A strategic blueprint for strengthening respiratory syncytial virus prevention among under-five children in low- and middle-income countries: Bangladesh as a model for new immunisation approaches.

Respiratory syncytial virus (RSV) is the leading cause of respiratory morbidity and mortality in children under five years of age, especially in low- and middle-income countries (LMICs). In 2023, two RSV immunisation options, including a maternal RSV vaccine and a monoclonal antibody (mAb), became approved in several high-income countries. The World Health Organization has recently prequalified the maternal vaccine and the Gavi has committed funding for its introduction, raising the prospect of RSV vaccine availability in LMICs in the near future. This analysis thus underscores the need for country-specific data on the burden of disease and seasonality, as well as the acceptability of new immunisation options and evaluations of their cost-effectiveness. Achieving successful implementation will require health system strengthening, targeted strategies to address unwillingness to vaccinate, securing sustainable financing for immunisation, and ensuring sustained policy commitment. As in many other LMICs, the RSV infection continues to pose a substantial public health concern in Bangladesh. However, evidence gaps persist regarding RSV epidemiology, healthcare system readiness, and public perceptions and willingness regarding new immunisation options. We use Bangladesh as a model to identify gaps, review available evidence, and outline strategies for integrating maternal vaccine and infant mAb into the country's maternal and child health programmes. Lessons drawn from this case study may be directly applicable to other LMICs, offering a pathway to equitable adoption of these life-saving interventions and reducing the substantial global burden of RSV.