A Lifeline for Infants: Gavi’s Push to End RSV Deaths in Low-Income Countries
- FHS Communications
(How Gavi support for RSV immunisation will advance health equity)
Every year, millions of young children around the world are infected by the respiratory syncytial virus (RSV), a common virus that can cause severe lung infections. Tragically, more than 100,000 of these children under five years die each year, with 97% happening in low-and middle-income countries where access to healthcare is limited. RSV also puts children at a higher risk of contracting bacterial pneumonia. Babies younger than six months are especially vulnerable, making maternal immunisation a promising approach to reducing the burden of infant morbidity and mortality due to RSV in the first few months of life.
Gavi’s Life-Saving Mission
Gavi, the Vaccine Alliance, is an international partnership that is driven by a mission to improve access to life-saving vaccines for children in the world’s poorest countries. Gavi’s support for RSV prevention strategies, including maternal vaccines and long-acting monoclonal antibodies, can keep many infants safe from severe illness and death. These powerful tools, the RSVpreF maternal vaccine and the RSV monoclonal antibody nirsevimab, have already been rolled out in wealthier countries, demonstrating a significant public health impact and highlighting the life-saving impact of these interventions.
Why LMICs Are Left Behind
Associate Professor Michelle Groome, Wits VIDA Principal Researcher and technical lead of the Maternal Immunisation Readiness Network in Africa and Asia (MIRNA), says that the costs of these new interventions are prohibitive in LMICs. In 2018, Gavi had already identified RSV as a priority for vaccine support, contingent on factors such as product licensure, WHO prequalification, a recommendation from the WHO Strategic Advisory Group of Experts (SAGE), financial feasibility, and the availability of funds. Delays in introducing these interventions mean that many young lives are not being saved.
Turning the Tide
“Several important milestones have now been reached. In 2024, SAGE [WHO Strategic Advisory Group of Experts] recommended that all countries introduce products for the prevention of severe RSV disease in infants,” notes Groome.
The RSVpreF vaccine is available as a single-dose vial, which was WHO prequalified as the first maternal respiratory syncytial virus vaccine in March 2025; multidose vials are expected by 2026, improving affordability for LMICs.
Health System Relief and Broader Impact
The introduction of RSV vaccines will free up health systems in LMICs, helping clinics and hospitals deliver better care overall and reduce respiratory disease mortality. However, political and financial pressures in high-income countries threaten global immunisation funding. “Reductions in financial support for Gavi, for example, by the United States, could have implications for global immunisation programmes in countries with the highest mortality rates,” explains Groome.
Investments in RSV prevention will aid the accomplishment of Sustainable Development Goal 3.2: ending preventable deaths of newborns and children younger than five by 2030. Thus, protecting infants from RSV saves lives—simple as that.
United for Equity
In a joint appeal published in June 2025 in The Lancet, 44 leading scientific and social organisations from across the globe called on Gavi to take urgent action to save millions of young lives by protecting them against RSV. In July 2025, the Gavi Board approved the maternal RSV vaccine investment case and its introduction into Gavi’s portfolio, bringing the introduction in low-income countries one step closer. “For non-Gavi-eligible middle-income countries like South Africa, there is a need for other mechanisms such as tiered pricing to ensure affordability and access,” explains Groome.
To be eligible for Gavi support, a country must have a Gross National Income (GNI) per capita of below the current threshold of $1,580. So, non-Gavi-eligible countries, like South Africa, must fund their own vaccine programmes, sometimes making it difficult for them to access these vaccines as they remain unaffordable.
However, these countries can negotiate directly with vaccine manufacturers to secure more affordable prices or even join forces to negotiate, as a collective, to enhance supply security. This tiered pricing strategy is used by pharmaceutical companies and global health organisations to set different prices for the same vaccine based on a country’s economic status or ability to pay. “This can improve access to life-saving vaccines and encourage equity by making vaccines affordable where budgets are limited,” says Groome, adding that South Africa may use this route to access the new RSV maternal vaccine in the public sector.