A Child Killer Meets Its Match

By Keith Klugman

Keith Klugman is Director of the Pneumonia program at the Bill & Melinda Gates Foundation.

SEATTLE – Like many others, I spent much of the last few years in isolation to avoid getting sick. And now we are learning that this widespread disappearing act produced some unexpected side effects. In particular, infections from once-common illnesses – like influenza and Respiratory Syncytial Virus (RSV) – plummeted.

But now, as much of the world has returned to its normal pre-pandemic rhythms, that brief respite is over. RSV, a dangerous infection that kills more than 100,000 young children each year, has returned with a vengeance. Several countries, including South Africa and Australia, have recorded major RSV outbreaks, and hospitals in the United States are filled with babies who are struggling to breathe.

The alarming uptick in RSV cases bodes ill for the winter months in the northern hemisphere, especially with an expected bad flu season. Yet while RSV can result in serious illness, like pneumonia, for very young children everywhere, it is rarely fatal in high-income countries like the US. Over 97% of deaths due to RSV occur in low- and middle-income countries – a glaring disparity that has made the disease one of the leading killers of newborns and young children in these countries.

Fortunately, new technological developments on the horizon may soon mitigate the threat posed by RSV. Promising advances in maternal immunization – vaccinating pregnant women to confer lifesaving protection on their babies – have the potential to save thousands of lives each year, and an effective RSV vaccine is finally in sight. Maternal immunization has been safely and effectively used for decades to protect newborns from other infectious diseases, including whooping cough and tetanus. If approved, this would be the first vaccine ever to protect children against RSV.

Although most RSV infections are mild, the virus can be much more severe in the youngest patients and can lead to pneumonia, which kills more children than any other infectious disease. Moreover, there are no drugs to treat RSV. For severe cases, medical oxygen is administered in a hospital to help babies breathe until the infection clears. But that, of course, assumes that they can get to a hospital with oxygen. For infants in parts of lower-income countries where hospital care or oxygen is out of reach, this common childhood illness can quickly become deadly. It is in these settings that an RSV vaccine has the greatest potential to save lives and spare families from crushing grief.

The Bill & Melinda Gates Foundation has supported efforts to advance the field of maternal immunization for 15 years, funding research and development for maternal vaccines against influenza, whooping cough, other newborn bloodstream infections, and RSV and Group B Streptococcus (GBS). Our most recent investment in maternal RSV vaccines is focused on improving affordability and access for lower-income countries. This is crucial for giving infants in these countries the best chance at life.

While the vaccine is still in development, I am hopeful that, if it is successful and gains regulatory approval, it will start to be rolled out – through Gavi, the Vaccine Alliance – in low- and middle-income countries as early as 2024. Quick and equitable access to this lifesaving vaccine in countries where RSV remains a major killer will have a real impact on reducing childhood illness and death around the world.

Yes, a successful rollout also depends on whether a vaccine is acceptable and taken up by local communities. But as matters stand, I am optimistic that it will be. Research has shown that pregnant mothers are more likely to receive a vaccine to protect their babies before birth than they are to protect themselves. Moreover, studies have found that if you can protect against RSV in the first few months of life, you can likely protect against other future respiratory infections, including pneumonia.

RSV is not a new problem. Pediatricians and many parents have long dreaded this illness, and for good reason. But we are on the cusp of finally developing and deploying the tools we need to protect infants when – and where – they are most vulnerable. We should all continue working toward a future where children – regardless of where they are born – can grow up to live full, healthy lives, safe from the dangers of RSV and childhood pneumonia. By ensuring equal access to these lifesaving vaccines, we can make that future a reality.