Use of Nirsevimab for Respiratory Syncytial Virus (RSV) prevention in India: current status and way forward

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections, hospitalisation and deaths among infants and young children globally.The burden is disproportionately high in lower and middle income countries, including India.Nirsevimab , a long acting monoclonal antibody, administered as a single dose, has demonstrated high effectiveness in preventing severe RSV disease and RSV-related hospitalisation in many high income countries.It is aligned with World Health Organization recommendations and has recently received marketing approval from the Central Drugs Standard Control Organization (CDSCO), India.However, its uptake in clinical practice in India is limited.Key barriers include the absence of national clinical or programmatic guidelines, limited national RSV surveillance data, high product cost, and operational and equity challenges within the health system.This narrative review summarises the epidemiological burden of RSV in India, including mortality, age and gestation-specific risk, and regional variation in seasonality.We discuss the strengths (S), weaknesses (W), opportunities (O) and challenges (C) related to introduction of Nirsevimab in India.We also discuss the current regulatory and policy landscape for Nirsevimab introduction on a large scale.We describe the strategic steps that can be taken going forward.Critical next steps include strengthening RSV surveillance, generating India-specific real world evidence and cost-effectiveness data, engaging policymakers and professional bodies, and exploring strategies to improve affordability and access.Strategic adoption of Nirsevimab into the health system of India has the potential to substantially reduce RSV-related morbidity and mortality among infants in India.