Taxonomy of the Full Health and Societal Value of Maternal Vaccination to Prevent Infant Respiratory Syncytial Virus Disease

We provide a taxonomy of the full health and societal value of maternal vaccination (MV) to prevent infant respiratory syncytial virus (RSV) disease. RSV is the leading cause of acute lower respiratory tract infections in infants and young children. Most children are infected by RSV before age one, and by age two, infection is nearly universal. Most cases are mild, but some are severe and can result in hospitalization, death, or long-term complications. RSV disease burdens have global scope but are typically higher in low- and middle-income countries. Globally, most severe cases occur among term and previously healthy infants, making RSV prevention in all infants a public health priority. Preventing infant RSV requires reliance on passive rather than active immunity. One recently developed passive immunization is RSVpreF, which has been found to be efficacious and to have an overall favorable safety profile, and which national immunization authorities will soon consider for inclusion in immunization schedules. Essential to realizing MV's potential contribution to this global public health priority are optimal coverage decisions by vaccine payers, informed by accurate value-for-money (VfM) assessments. To support VfM assessments and optimal coverage decisions, we formulate a taxonomy of the values promoted by MV. This taxonomy distinguishes between narrow health benefits and broader socioeconomic benefits. It distinguishes among benefits to infants; the mother, parents, caregivers, and household members; the health system; and the broader population, society, and government. Value elements include infant health (including from reduced mortality, severe disease, and long-term complications), reduced health system costs, reduced caregiver burdens, financial risk protection, parental peace of mind, averted parental bereavement, process utility from transference of injection burdens and risks from infant to mother, health and socioeconomic equity, antimicrobial resistance reduction from averted inappropriate antibiotic use, potential enhanced education from reduced long-term sequelae, and potential herd effects.