When Michelle Pratt’s twin sons were born prematurely at 32 weeks and four days, she was eager to make sure they wouldn’t get sick — including from respiratory syncytial virus, or RSV.
RSV is a common, highly-contagious virus that causes infections of the respiratory tract. It can quickly become dangerous for infants, leading to hospitalization and — in rare cases — death.
“As a parent, you want to do everything you can to protect your children,” said Pratt.
“Just last year, we had two close friends and their children [who] were hospitalized for RSV. So, it’s a very common occurrence.”
Pratt is a dermatologist in St. John’s. She did a deep dive into medical research during her pregnancy, looking at guidance from national expert groups, such as the Canadian Pediatric Society, as well as the National Advisory Committee on Immunization (NACI).
“They all have the same message — that they recommend nirsevimab as first-line prevention for severe RSV for newborn babies and young infants,” she said.
Nirsevimab is a monoclonal antibody, also known by its brand name Beyfortus. It was approved by Health Canada in April 2023 and recommended for all infants in their first RSV season. The single-dose drug is given to infants shortly after birth and provides protection for about five months.
Less than a year later, the department also approved a new bivalent vaccine, called Abrysvo, which is given to pregnant people between 32 and 36 weeks of gestation to protect the baby for the first six months after birth.
In 2024, NACI, which advises the federal government, recommended that provinces work “towards a universal RSV immunization program for all infants.”
When Michelle Pratt’s twins were born, she quickly learned that an RSV antibody for them wouldn’t be publicly covered. She wants to see the provincial program expanded to all infants — and doctors across the country agree. CBC’s Henrike Wilhelm reports.
Most provinces have followed that recommendation, offering coverage of nirsevimab to varying degrees.
Coverage for high-risk infants only
Only four provinces — Newfoundland and Labrador, Alberta, British Columbia and New Brunswick — reserve coverage for high-risk infants.
According to the provincial Department of Health, that group includes children under the age of two with chronic lung or congenital heart disease, and premature babies born “at less than or equal to 30 weeks.”
That criteria excluded Pratt’s sons, who were born a little over two weeks past the cut off.
“When they’re born that early, you just don’t know what way things are going to go. So, it was a very stressful time,” said Pratt.
“Knowing that there was this option out there that may prevent them from having a severe illness or needing to be hospitalized … I was disappointed that we weren’t able to get access to what has really become now the standard of care.”
It’s a view that is shared by health-care professionals across the country, who advocate for wider access to the drug.
“RSV is a terrible disease for infants. One in 50 infants will be hospitalized in their first year of life, and it’s usually due to RSV,” Dr. Shelley Ross told CBC News from Vancouver.
“Every infant, no matter what their postal code, deserves to be protected against RSV.”
Ross is past president of the Federation of Medical Women of Canada, and co-chair of its RSV Task Force. She said the approval of the two new products was a major achievement.
“I think when you’ll look back in time, they’re going to say that the onset of vaccines to prevent RSV in infancy was a highlight in this past century,” she said.
“What an opportunity to change things.”
Ross said the federation has been actively advocating with provincial governments to expand coverage — something that has already proven successful.
“What we’ve seen in the provinces that have implemented these measures: dramatic improvement in decreasing emergency room visits, admissions to hospital, admissions to ICU. So, we know that both these vaccines do work, and we know that they’re safe,” said Ross.
Effectiveness of antibody backed by data
That sentiment is echoed by the Society of Obstetricians and Gynecologists of Canada, which aims to achieve universal RSV protection.
And while an increasing number of provinces “have come on board,” Newfoundland and Labrador is “far behind,” said society spokesperson Dr. Darine El-Chaâr.
She practices in Ontario as a maternal fetal medicine specialist at The Ottawa Hospital, and as a clinician-scientist at the Ottawa Hospital Research Institute. She said Ontario is the only province covering both the antibody shot and the maternal vaccine, and it’s seeing a significant impact.
“If you just look at our Ontario Respiratory [Virus] Tool, when you look at the impact of hospitalization, between the season before and that year’s peak, there was a difference of 162 hospital beds that were occupied that were less,” said El-Chaâr.
“And already, we’re seeing similar trends for this year’s respiratory season.”
She said in neighbouring Quebec, which covers the infant antibody, results have been similar — showing an 86 per cent reduction in emergency visits, 89 per cent reduction in hospitalizations, and 88 per cent drop in ICU admissions.
“The SGOC stands firmly that these products should be … universally publicly-funded during RSV season at this time,” said El-Chaâr.
But there’s no sign of a change in policy in Newfoundland and Labrador.
While the province is “exploring nirsevimab a little more closely now,” Chief Medical Officer of Health Dr. Janice Fitzgerald said there are no concrete plans to expand coverage.
“Certainly, NACI has recommended that provinces consider moving towards a universal coverage, and that could be phased in given the logistics context, financial considerations,” said Fitzgerald.
“There’s lots of things to consider. We’ve been exploring … what that could look like here, but we haven’t come to any conclusions.”
That’s despite RSV cases increasing in recent years, according to data provided by the Department of Health. In the 2021-22 season, 196 cases — or 1.6 per cent out of all tests — were detected in the 2021-22 season. That number went up in the 2024-25 season — to 1,062 cases, or 3.9 per cent out of all tests.
As of late January, 74 cases had been detected.
When asked about the number of RSV-related hospitalizations, admissions to the intensive-care unit and number of deaths, the department said it isn’t able to “provide data on severe outcomes.”
Fitzgerald said based on historical information from hospitalization data, “we do certainly see hospitalizations and ICU admissions, for infants especially.”
Private purchase out of reach for many
As of Oct. 6, 2025, nirsevimab is available for private purchase across Canada. For this RSV season, Pratt and her husband decided to pay for it out of pocket for their sons.
“It’s definitely the most benefit to newborns and babies less than eight months, but there’s still benefit to young infants receiving it after that period,” said Pratt.
“It’s given us a lot of peace of mind as parents, knowing that they have that protection.”
How important protection is, she said, became clear recently when one of her sons ended up in the intensive-care unit with bacterial pneumonia.
“Being in that position as a parent and watching your child struggle to breathe, it’s hard to put into words what that’s like. It really stays with you,” said Pratt.
“It just goes to show how quickly even healthy infants can become really sick to a life-threatening point.”
While the antibody can vary between $750 and $905, according to the Federation of Medical Women of Canada, the list price for maternal vaccine Abrysvo is about $230.
It’s a price point that’s putting private purchase out of reach for many, said Pratt. As a physician, she said she knows that many people struggle to afford medications.
She would like to see a universal access program in place. While the upfront cost for public health might be high, she said the prevention of costly hospitalizations will save money in the long run.
“It’s not fair that a baby born … in Ontario has access to this medication for free versus a child who’s born here in Newfoundland and Labrador doesn’t have that same access,” she said.
“At the end of the day, I just think it’s the right thing to do.”
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