Andrew Ullmann and Michael Moore 

For six decades, respiratory syncytial virus (RSV) in infants was a public health problem without a solution. 

According to the European Centre for Disease Prevention and Control (ECDC), an estimated 250,000 children under five are hospitalised each year across Europe due to RSV infection, overwhelming paediatric wards each winter, and leaving families with lasting emotional and financial scars – yet clinicians have almost nothing to offer beyond supportive care.

That era is over. Since 2022, the European Union (EU) has authorised safe and effective RSV prevention tools: long-acting monoclonal antibodies for infants and maternal vaccines for pregnant women. 

The European Centre for Disease Prevention and Control (ECDC) now reports that 23 EU/EEA countries recommend RSV immunisation. The science is settled. The tools are available. The tragedy now is no longer a lack of medicine; it is a lack of political will for timely access.

Troubling divide

The first few seasons of implementation have revealed a troubling divide. Some countries moved decisively and are seeing dramatic results. Others remain held back by structural barriers, political inertia, and fragmented delivery systems. 

Between us, we have spent decades on both sides of this equation — one of us (Ullmann) spent eight years in the German Bundestag while holding a chair in infectious diseases; the other (Moore) served as an Independent politician for over a decade and served as Health Minister in the Australian Capital Territory. 

We have made the case for public health interventions and had to decide whether to fund them. That dual perspective compels us to say plainly: the remaining barriers to RSV prevention in Europe are not scientific. They are political, structural, and communicative – and every one of them is solvable.

Europe’s first real-world seasons: a scorecard

The data from the 2023/24 and 2024/25 RSV seasons tell a clear story.

Spain set the benchmark. The region of Galicia was among the first in Europe to roll out a monoclonal antibody, achieving over 90% uptake and an 82% reduction in infant RSV hospitalisations. 

The multi-country REACH study, presented at ESPID in 2025, confirmed a 69% reduction in infant RSV hospitalisations across Spain in 2024/25 compared with the pre-immunisation season of 2022/23. Crucially, once Galicia moved, other Spanish regions followed – no health authority wanted to be the one that failed to protect its children.

Italy demonstrated that rapid scale-up is achievable. A central recommendation provided political cover for regional health authorities, and the approach of starting with infants born during the RSV season before expanding to universal coverage proved effective. Lombardy’s 2024/25 campaign showed marked reductions in both emergency department visits and hospitalisations. Some Italian regions achieved coverage rates above 85%.

Germany’s first season under the STIKO recommendation was promising but incomplete. Coverage reached 54% for pre-season infants — a notable achievement for a newly introduced programme — and RSV incidence in children under one year dropped by more than half.

At the University Hospital of Würzburg, postnatal coverage reached 68%. One finding should focus minds: every severe RSV case requiring paediatric intensive care during that season occurred in unimmunised infants. Yet, a parental acceptance study at German university hospitals found that while only 14% of parents actively declined, nearly a third remained undecided. This is not an opposition problem. It is an information gap — and therefore fixable.

UK’s cautionary tale 

The United Kingdom chose a different path, opting for maternal vaccination as its primary strategy. The REACH study measured a 26.7% reduction in infant RSV hospitalisations compared to Spain’s 69% with monoclonal antibodies. 

Maternal vaccine uptake reached 53% overall, with some disparities: coverage among Black British-Caribbean women was as low as 28%, compared to 61% among White British women. 

This is not a failure of the vaccine itself, which has demonstrated efficacy in clinical trials. It is a cautionary lesson in what happens when a single-modality strategy is deployed due to a possible lack of awareness and without adequate attention to delivery infrastructure and equity.

The barriers that data alone won’t fix

In our work with RSV advocates and public health professionals across multiple countries, we hear the same obstacles described again and again – and very few of them are about the evidence.

The first and perhaps most consequential barrier is framing. RSV is still widely perceived as a paediatric problem rather than a population-level public health issue. This distinction matters more than it might seem because it determines which budget line pays for prevention, which ministry owns the policy, and how much political capital a government is willing to spend. 

When RSV is reframed as a workforce issue – parents unable to work, productivity losses, the strain on family wellbeing – and as a health system capacity issue – emergency departments overwhelmed, elective procedures delayed – the political calculus changes entirely.

The second barrier is infrastructural. Consider the Netherlands, where a high proportion of births occur at home. Midwives are typically the first point of contact in healthcare, but they are not authorised to administer monoclonal antibodies. 

By the time a newborn reaches a health centre, days or even weeks may have passed – a critical window during which infants are most vulnerable to severe RSV infection. 

