Like the common cold, respiratory syncytial virus (RSV) is highly contagious. It is spread through airborne respiratory droplets and contact with contaminated surfaces. RSV infection is often difficult to distinguish from the common cold because it has similar symptoms and typically clears up without medical intervention.
However, in some cases, it can become serious enough to need medical care or even a hospital stay, especially for babies under six months, who are most vulnerable. Severe illness typically affects the lower respiratory tract and can lead to bronchiolitis or pneumonia, which can cause difficulty breathing. Babies who are hospitalised may need extra help, such as oxygen to help them breathe, fluids through a drip to keep them hydrated and, in serious cases, a machine to help them breathe.
RSV is a major cause of illness and death in children under five, especially in the first six months of life, in low- and middle-income countries. A recent global study estimated that in 2019, RSV was responsible for just over 100,000 deaths in children under five. This made up 2% of all deaths in this age group, and 3.6% of deaths in babies aged 28 days to six months. Nearly half of all RSV-related deaths occurred in babies under six months, and 97% of these deaths were in low- and middle-income countries.
A new vaccine to prevent RSV in infants
A new vaccine provides infants with significant protection against severe RSV disease. It is given to pregnant women some time during their third trimester of pregnancy (from week 28 to birth). Protective antibodies elicited by the vaccine are transferred from the mother to the foetus across the placenta.
Currently, only one pharmaceutical company, Pfizer, markets the maternal RSV vaccine. It is sold under the brand name Abrysvo. It is also known by the generic name RSVpreF. The South African Health Products Regulatory Authority approved Abrysvo in December 2024, and it became available in the private sector in 2025.
The effectiveness of the vaccine in preventing severe RSV disease was first announced in November 2022. This followed early positive results from the Maternal Immunisation Study for Safety and Efficacy that was conducted in 18 countries, including South Africa. It showed that infants born to mothers who received the maternal RSV vaccine had an 82.4% lower risk of developing severe RSV-associated lower respiratory tract illness within the first 90 days of life, compared with infants whose mothers received a placebo. At 180 days after birth, the vaccine was 70% effective in reducing the risk of severe RSV illness.
A comprehensive implementation guideline will be needed to address areas such as monitoring and evaluation, supply chain capacity, health-care worker training, and demand creation
— Foster Mohale
Recommendations from health agencies
In September 2023, the US Centers for Disease Control & Prevention recommended giving the RSV vaccine to pregnant women to help protect their babies from severe illness.
One year later, in September 2024, the World Health Organisation (WHO) recommended that all countries introduce the maternal RSV vaccine. It also recommended an alternative for babies whose mothers weren’t vaccinated: a single dose of the monoclonal antibody nirsevimab, ideally given at birth or before discharge from the birthing facility. While acknowledging cost limitations, the WHO noted that if not given at birth, the antibody can be given at the baby’s first health visit. In countries offering it only during RSV season, older infants can receive the dose just before their first season begins. Nirsevimab is not yet registered in South Africa and cost is expected to be a barrier to its rollout in the country.
South Africa has not yet adopted formal guidelines for the broad use of the maternal RSV vaccine. But the National Advisory Group on Immunisations (Nagi) recently recommended that the national department of health introduce the RSVpreF vaccine in the public immunisation programme as a single-dose vaccination for all pregnant women. This recommendation was outlined in a letter to health minister Aaron Motsoaledi on April 23.
Health department spokesperson Foster Mohale tells Spotlight: “In line with the Nagi terms of reference which govern the committee’s work, the department is assessing the cost and other implications of RSV vaccine introduction with relevant senior managers and other stakeholders. Feedback will be provided to the Nagi chairperson once a decision regarding possible introduction has been reached.”
Price remains a barrier
Pfizer is selling Abrysvo in South Africa as a single-dose vaccine, priced around R3,746, excluding VAT and dispensing fees. This price for the private sector is significantly higher than the government’s threshold for broad rollout, according to a cost-effectiveness analysis of RSV immunisation.
The analysis found that at $5 (about R90) per dose, the vaccine would offer savings to South Africa’s health sector. But if the price exceeds $40 (about R700) per dose, widespread procurement may no longer be feasible.
Pfizer’s pricing of Abrysvo in South Africa’s private sector is “disappointingly high”, Shabir Madhi, professor of vaccinology at Wits University, tells Spotlight. He believes “something has gone awry in terms of pricing of the vaccine in South Africa”.
He points out that the Pan American Health Organization (PAHO), which works to improve the health and quality of life of populations in the Americas, secured a price of $49 (about R800) per dose for procurement of the vaccine for use in Latin American countries. “It does tell us that the cost of producing a vaccine is nowhere close to $200 if the same vaccine is being provided at $49 to PAHO,” Madhi says.
Pfizer did not answer questions from Spotlight about whether a lower price would be offered to the public sector, but a company spokesperson says: “We are committed to working with the government and health-care stakeholders to ensure our medicines and vaccines are available to all those who need them in South Africa.”
Mohale says: “There has been engagement with Pfizer, and they have indicated that the [public sector] price of the maternal RSV vaccine is likely to align with current PAHO pricing.”
Apart from pricing, introducing the maternal RSV vaccine involves several other health system considerations, he says.
“A comprehensive implementation guideline will be needed to address areas such as monitoring and evaluation, supply chain capacity, health-care worker training, and demand creation to ensure effective and sustainable rollout.”
Madhi adds that fortunately, South Africa, unlike some other countries, already has established vaccine programmes for pregnant women.
“We’ve been vaccinating pregnant women with the tetanus vaccine for decades now, and last year we introduced the acellular pertussis, tetanus, diphtheria combination vaccine for pregnant women,” he says.
This article was first published by Spotlight — health journalism in the public interest. Sign up for the Spotlight newsletter.
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