RSV ready? Exploring feasibility and acceptability of RSV immunization options in low- and middle-income countries

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.