Author: Evan Kimber, EMJ, London, UK
Citation: EMJ Microbiol Infect Dis. 2024; DOI/10.33590/emjmicrobiolinfectdis/11000037. https://doi.org/10.33590/emjmicrobiolinfectdis/11000037.
“PHENOMENAL,” was how Jessica Fleming, University of Washington, Seattle, USA, described the science behind the development of breakthrough prevention products, which aim to combat the significant burden of respiratory syncytial virus (RSV). She chaired a captivating session, alongside Joyce Nyiro, Kenya Medical Research Institute (KEMRI), Wellcome Trust Research Programme, Kilifi, Kenya, at the eighth Respiratory Syncytial Virus Foundation (ReSViNET) Conference, which took place in Mumbai, India, between 13th–16th February 2024 . The presentations in this sitting gave a global oversight on the formidable challenges that are often overlooked, or underestimated, when completing the decision-making, introduction, and routine delivery of interventions on a large scale.
MONOCLONAL ANTIBODIES AND MATERNAL VACCINES
The power of monoclonal antibodies (mABs) is well documented; they are precise in nature and useful in targeting specific diseases. Rose Jalang’o, Ministry of Health, Nairobi, Kenya, began by reminding the audience that at current, these are not routinely delivered, and experience is limited in the public sectors of Kenya, where vaccines are favoured instead. The Kenyan public healthcare system deploys tetanus and diphtheria inoculations, and has done so for four decades. Jalang’o recommended that we learn from this, and our response to the COVID-19 pandemic, by integrating models where possible whilst providing RSV protection. By using history to guide future initiatives, she discussed means to improve maternal and adult uptake of these provisions, particularly for boosting low follow-up jab rates.
“In the African setting, there can be a lot of hesitancy from pregnant mothers,” was the way she described one of the barriers to overcome, going on to suggest the reason for this being “a community affair.” To improve vaccine delivery and uptake, initiatives must target educating healthcare workers and the communities which surround pregnant mothers. In the past, these populations have expressed hesitancy toward vaccines and new initiatives, for fear of adverse outcomes, or because they were recommended to avoid inoculating during the first trimester of pregnancy. Jalang’o emphasised that education will play a major role in addressing rumours or misconceptions, in order to bring about change amongst these maternal populations. To receive support in these settings, essential criteria for mABs and vaccines to meet include World Health Organization (WHO) prequalification, approval from a national regulatory body, and availability of funding. Focal points for improving nationwide provision centre around building upon existing infrastructure and service delivery points, guiding decision-making at a community level, implementing affordability strategies, monitoring surveillance systems, and raising public awareness to better community engagement. “We are looking at doing a life course approach to vaccination,” was the conclusion Jalang’o delivered, speaking about the platform Kenya is trying to create for mABs and vaccines.
HEALTHCARE FACILITIES AND MATERNAL IMMUNISATION READINESS
Having played a crucial role in the introduction of maternal vaccines in the Kenyan response to the coronavirus pandemic, Rosemary Njogu, Jhpiego, Nairobi, Kenya, presented her esteemed outlook on the Maternal Immunization Readiness Initiative (MIRI). This programme is globally endorsed, tested in Bangladesh and Kenya, and aims to prepare future maternal vaccine efforts against RSV and group B Streptococcus, giving newborns timely protection in doing so.
Njogu explained the assessment tool was based on 25 primary and secondary healthcare facilities, which make up the bulk of Kenyan immunisation sites. She described the development process and how both service availability and readiness are investigated, alongside quality of care, and health information systems. The key lesson described in her presentation was that engaging all stakeholders and incorporating input from local facilities is crucial to rolling out an effective maternal immunisation programme. Developing and promoting programmes like MIRI is essential to the global implementation of RSV protection; these will prove effective in detecting gaps in readiness, and warn about likely barriers to provision. Organisations such as these can generate useful conversations at local, county, and national levels.
ROLLING OUT NEW VACCINES
Shifting the focus from Africa to the Indian subcontinent, Pradeep Haldar, a former advisor on reproductive child health to the Ministry of Health and Family Welfare, Government of India, delivered a presentation on vaccine roll out. He began by describing the scale and size of this operation, reminding observers that there are 29 million pregnancies in India each year.
To standardise and support immunisation protocols in nations like India, organisations such as the National Technical Advisory Group on Immunization (NITAG) work to bring together experts and make recommendations relating to the introduction and expansion of vaccines. These teams should include experts from a range of backgrounds, from public health, to nursing and drug regulation. Subgrouping teams to quality check areas and maintain vaccine security, ethics, equity, economic benefit, and health improvement was also a key point from his presentation, not to mention the declaration of conflicts of interest to ensure unbiased decision-making. When introducing a new vaccine to India, a three-step process is involved that incorporates technical, administrative, and implementation approval. Factors that are considered include disease burden; safety and efficacy of the vaccine under scrutiny; affordability and financial sustainability; and vaccine production capacity.
One of the points Haldar stressed was the effectiveness of replacing an existing vaccine intervention with a new vaccine, as has been done with measles, exhausting doses before swapping to mumps and rubella. Instead of building new infrastructure, the same should be done for RSV. Another point to mention was the helpfulness of establishing a clear immunisation schedule that advises based on age and timing of dosage. This should be applicable across the country and communicated under a nationwide campaign to galvanise immunisation efforts, seen before in India with polio, measles, and rubella.
CONCLUSION
This symposium at ReSViNET brought forward a plethora of points to be aware of and anchor interventions in the near future. If RSV immunisation programmes are to flourish on a global scale, national and international cooperation is essential, coordinating an educated provision of health service, based on recent vaccines, and with buy-in from governing bodies as well as local communities.
