Fear and Wheezing in Pediatric Medicine

Thoughts on the new RSV vaccine

Few things are scarier than watching your child struggle to breathe.

Respiratory syncytial virus makes it hard for kids to breathe. A common childhood illness, RSV causes inflammation in the lungs leading to coughing, wheezing and shortness of breath. Children under five often get very sick from RSV, as their already small airways become inflamed. Babies under six months can become life-threateningly ill.

As a mother and a pediatric primary care provider, I have had many frightening experiences with RSV. I learned about the virus when my first child was ten months old and she could barely breathe. I was terrified. My pediatrician wanted to admit her to the hospital, but all of the pediatric beds in town were full of other children with RSV. Because I was a 24 year old single mother student midwife, the doctor decided I could provide the necessary observation and care to my child and sent us home with steroids, bronchiodilators and instructions to go the emergency room if the symptoms got any worse. The next few days were a rite of passage for both of us as I tried to keep my cool while hovering over a very sick baby.

The protocol for managing RSV has changed over past decades. Steroids and albuterol (drugs used to decrease inflammation and open up the bronchioles in the lungs) are no longer given. Now children with severe cases are admitted to the hospital and treated with fluids and high flow oxygen while the body inevitably clears the virus.

Every few years the virus moves through my town and at least a few of the infants and young children in my practice are hospitalized with severe cases. I am not cavalier about RSV.

RSV is an illness with very high morbidity, meaning a large percentage of children with the condition will need hospitalization, but relatively low mortality, meaning a very small percentage of children with the virus will die. During bad RSV years, our local hospital system is severely strained by large numbers of small children needing inpatient care for their severe symptoms. In my town, I have seen RSV overload the hospitals to the point of ER hallways lined with children on oxygen, single hospital rooms split into triples to accommodate the huge number of admissions, and cancellation of elective adult surgeries because children are being cared for on adult units as the system overflows with wheezing, gasping kids.

It would be great if we had a safe and effective way to prevent RSV from ravaging our communities every three to five years. But we don't. Instead we have another risky gamble with the health of pregnant women and infants that will further enrich Big Pharma and increase the already abysmally high rate of preterm birth in the United States.

Abrysvo, a new mRNA vaccine manufactured by Pfizer, has been approved for use during pregnancy to prevent RSV in infants. The relatively small studies done on the vaccine (fewer than 5500 women participated) showed a moderate decrease in severe cases of RSV in infants born to the mothers who took the new drug compared to the placebo group. Many children of the mothers who took the drug still developed severe RSV, so the experimental injection does not appear to come anywhere close to fully preventing RSV.

Somehow over the past four years, society has stopped expecting vaccines to actually prevent illnesses. Now we are told that vaccines were never designed to prevent disease, just to lower the number and severity of cases. Interestingly, my patients who receive the old-school vaccinations (you know, the immunizations given in the 1970s through 1990s) aren’t developing breakthrough cases of polio and measles, or even chicken pox. That’s because those old vaccines actually work at preventing disease. Now we receive and regurgitate propaganda that vaccines were only ever intended to decrease the severity of illness. So probably no one will care that the new RSV vaccine does not prevent RSV.

We have no data on the long term effects of this new medication on children, or their mothers who have been injected with it. But what we do have is a signal showing that mothers who received the mRNA vaccine for RSV were significantly more likely to give birth to premature infants than those who received the placebo.

Prematurity carries greater short and long term health risks to children than RSV. Regulators at the CDC recognize that Abryso is linked to prematurity and because of this have only approved the drug for women who are at least 32 weeks pregnant in order to lower the risk of severe prematurity. Full term babies are born between 37 and 42 weeks, babies born before 32 weeks are considered severely premature, from 32 to 34 weeks infants are considered moderately premature, and from 34 to 36.5 weeks babies are considered preterm.

I am grateful that Pfizer and the CDC do not want to risk increasing the number of babies born before 32 weeks. Severely premature infants and their parents suffer immensely.

But being born between 32 and 36.5 weeks gestation also has lifelong negative effects. These babies are significantly more likely to die in the first year of life from all cause mortality (including RSV, for which they will be only partially protected according to the results of the study on the vaccine). They are more likely to have learning disabilities and behavioral disorders, which affect not only their quality of life but also the lives of their family members and the lives of everyone who interacts with them. As they age, they are more likely to develop heart disease, diabetes and high blood pressure than people who were born at term.

In addition to the known risk of prematurity, there may be other negative effects of injecting pregnant women with this new mRNA vaccine. mRNA technology, where artificial genetically engineered messenger RNA is injected into the body to trick the cellular DNA into manufacturing proteins, was first approved for human use in 2020. Anyone who tells you that this technology has no long-term negative consequences is either lying or somehow has access to a time machine. No one has any idea how mRNA injections during pregnancy (or childhood and adulthood) affect humans in the long term. Remember that it took over 30 years for scientists to figure out that giving the drug DES to pregnant women to prevent miscarriage was causing cancers and reproductive tract anomalies in the children exposed to it in utero.

Even though RSV has me shaking in my boots every few years as I am arranging transport to the hospital for very sick children in my care, I cannot recommend that mothers risk taking this new injectable technology. We have no idea the extent of the new problems we may be creating with this new drug, and so far the data shows the risks do not justify the perceived benefit.