In his excellent Forefront article on legislative reforms to strengthen the Vaccines for Children (VFC) program, which is entering its third decade, Richard Hughes IV underscores the importance of updating the law to protect people of all ages. Another priority—one that can be addressed under existing law and without congressional action—is ensuring that as the science evolves, the program continues to ensure that children benefit from the full range of modern preventive therapies against transmissible, potentially deadly childhood disease.
The recommendations of the Advisory Committee on Immunization Practices (ACIP) set the nation’s immunization standards. The ACIP has already begun to align its recommendations to encompass not only traditional vaccines, which work by building protection over time, but also monoclonal antibodies (mAbs), which confer immediate protection against communicable disease. Both types of products confer immunity; as a result, the ACIP’s decision that newer immunization technologies fall within the scope of its charter authority is not only consistent with, but arguably required by, its 1964 founding mission—to advise the Surgeon General “regarding the most effective application in public health practice of specific preventive agents which may be applied in communicable disease control.”
The ACIP is now about to begin formal consideration of immunization recommendations for mAbs designed to prevent respiratory syncytial virus (RSV). A particularly vicious virus that strikes in infancy and early childhood, RSV can trigger serious illness in children; for infants, it can be life-threatening. RSV tends to be cyclical, striking from late fall through early spring and is the most common cause of deadly pneumonia and bronchitis in babies. Most children will experience RSV before they turn two, and RSV strikes millions of children worldwide.
Beyond causing widespread, costly sickness, RSV kills an estimated 500–1,000 children in the US annually. Death from RSV is an especially serious risk for premature babies and those younger than six months of age, children younger than two with chronic lung disease or congenital heart disease, children with weakened immune systems, and those with neuromuscular disorders, including children who experience difficulty swallowing or clearing mucus.