Similar delivery pathway gaps exist across Europe, wherever immunisation programmes assume hospital-based birth as the default. One size does not fit all.

Third, terminology itself creates confusion. The distinction between vaccines and monoclonal antibodies is meaningful to clinicians but baffling to parents and policymakers alike. 

In a post-COVID environment where vaccine hesitancy remains elevated, this confusion is not neutral – it generates unnecessary resistance. Countries that adopted the simple framing of “RSV prevention” rather than expecting the public to navigate technical distinctions achieved markedly higher uptake.

Finally, and this is something we can speak to from direct experience, policymakers respond to different incentives than clinicians. 

A health minister facing competing demands from cancer services, cardiovascular disease, mental health, and social care will not be moved by cost-effectiveness ratios alone. 

They need to understand cost savings – hospital beds freed up this winter, emergency departments decongested this season, and parents returning to work this month. 

The distinction is not academic. One of us (Ullmann) observed it repeatedly in the Bundestag. Many policymakers are not really interested in a cost-effective solution. They want to know what can save money quickly. And the public health officials who write guidelines and allocate regional budgets are equally important — and far too often overlooked in advocacy strategies.

What the successful countries did right

The lessons from Spain and Italy are transferable, and they go well beyond the clinical evidence.

Both countries benefited from national-level recommendations that gave political cover to regional health authorities. In Spain, once Galicia published its results — crucially, not just in Spanish but also in English-language journals — other regions came under immediate pressure to follow suit. Publication strategy became an advocacy strategy.

RSV prevention through monoclonal antibodies has an unusual advantage: the impact is visible within a single season. Unlike some immunisation programmes, where benefits accumulate over years, the before-and-after effect of RSV immunisation is evident across the entire health system. Doctors, hospital managers, and nursing staff all notice when paediatric wards are less full during winter. This immediacy is a powerful tool for sustaining political commitment.

Coalition-building proved essential. Success came about when paediatricians, academic researchers, patient groups, and the media worked in concert. In Spain, sustained media coverage of RSV outbreaks created public demand that reinforced the clinical evidence. Advocates did not simply publish papers and hope for the best; they built and maintained relationships with journalists and editors over time.

And a practical insight that should not be underestimated: delivering monoclonal antibodies in the birth centre, as part of routine newborn care, removes friction. It eliminates the need to recall families, avoids missed appointments, and carries inherent credibility. When something is administered as standard care in the first days of life, parental trust follows naturally.

What Europe must do now

As we approach the 2026/27 RSV season, we see five priorities.

First, every EU/EEA country should have a funded RSV infant immunisation programme in place, either through the public health authority or through the mandatory health insurance, as applicable. 

Twenty-three countries now recommend immunisation, but not all have backed that recommendation with funding. 

Second, messaging must be unified and simple. “RSV prevention” should be the standard term and should be easy to implement in the health care system. Health literacy is a system responsibility, not a burden to place on parents navigating a newborn’s first weeks.

Third, delivery pathways must be designed on a country-by-country basis. Countries with high rates of home birth, decentralised health systems, or fragmented primary care need tailored strategies, not imported models.

Fourth, we must invest in advocacy infrastructure. Clinicians and public health professionals need structured support in communicating with policymakers and the media. The ability to translate science into politically compelling arguments is a skill – and one that can and should be taught. Science alone has never been sufficient to drive implementation. It takes people who can carry that science into the rooms where decisions are made, and these are parents and physicians.

Fifth, countries must commit to rapid, transparent publication of their outcomes. Spain’s early results created a demonstration effect that accelerated adoption across Europe. Every country implementing RSV prevention owes it to the continent – and to the families it serves – to publish what it finds, quickly and in English, so that the evidence base continues to grow.

The season ahead

The science has delivered. The tools are here. What is needed now is the political courage to ensure funding for these programmes, the structural imagination to deliver them across the diverse healthcare settings across Europe, and the communication skills to sustain public and political support that makes implementation possible. 

Every RSV season without comprehensive prevention is a season of preventable hospitalisations, preventable family suffering, and preventable strain on health systems that are already under immense pressure. We have waited sixty years for these tools. We should not waste another winter.

Dr Andrew Ullmann is a former member of the German Bundestag (2017–2025) and professor of infectious diseases at the University Hospital of Würzburg in Germany.

Dr Michael Moore AM is chair of the World Federation of Public Health Associations’ (WFPHA) International Taskforce on Immunisation, Minister for Health in the government of the Australian Capital Territory (1998–2001), and former president, of the WFPHA (2016–2018) in Australia.

Image Credits: Alamy.