An implementation framework for planning an RSV immunization program for infants using the long-acting monoclonal...

Area of Science:

• Pediatric infectious diseases
• Vaccinology
• Health systems strengthening

Background:

• Respiratory syncytial virus (RSV) causes significant global childhood hospitalizations, particularly in infants under one year.
• While most infections are mild, RSV can lead to severe lower respiratory tract infections (LRTIs) like bronchiolitis and pneumonia.
• Two new immunizations, a maternal vaccine (RSVpreF) and a long-acting monoclonal antibody (mAb) (nirsevimab), aim to protect infants from severe RSV disease.

Purpose of the Study:

• To present a framework for evidence-based planning of long-acting mAb immunization programs for RSV prevention.
• To guide health systems in the preparation and implementation of widespread nirsevimab delivery.
• To offer a tool for improving ongoing implementation in countries where programs have already started.

Main Methods:

• Development of a framework based on a pragmatic literature review.
• Incorporation of authors' perspectives and early implementation experiences.
• Organization of the framework into five domains aligned with WHO health system building blocks.

Main Results:

• The framework addresses key implementation areas: governance, funding, demand, service delivery, and monitoring.
• It provides a structured approach to planning for the novel strategy of universal long-acting mAb use.
• Examples of considerations within each domain are provided to facilitate practical application.

Conclusions:

• Effective planning is crucial for the successful implementation of novel immunization strategies like long-acting mAbs for RSV.
• The proposed framework offers a comprehensive guide for health systems to prepare for and optimize RSV immunization programs.
• This structured approach supports the goal of protecting all infants from severe RSV-related illness.