New RSV Vaccines Show Promise, But Global Implementation Challenges Remain

The fight against respiratory syncytial virus (RSV) has reached a pivotal moment with the approval of several effective vaccines and treatments, but challenges in global implementation and uptake persist, according to an editorial published in The Lancet Respiratory Medicine.

Recent clinical trials have demonstrated the efficacy of new RSV vaccines and monoclonal antibodies in protecting vulnerable populations. The CDC recommends a bivalent prefusion F vaccine (RSVpreF) for pregnant women at 32-36 weeks to protect infants from severe RSV-associated lower respiratory tract infections. Additionally, nirsevimab, a monoclonal antibody, has been approved for infants under 12 months entering their first RSV season.

For adults over 60, both RSVpreF and RSVPreF3 OA have received FDA approval. They show effectiveness in reducing RSV-associated lower respiratory tract infections. Countries like the UK and Canada have also approved these vaccines for use.

However, vaccine uptake in the United States has been low. As of May 2024, only 24.4% of adults over 60 were vaccinated against RSV, with an additional 10.7% planning to get vaccinated. Among pregnant women, the coverage was just 17.8%. Factors contributing to low uptake include poor knowledge about the vaccine, safety concerns, and a lack of discussions with health care providers.

Experts emphasize the need for formal vaccination plans, patient education, and health promotion to improve uptake rates. Real-world studies of vaccine effectiveness will be crucial to monitor outcomes and potential changes in RSV epidemiology.

The World Health Organization is developing a global surveillance system for RSV to identify at-risk groups and evaluate vaccine impact. Researchers are also working on tools to predict RSV infection risk in newborns, which could help allocate resources more effectively.

While progress has been significant, ensuring equitable access to these new interventions remains challenging. Many newly approved vaccines are likely unaffordable for low- and middle-income countries, highlighting the need for affordable RSV interventions prioritizing global results over profit.

As the world enters this new era of RSV prevention, the focus now shifts to monitoring vaccine delivery programs and using real-world data to guide decision-making and achieve worldwide reductions in RSV-related morbidity and mortality.

Reference
The Lancet Respiratory Medicine. Respiratory syncytial virus vaccines: the future is bright. Lancet Respir Med. 2024;12(7):499. doi:10.1016/S2213-2600(24)00184-X