Quebec Ministry of Health expanded the criteria to include healthy full-term (HFT) newborns from Nunavik based on their high RSV hospitalisation rates. Objectives: The aim of this study was to describe the impact of this programme on Nunavik health services during the first RSV season after its implementation (2016-2017) by studying challenges, concerns and needs of healthcare workers (HCWs). Methods: An ethnographic approach was used. Semi-structured interviews focusing on HCWs experiences, and opinions to improve the new programme were conducted with 20 HCWs involved in its implementation. Results: Main reported challenges and concerns were: additional work(over)load, lack of information and evidence about the need and efficacy of palivizumab in HFT newborns, communication issues between stakeholders, and ethical issues regarding the Inuit population. Conclusion: The study revealed significant feasibility and acceptability issues. The programme was highly resource consuming. To address HCWs' concerns, evidence-based data regarding palivizumab effectiveness in HFT infants, as well as consultation and involvement of Inuit population are warranted. ARTICLE HISTORY

Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada

“…It is worth noting that our study was mainly focused on estimating the cost-effectiveness of the RSV immunization programs without consideration of the feasibility and acceptability of the strategies. A recent study [30] disclosed significant concerns and challenges among health-care workers regarding the pilot RSV immunization program in Nunavik as a result of limited human resources, lack of evidence regarding the effectiveness of palivizumab for healthy full-term infants, and ethical and communication challenges in the Inuit population.…”

“…Palivizumab was offered to all high-risk and eligible healthy full-term infants during the RSV season. However, recent reviews by Nunavik Public Health and the Institut national de santé publique du Québec (INSPQ) raised concerns of the feasibility, ethical issues, and real-world effectiveness of palivizumab pilot program specific to healthy full-term infants in Nunavik [ 24 , 30 ], and the program was not continued. Given the high costs of palivizumab programs associated with monthly injections [ 23 , [31] , [32] , [33] ] and a high unmet medical need for RSV prevention, there is a need to evaluate the effectiveness and cost-effectiveness of alternative RSV prophylactic strategies for the infant population in Nunavik [ 27 , 34 , 35 ].…”

Effectiveness of palivizumab immunoprophylaxis to prevent respiratory syncytial virus hospitalizations in healthy full-term <6-month-old infants from the circumpolar region of Nunavik, Quebec, Canada

“…No additional human resources were available to run this program and shifting resources to the PVZ program caused a hidden but real opportunity cost in terms of reduced activities in other important programs like immunization or sexually transmitted diseases control. Even if more resources had been available, the refusal rate and lack of compliance likely reflect limited acceptability or importance of the PVZ program for Inuit families, as highlighted in a qualitative analysis carried out during the first year of implementation ( Lorcy et al, 2020 ).…”

“…According to these experts, RSVH rates were very high in this population and caused substantial costs associated with airborne medical evacuation; the efficacy of PVZ to prevent RSVH in HFT infants was expected to be similar to that found in premature children; and this intervention was considered to be both feasible for the healthcare system and well accepted by the population. More details about the decision-making process leading to this recommendation can be found elsewhere ( Lorcy et al, 2020 ). Following this decision, Quebec Ministry of Health mandated the Institut national de santé publique du Québec (INSPQ) to conduct quantitative and qualitative analyses.…”

“…Following this decision, Quebec Ministry of Health mandated the Institut national de santé publique du Québec (INSPQ) to conduct quantitative and qualitative analyses. Results of the qualitative evaluation were published elsewhere ( Lorcy et al, 2020 ).…”