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RSV ready? Exploring feasibility and acceptability of RSV immunization options in low- and middle-income countries
Manjari Quintanar-Solares1, Jessica A Fleming1, Wilkister Musau2
1PATH; 437 N 34th Street, Seattle, WA 98103, USA.
Insights
Stakeholders in Kenya, Nepal, and Peru found maternal and infant respiratory syncytial virus (RSV) immunization acceptable and feasible. Integrating these products into existing health programs is key for policy planning in low- and middle-income countries.
Area of Science:
- Global Health
- Vaccinology
- Pediatric Infectious Diseases
Background:
- Respiratory syncytial virus (RSV) is a major cause of infant pneumonia mortality, particularly in low- and middle-income countries (LMICs).
- The World Health Organization recommends two new RSV preventive products: a maternal vaccine and an infant monoclonal antibody (mAb).
- Understanding the acceptability and programmatic feasibility of these products is crucial for LMIC policy and implementation.
Purpose of the Study:
- To assess stakeholder perceptions of the operational feasibility and acceptability of maternal and infant RSV immunization options in LMICs.
- To explore stakeholder preferences for implementing RSV prevention strategies.
Main Methods:
- A formative study was conducted in Kenya, Nepal, and Peru from June to September 2024.
- Semi-structured interviews were held with 69 stakeholders at national, district, and health center levels.
- Interviews focused on maternal and infant RSV immunization feasibility, acceptability, and implementation preferences.
Main Results:
- Stakeholders broadly supported both maternal vaccination and infant mAb immunization as feasible and acceptable.
- Nepal stakeholders favored maternal vaccination; Kenya and Peru showed mixed views, citing concerns like vaccine hesitancy and access.
- Infant mAbs were seen as compatible with existing platforms, but cost and misconceptions were noted. Year-round immunization was preferred.
Conclusions:
- Both maternal and infant RSV immunization options are acceptable and feasible for integration into existing public health programs.
- Country-specific factors like community acceptance, health system capacity, data availability, and affordability are critical for introduction decisions.
- Findings can guide policymakers in preparing for the introduction and scale-up of RSV prevention products.
Background:
Respiratory syncytial virus (RSV) is the leading cause of pneumonia-related mortality in infants younger than 6 months, with the majority of deaths occurring in low- and middle-income countries (LMICs). Two RSV preventive products-a maternal vaccine and a long-acting monoclonal antibody (mAb) for infants-were recently recommended by the World Health Organization. Understanding the acceptability and programmatic feasibility of delivering these products is essential for policy and implementation planning in LMICs.
Methods:
PATH conducted a formative study in Kenya, Nepal, and Peru (June-September 2024). Semi-structured interviews were held with 69 stakeholders at national, district, and health center levels, selected for their experience in maternal health and/or immunization programs. Interviews explored perceptions of operational feasibility and acceptability of maternal and infant RSV immunization options, and stakeholder preferences for implementation.
Results:
Stakeholders across all three countries broadly supported the feasibility and acceptability of both maternal RSV vaccination and infant mAb immunization. Stakeholders in Nepal favored maternal vaccination, citing reduced burden on infants and the ability to reach babies born outside health facilities. Views in Kenya and Peru were mixed: maternal vaccination was seen as acceptable by most, but stakeholders raised concerns regarding vaccine hesitancy and limited antenatal care access, particularly in rural areas. Infant mAbs were viewed as compatible with existing at-birth immunization platforms, but concerns included injection burden, cost, and misconceptions regarding use being limited to high-risk populations. Stakeholders expressed a strong preference for year-round immunization over seasonal campaigns.
Conclusions:
Both maternal and infant RSV immunization options were viewed as acceptable and feasible if integrated into existing public health programs. Introduction decisions will require additional country-specific considerations, including community acceptability of option(s), health system/workforce capacity, availability of relevant epidemiology data, and product affordability. These findings can guide policymakers as they prepare for potential RSV prevention product introduction and scale-up.
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