Respiratory syncytial virus prevention in infants and equity in Latin America and the Caribbean: from evidence to action

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract illness in infants worldwide, responsible for more than 100,000 deaths annually in children under five, most of them in low-and middle-income countries. 1In Latin America and the Caribbean (LAC), where the majority of disease likely occurs in the community, RSV-associated bronchiolitis and pneumonia are also important causes of pediatric hospitalization, indication for oxygen therapy, and admission to intensive care units. 2 The burden of morbidity and mortality is highest among the most vulnerable: preterm infants, children with underlying chronic diseases or altered immunity, and those living in disadvantaged or remote areas. [1][2]][3] The recent availability of two highly effective prophylactic strategies, maternal vaccination during pregnancy (RSVpreF bivalent vaccine) and long-acting monoclonal antibodies (nirsevimab and clesrovimab) administered to infants from birth through the first months of life, represents a historic opportunity to prevent severe RSV disease in the region. [4][5]5][6] However, their implementation must be framed within the principles of the children's right to health and guided by a strong commitment to equity and health justice.LAC is becoming a reference region for RSV prevention, with countries adopting diverse strategies adapted to local contexts.Chile implemented a universal approach with monoclonal antibodies, protecting all newborns with a dose at birth, infants under six months of age as a catch-up dose, and high-risk children up to two years of age, with clear public health impact and broad community acceptance. 5Argentina prioritized maternal vaccination as its main strategy, showing effectiveness in preventing hospitalizations and severe disease consistent with the efficacy reported in prelicensure clinical trials and a more modest effect on healthcare utilization. 4Paraguay introduced monoclonal antibodies at birth and in the first months of life