Despite major breakthroughs in identifying and combating respiratory diseases, two of the most prevalent – respiratory syncytial virus (RSV) and pneumococcal disease – continue to pose a significant health burden globally, particularly in infants, young children, and older adults. 

Against this backdrop, a recent panel at the European Society for Paediatric Infectious Diseases (ESPID) meeting, held in Bucharest in May, explored immunisation strategies to enhance prevention efforts, with particular attention to RSV and pneumococcal disease across high-, middle-, and low-income countries.

New tools unlock unprecedented opportunities 

New prevention tools, including immunisation, are unlocking unprecedented opportunities to protect health, but the real power lies in how these innovations are now being rolled out. 

Countries and communities that invest in infrastructure, data systems, education, and equitable access are beginning to close longstanding protection gaps and turn evidence-based scientific breakthroughs into lasting public benefits. 

Given the persistently high morbidity and mortality rates and the strain on healthcare resources—even in countries with more developed systems—addressing RSV and pneumococcal disease should remain a key priority for policymakers globally.

RSV: Leading cause of pneumonia in babies

Despite being first identified in the 1950s, RSV remains the leading cause of bronchiolitis and pneumonia in children under one year old globally. Innovations that provide lasting protection have only recently become available.

Pneumococcal disease has long been recognised as a major cause of serious illness in children, from pneumonia to meningitis and bloodstream infections. While vaccines have significantly reduced disease in many settings, the burden remains high, particularly where coverage is limited or surveillance is weak.

Strengthening data systems to track disease trends in children is essential to guide protection strategies and close the remaining gaps.

Profound social impact 

The National Coalition for Infant Health found in a US survey that 68% of parents reported that watching their child suffer from RSV impacted their mental health, and around 20% either lost or quit their jobs due to the demands of caregiving. The findings spotlighted a significant indirect financial burden for families, emphasising how RSV disrupts lives beyond clinical settings.

Professor Susanna Esposito from the University of Parma, Italy, echoed these sentiments in the European context, referencing the ResQ Family Study. She highlighted the considerable stress placed on families, noting: “The time spent in hospital averages six days, and about one-third of infants are hospitalised in neonatal or paediatric intensive care units.” 

The resulting productivity loss for families – averaging 29 hours per week – further underscores the broader societal impact. Addressing the pneumococcal disease burden specifically, Esposito emphasised: “In the case of infants, it is very important to begin pneumococcal vaccination early in the first year of life to reduce not only invasive diseases and pneumonia but also bacterial carriage and acute otitis media. This is very, very important, and we should start very early.”

Pneumococcal disease and pneumonia significantly disrupt family dynamics and caregiving roles in older adults.

Although direct evidence is limited, clinical experience shows that older adults face lengthy recoveries marked by prolonged fatigue, reduced mobility, and difficulty performing daily tasks. This decline inevitably compromises their ability to care for grandchildren or dependent spouses, placing additional strain on families and highlighting the importance of preventive measures such as immunisation for children and adults. 

Challenges and opportunities for policymakers

Addressing RSV and pneumococcal burdens demands active political engagement. Panel moderator Mark Chataway noted, “Public health experts must frame the narrative clearly and compellingly for policymakers.” 

It is critical to emphasise the visibility of RSV outbreaks, particularly the strain on healthcare systems, especially during peak seasons when hospital capacities are overwhelmed. This is an important factor for politicians because when hospitals are full, it is impossible to effectively care for young patients.

Professor Federico Martinón-Torres from Hospital Clínico Universitario de Santiago in Spain, advocated for clarity in communicating with policymakers. 

“You must translate complex epidemiological data into terms that policymakers can easily grasp. Politicians like to invest in short-term impacts,” said Martinón-Torres.

“While there has been a considerable level of awareness about RSV in recent years, the burden of pneumococcal disease is not fully understood. So it is necessary to build a case to make policymakers understand not just the disease burden but its economic implications as well. New immunisations for specific populations can make it easier to generate real-world evidence (RWE) that could support policy change.” 

For Professor Rudzani Muloiwa from the University of Cape Town in South Africa: “Every day without immunisation means more deaths. We must be proactive.”

Drawing from past experiences with delayed vaccine introductions, such as that against pneumococcal disease, Muloiwa described proactive measures undertaken in South Africa and by the World Health Organization’s Africa region to ensure readiness for RSV immunisation once available. 

Navigating vaccine hesitancy

Despite clear benefits, vaccine hesitancy remains a significant challenge. Panellists discussed strategies for increasing vaccine uptake, drawing lessons from COVID-19 experiences. Post-pandemic awareness of respiratory infections presents an opportunity to advocate effectively for RSV and pneumococcal disease prevention.

“It is crucial to define tailored-for-age strategies that reduce the burden of disease,” Espotino said, highlighting how understanding local epidemiological contexts helps create region-specific immunisation schedules.

A national research study (awaiting publication) from Italy found that parents tend to be more comfortable with RSV monoclonal antibodies (mAbs) than vaccines, considering them a safer option. This reflects a broader shift in attitudes due to post-COVID vaccine hesitancy, with mAbs seen as a new way of protection.

A particularly innovative aspect discussed was using artificial intelligence (AI), and Esposito detailed ongoing studies in Italy leveraging AI to improve RSV prevention strategies and optimise vaccine schedules for pneumococcal disease. 

“AI can help us in improving surveillance, risk monitoring, and the implementation of population-based strategies,” she explained.

Advocacy and collaborative action

The panellists championed the necessity of building robust coalitions of clinical experts, policymakers, patient advocates, and the public. They argued that providing a platform for all aligned stakeholders can effectively drive policy change. 

“We should be empowering people to demand vaccines,” Muloiwa said, underscoring the power of community advocacy to pressure governments into timely action.

Martinón-Torres shared insights from Spain’s successful RSV immunisation strategy, attributing it to early preparation, budget allocation, and robust advocacy, highlighting, “All necessary stakeholders must align. Politicians, public awareness, and expert advocacy are crucial.”

A unified call to action

In their concluding remarks, panellists unanimously advocated that policymakers prioritise prevention through immunisation, highlighting its immediate benefits. Professor Esposito encapsulated the collective frustration and profound optimism of those advocating enhanced immunisation efforts: “Every hospitalisation from a preventable disease represents a missed opportunity. We must increase awareness about the importance of preventive tools.”

The ESPID panel discussion thus serves as a compelling blueprint for proactive public health action, urging immediate, sustained, and collaborative efforts to prevent RSV and pneumococcal diseases. Such efforts are critical for high-, middle- and low-income countries and global health resilience.

This article is based on a policy panel held at the 43rd European Society for Paediatric Infectious Diseases (ESPID) meeting in Bucharest on 26 May 2025, that was sponsored by MSD.

Robert Cohen, MD, is a professor and paediatric infectiologist at the Intermunicipal Hospital of Créteil, France, and serves as President of the French Group of Paediatric Infectious Diseases.

Susan Hepworth is the Executive Director of the National Coalition for Infant Health, a collaborative of professional, clinical, community, and family support organisations focused on education and advocacy to promote patient-centred care for all infants and their families.

Image Credits: Alamy, FINN Partners.