Into a hopeful era against infant respiratory infection

August 9, 2018 by Deborah Atherly and Cyril Engmann, MD, FAAP, FAPS

A new resource sheds light on what’s needed to get ready for a new vaccine that, if approved, could help pregnant mothers protect their babies from a common cause of serious respiratory infections—respiratory syncytial virus.

Mother holding young infant. Photo: PATH/Georgina Goodwin

Respiratory syncytial virus causes particularly dangerous respiratory infections in young infants. The answer to protecting these babies may lie with mom’s antibodies and vaccines in development. Photo: PATH/Georgina Goodwin.

What do smallpox, polio, and malaria all have in common? At one time or another, they all seemed insurmountable. But, the global health community banded together, worked the problem, and brought about change. Now, these diseases are respectively gone from the earth, nearing eradication, or being addressed more aggressively than ever. They also represent some of the many global health achievements that crossed the threshold from hopeless to hopeful.

Today, our eye is on another ‘crossing’ that may be on the horizon—protecting infants from respiratory syncytial virus (RSV). This virus sickens more than 30 million children each year globally and kills 120,000, mainly infants under six months old. For low-income families, RSV can also mean substantial hardship due to medical costs and lost livelihoods while caring for the sick. Mild cases can look like a cold, but infants are prone to dangerous complications like inflamed airways (bronchiolitis) and lung infection (pneumonia) that make breathing difficult. Though no RSV vaccine yet exists, several are being developed and the first could be approved within the next few years. The leading vaccine is designed to be given during pregnancy (maternal immunization) to give moms immunity that they can then pass to their babies for protection in the early, most vulnerable, months of life. It’s an approach also used against diseases like maternal and newborn tetanus, influenza, and pertussis.

Although RSV is potentially on deck to transition from widespread threat to widely preventable, the way forward isn’t yet fully charted. How a maternal RSV vaccine will get from development to routine delivery in low- and middle-income countries (LMICs) (where almost all RSV deaths occur) needs to be figured out as soon as possible.

Time to get to work.

An analysis recently released by the Advancing Maternal Immunization (AMI) collaboration is meant to help the global health community do just that.

Piecing the puzzle together

Imagine a partially completed jigsaw puzzle. Large gaps might seem insurmountable until you start identifying the missing pieces and fitting them together one by one.

Developed by more than 65 diverse experts from across the world’s immunization and maternal, newborn, child health (MNCH) sectors and coordinated by PATH and the World Health Organization, AMI’s analysis takes that next step into mapping a baseline view of which puzzle pieces we already have in place and which ones we don’t. It identifies the gaps in the information and conditions needed to support maternal RSV vaccine decision-making and delivery. Using the report as a guide, researchers, policymakers, funders, advocates, healthcare implementers, and other stakeholders can more easily gauge where to plug in to fill in the gaps and ultimately complete the puzzle.

“AMI’s analysis takes that next step into mapping a baseline view of which puzzle pieces we already have in place and which ones we don’t.”

What did we learn?

The analysis looks at what we know and don’t know around topics like RSV’s disease burden; maternal RSV vaccine performance; costs and other economic factors; RSV vaccine policy and demand needs; and implementation considerations across LMIC immunization and MNCH programs. And, as expected, several themes rise to the surface.

Stakeholder awareness and perceptions of RSV and maternal immunization will drive decision-making around introduction, acceptability, and uptake in LMICs. Some experts observe, however, that RSV remains largely unrecognized, particularly in countries and communities. Gaining a better understanding of awareness and perceptions is essential. So is developing context-appropriate strategies for communicating information that improves awareness and generates demand among key stakeholders like pregnant women, families, healthcare workers, policymakers, community leaders, and others.

Understanding what normal pregnancy complication rates are in LMICs prior to RSV vaccine introduction is important, as is establishing sites that track maternal immunization safety after introduction.

Delivery strategies tailored to country context are needed and will likely require coordination between immunization and MNCH stakeholders. As such, the way that countries deliver immunization and/or antenatal care services may need adjusting and sustainable financing mechanisms will need to be identified to ensure that vaccine access and delivery can be achieved.

These are just some of the findings. Many more details can be found in the full report.

Pregnant women in African sit side by side. Photo: PATH/Evelyn Hockstein.

Vaccines are in development that may help pregnant women pass immunity against respiratory syncytial virus to their infants by getting immunized themselves. Photo: PATH/Evelyn Hockstein.

What’s next?

Indeed, AMI’s gap analysis is a valuable step toward helping stakeholders home in on gaps remaining to be filled to get ready for maternal RSV vaccine introduction. But now we need to fill those gaps with research, discussion, planning, and action. The work we all do now to advance maternal RSV vaccine may also pay off against other diseases and inform a broader platform for maternal immunization. Such a platform, if established, could leverage resources to counter multiple diseases at once, including those with existing maternal vaccines as well as others with vaccines potentially in the future like Group B Streptoccocus.

“If you think you’re well positioned to fill in pieces of the RSV maternal immunization puzzle, now is as good a time as any to get started.”

A lot of the needed work is already underway through a variety of organizations and researchers, so progress is in motion. Additional efforts, however, are also urgently needed to tackle priorities not yet being addressed. The next item on AMI’s to-do list is to develop a roadmap that outlines priority next steps based on the findings from the gap analysis, which should help provide some concrete ideas.

This may all beg the question, “How can I help?” If you think you’re well positioned to fill in pieces of the RSV maternal immunization puzzle, now is as good a time as any to get started. Like with any other global health achievement, we have an opportunity to put in the work early and springboard into an even more hopeful era—one where infants breathe easier and mothers breathe a sigh of relief.

Additional resources