Decision-Making About Respiratory Syncytial Virus Immunization for Infants: Qualitative Interview Study

Respiratory syncytial virus (RSV) is the leading cause of infant hospitalization in the United States. Although maternal RSV vaccination and infant RSV monoclonal antibody products are recommended to protect infants during their first RSV season, uptake has remained modest. Understanding how pregnant individuals make decisions about these products is critical for informing strategies that support timely immunization.

The study aimed to examine the behavioral and social drivers shaping decisions regarding RSV vaccination during pregnancy and infant RSV monoclonal antibody immunization among pregnant individuals in the United States.

We conducted an exploratory qualitative study from a relativist epistemological perspective, using semistructured interviews with 12 pregnant and postpartum adults recruited across the United States between October 2024 and May 2025. Participants were purposively sampled to include individuals with positive, uncertain, and negative intentions toward RSV vaccination. Interviews were guided by the World Health Organization's behavioral and social drivers of vaccination framework and analyzed using a framework analysis approach. Screening survey data were summarized descriptively to characterize participant immunization intentions and contextualize the qualitative findings.

RSV immunization decisions reflected interacting behavioral, emotional, social, and practical influences rather than attitudes alone. Participants with positive vaccination intentions described greater trust in medical expertise, confidence in vaccination, and personal or professional experience with RSV illness. Those with unsure or negative intentions emphasized the novelty of RSV vaccines, concerns about safety and long-term effects, and greater reliance on clinician recommendations and peer experiences when making decisions. Across intention groups, participants expressed a preference for receiving protection during pregnancy rather than after birth but reported uncertainty related to vaccine availability, timing within the 32- to 36-week eligibility window, and inconsistent integration into prenatal care. Participants consistently identified trusted clinician communication, opportunities for early discussion, and access to clear educational materials as important influences on decision-making.

Decisions regarding RSV immunization during pregnancy are shaped by interconnected motivational, interpersonal, and structural factors. Integrating education on RSV and RSV immunization options earlier in prenatal care, strengthening clinician recommendations, and reducing logistical barriers to maternal vaccination may improve informed decision-making and timely uptake of infant RSV protection.