Respiratory syncytial virus prophylaxis for children in Africa: Challenges, opportunities and public health strategies.

Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract infections (LRTIs) in young children, accounting for an estimated 94 600 to 149 400 deaths annually and over 33 million cases of LRTI. The burden is particularly acute in Africa, where limited healthcare access, malnutrition, and co-infections exacerbate outcomes. Despite the introduction of maternal vaccines, such as RSVpreF (respiratory syncytial virus prefusion F protein vaccine), and monoclonal antibodies (mAbs), such as nirsevimab, barriers including high costs, infrastructure limitations, and vaccine hesitancy hinder implementation in African settings. This article examines the challenges of RSV prophylaxis in Africa, including the economic burden of interventions, cold chain requirements, and the scarcity of robust epidemiological and surveillance data. It highlights the need for expanded molecular surveillance and localised clinical trials to ensure the safety and efficacy of these interventions. Vaccine hesitancy, rooted in historical failures such as the formalin-inactivated RSV vaccine, underscores the importance of culturally sensitive community engagement. Opportunities for advancing RSV prevention in Africa include integrating maternal vaccines into antenatal care systems, aligning vaccination schedules with RSV seasonality, and leveraging private sector partnerships. Advocacy for WHO prequalification is essential to enable global procurement and secure international funding. A dual approach combining maternal vaccines with mAbs offers comprehensive protection, particularly for high-risk infants. By addressing these challenges and leveraging available opportunities, Africa can lead efforts to reduce RSV-associated morbidity and mortality, improving outcomes for its most vulnerable populations.