This past winter, many parents became aware of respiratory syncytial virus (RSV) for the first time. An especially severe RSV season in the United States packed children’s hospitals and caught parents by surprise, much as COVID had the previous year. New preventative tools for both of these diseases could help to significantly reduce the public health burden of seasonal respiratory viruses. But, once again, health systems must bridge the gap between innovation and uptake.
Voices for Vaccines, a program of the Task Force for Global Health, has spent much of the past year reaching out to families hard hit by RSV, a viral respiratory disease that hospitalizes about 69,000 children each year, in addition to between 60,000-160,000 older adults. Though the symptoms often resemble those of a cold, it remains a leading cause of pneumonia in infants.
The US FDA approved three tools to combat RSV just this year: vaccines for pregnant women and seniors, and a monoclonal antibody called Beyfortus to be given to children in the first year of life. All were subsequently recommended by the CDC. With high uptake, Beyfortus could prevent some of the worst harms of RSV in infants. First-person accounts from parents can help others who may be hesitant to use it.
One mother of a six-week-old child illustrates why this is important. “RSV was not something I had even heard of. I thought it was just a bad cold,” she wrote, following her daughter’s bout with RSV that turned into a trip to the Pediatric Intensive Care Unit. She added that “before this happened, I probably would have declined a vaccine or preventative treatment.”
Misconceptions that childhood diseases are benign, from influenza to polio and others, are a major barrier to vaccination. Parents who hold those beliefs may be skeptical of traditional public health messaging, but hearing stories from other parents can highlight both the personal and public consequences of illness.
One mom wrote about taking her toddler to two different ERs, “packed wall-to-wall with coughing kids” just like her own. Another, who works as a pediatrician, saw her son admitted at the hospital where she works: “It was full of children with RSV. I had cared for many of them in the days prior.”
Despite the risk of RSV, it remains an open question as to whether or not seniors will get vaccinated. And pediatric vaccination rates for COVID, a disease of comparable impact in kids,still lag far behind the target for adequate protection.
The stories on the Voices for Vaccine site aim to reach parents to help reduce the impact of RSV. They are honest about how difficult severe disease can be. The authors put themselves in the shoes of the reader to tell a cautionary tale.
“I never imagined that we would still be dealing with the repercussions [of RSV] more than a year and a half later,” wrote one parent. Her infant son developed breathing issues following hospitalization, which may be more common with RSV.
Another mom shared the most vulnerable details of her experience, including how she was prescribed medication to prevent nightmares about her son’s hospitalization. “It is my greatest hope,” she continues, “that there is one day a vaccine for RSV to protect children and families everywhere.”
Her story was shared just months before the FDA approved a monoclonal antibody, Beyfortus, designed to prevent RSV infection when babies are most vulnerable. It is now recommended for all children in their first year of life, and made freely available for those without insurance through the Vaccines for Children program. This federally funded program purchases vaccines (and now antibodies) and provides them at no cost through certain providers.
This is the first year of the U.S. nationwide roll-out of Beyfortus. Time will tell how effective the outreach has been, and how much more needs to be done to limit the impacts of a newly preventable disease.
Meanwhile, an equitable approach to prevention must also center the global impacts of RSV. The same disease that is a leading cause of hospitalization for young children in the US is a leading cause of death for children worldwide. Yet tools to prevent it could take years to reach low- and middle-income countries, as more cost-effective options are still in development.
RSV is quite dangerous if not promptly treated. One mom shares how the situation deteriorated from her caring for a sniffling child to being asked if she had a will prepared. Thankfully her son survived, but he might not have without emergency care. “Many children do very well,” said Dr. Bill Schaffner, a scientific advisor for VFV, “but deaths due to RSV can become very common if that’s not available.”
Schaffner added: “There are data to suggest childhood RSV infections may predispose to asthma, which causes a lot of disability.” The long-term care this requires may not always be accessible in low-income settings even if a child survives.
Task Force programs seeking to expand access to COVID and influenza vaccination, which still lag behind in many parts of the world, build the capacity and confidence to deliver many kinds of vaccines. The roll-out of RSV antibodies and vaccines in the U.S. will hopefully be followed by increasing access in the global south.
Certainly, parents who have felt the burden of RSV hope to see it reduced for others around the world. As mom Leslie Cook wrote for VFV: “If a vaccine can help prevent even one family from experiencing what we did and still do, it will be invaluable.”