As we mark World Pneumonia Day, it is imperative to acknowledge the ongoing battle against respiratory syncytial virus (RSV), a leading cause of severe respiratory infections in young children. Every year, RSV claims over 100,000 lives among children under five, with close to 97% of RSV-associated deaths occurring in low- and middle-income countries (LMICs)[1]. This alarming statistic underscores the urgent need for equitable access to effective interventions.

New advancements bring hope, with two recent approaches to prevention: maternal vaccination and the administration of monoclonal antibodies to infants.

Pfizer has introduced an RSV vaccine for maternal immunisation that, when administered during the third trimester to pregnant women, can protect newborns from RSV. While promising, this approach depends on consistent prenatal care, which can be challenging in LMICs.

To fill this gap, monoclonal antibodies have emerged as a significant advancement. Treatments like nirsevimab, developed by Sanofi and AstraZeneca, and clesrovimab, developed by MSD, could offer long-acting protection against RSV with a single dose. Nirsevimab has already been rolled out in some high-income countries such as Spain, France and the US with astounding effectiveness[2]. Given the global burden of RSV disease, the World Health Organization’s Strategic Advisory Group of Experts (SAGE) on Immunization recommended that all countries introduce passive immunisation for the prevention of severe RSV disease in young infants. However, SAGE also noted with concern “the limited availability and high cost of the monoclonal antibody which will seriously limit global access and equity”[i].

Our recent commentary, “Access to Highly Effective Long-Acting RSV-Monoclonal Antibodies for Children in LMICs—Reducing Global Inequity,” published in The Lancet Global Health emphasises the urgent need for strategies to prevent severe RSV lower respiratory tract infections in infants. By ensuring the availability of long-acting RSV-monoclonal antibodies, we can bridge the healthcare equity gap, significantly reducing the burden of severe RSV infections and associated mortality.

 

At MPP, we believe that voluntary licensing – which is both right for health and smart for business – and technology transfer can play a pivotal role in these efforts. By partnering with pharmaceutical companies through voluntary licences, we can contribute to making these life-saving therapies accessible and affordable in LMICs. Our commitment to leveraging our resources and expertise remains steadfast, aiming to make RSV therapies available to those who need them most.

A crucial aspect of this initiative is collaboration with public health organisations and UN agencies such as WHO, innovator pharmaceutical companies, generic manufacturers, governments in low- and middle-income countries, and civil society. By working together, we can facilitate access to monoclonal antibodies and biotherapeutics, making these critical therapies available at a lower cost, meeting demand, and addressing the needs of populations most affected. Through technology transfer partnerships, we can ensure selected quality-assured manufacturers have the necessary know-how to produce these products. This approach creates a faster, more reliable supply chain.

By acting decisively, we can leverage these advancements to protect the most vulnerable populations and build a healthier future for all children, no matter where they are born.

This World Pneumonia Day, let us renew our dedication to combatting RSV and ensuring that no child is left behind. Together, we can make a significant difference in the lives of countless children and their families.

Charles Gore

[1] Highlights from the Meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization, 23-26 September 2024 and The Lancet, Respiratory Syncytial Virus, YouTube video, October 2024

[2] U.S. FDA, FDA Approves New Drug to Prevent RSV in Babies and Toddlers, July 2023 and The Lancet, Effectiveness and impact of universal prophylaxis with nirsevimab in infants against hospitalisation for respiratory syncytial virus in Galicia, Spain: initial results of a population-based longitudinal study, August 2024