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Child health specialists are pleading with Pharmac to find the money to keep funding a preventative drug for high-risk babies.
Pharmac says it would like to keep funding Palivizumab, which is given to babies to reduce the risk of RSV infection - but the temporary funding has run out and it does not have the budget for it beyond 2023.
Pharmac chief medical officer Dr David Hughes said funding for this treatment was always intended to be temporary, as it came out of the government's Covid-19 funding.
"It has been ranked on the options for investment list and is a medicine we want to fund, however, due to its relative ranking and Pharmac's current budget position, is unable to be progressed at this stage for funding beyond 2023.
"We understand that this will be disappointing news for healthcare practitioners treating infants and young children who may have benefited from this treatment, and their whānau."
The drug funding agency agreed Palivizumab had lowered the rate of hospitalisations for Respiratory Syncytial Virus (RSV) but said there was "limited evidence" that it had reduced deaths.
In an open letter to Pharmac, Auckland University neonatal specialist Associate Professor Jane Alsweiler, paediatrician Adrian Trenholme and infectious disease specialist Emma Best said doctors were "extremely disappointed" that Pharmac had pulled funding for this small group of highly vulnerable infants.
"We, the undersigned, foresee this decision leading to infants becoming critically sick with RSV in 2024, utilising intensive care for long periods of time and perpetuating the inequitable morbidity from this infection in New Zealand."
RSV can be fatal, especially to premature babies or those with congenital heart problems, and severe or repeated RSV infections cause long-term lung damage, such as bronchiectasis.
Funding palivizumab was "a critical equity issue", as Māori babies were more likely to be born pre-term and have a higher risk of hospitalisation from RSV, and Māori infants had lower rates of surgical intervention with some congenital heart defects and lower rates of survival.
"RSV clearly falls into the respiratory health category identified in Pharmac's Māori health area of focus," they wrote.
Palivizumab is routinely used for high-risk children in Australia, Europe and the United States and has been licensed in NZ since 2000 to prevent RSV infection.
It has been funded for the past two years in New Zealand due to a surge in RSV cases in the winter of 2021, when very sick babies filled paediatric intensive care units causing the cancellation of time-critical surgery for babies with heart problems.
In announcing its decision on 31 October, Pharmac said funding for the drug over the last two winters had come out of ring-fenced funding for the Covid-19 response, which was separate from the Combined Pharmaceutical Budget (CPB).
"We acknowledge that palivizumab reduces hospitalisation rates for at-risk babies. Our clinical advisors have recommended it be funded with a high priority. However, there's limited evidence that it reduces the number of deaths from RSV."
Pharmac would like to fund palivizumab, but due to its "current budgetary constraints", it was not able to do so for the upcoming RSV season.