Preventing death and disease from Respiratory Syncytial Virus (RSV) and Pneumococcal Disease in all our children

RSV and pneumococcal disease are longstanding threats to child health, but we are at a turning point: after decades of research, we now have safe and effective tools that can greatly reduce severe disease and hospitalization in young children.

With this Call to Action, the World Federation of Public Health Associations (WFPHA) and supporting leaders and organizations aim to catalyze urgent, equitable, and sustained investment in protecting every child against preventable respiratory disease.

By doing so, we take a decisive first step in a broader, lifelong commitment: a life-course approach to immunization that safeguards health not just in the first months of life, but at every stage.

Preventing RSV and Pneumococcal Disease in Every Child

Pneumonia is preventable

Pneumonia is the leading infectious killer of children under five. It is not inevitable; it is preventable.

RSV is the single most important cause of severe pneumonia in infants globally. Pneumococcal disease is the second. Together they account for the majority of childhood pneumonia deaths. Both are preventable.

RSV also causes bronchiolitis and other RSV-attributable respiratory illnesses.

Yet the children who bear the greatest burden have the least access to prevention.

We have the tools to prevent severe respiratory disease

We have the tools. We need the political will. We need to act urgently.

Two WHO SAGE-endorsed approaches can prevent severe RSV disease in infants:

• RSV prevention: RSV long-acting monoclonal antibody interventions or RSV maternal vaccination must be introduced and expanded.
• Pneumococcal disease prevention: The pneumococcal conjugate vaccine (PCV), already widely available, must be maintained and expanded.

Particular emphasis is needed on RSV because PCV is already included in many national immunization programs, while an advocacy gap remains for RSV.

The burden of RSV in children

More than 3.6 million children under five are hospitalized each year because of RSV, creating recurring strain on pediatric wards and ICU capacity, especially during seasonal peaks.

Approximately 100,000 children under five die from RSV-attributable respiratory illness annually, and 97% of RSV deaths occur in low- and middle-income countries.

Pneumonia also claims the lives of approximately 700,000 children under five each year.

Countries should make evidence-based immunization policy decisions based on local epidemiology, disease burden, health system readiness, and national public health goals.

Immunization is an investment

Prevention is one of the most cost-effective government investments.

Immunization programs overall are estimated to return $20–$52 for every $1 invested.

Evidence from different settings demonstrates the potential economic value of RSV prevention. In Chile, nirsevimab was cost-saving. In Spain, a universal long-acting monoclonal antibody program averted 215,878 RSV events and saved approximately €48 million in direct costs. In Canada, approximately 47,609 RSV health-related events were averted, with around CAD$45 million in healthcare savings.

The key takeaway is clear: prevention is an investment, not a cost. A major barrier is budget silos, where vaccine and drug budgets may sit in separate ministries or funding streams.

Results can be visible within one year

Act today.

In one year:

• Pediatric RSV hospitalizations can fall by up to 88%.
• ICU admissions can drop by up to 90%.

Results are visible, measurable, and politically rewarding.

Every country needs an approach suited to its context

There is no one-size-fits-all approach. Every country must select the approach best suited to its context, products, and system.

WHO recommends long-acting monoclonal antibody or maternal vaccination for universal implementation. The choice depends on infrastructure and delivery capacity, and some countries may use both.

RSV seasonality varies by region and climate. Local epidemiology and timing should guide strategy.

Alongside PCV, RSV immunization provides a synergistic shield against two leading infectious causes of severe childhood pneumonia.

A Call to Action for RSV Immunization and PCV

Governments and policymakers

WFPHA calls on all stakeholders, including government ministers, politicians and policymakers, health professionals, funders, industry, community leaders and civil society, to act urgently and decisively to make RSV immunization a national priority in every country, for every child, while maintaining, simplifying and strengthening PCV immunization.

Politicians and policymakers should:

• Prioritize RSV prevention alongside PCV.
• Allocate funding and bridge vaccine and drug budget silos.
• Set a national target for RSV coverage for every infant by next season.
• Enhance surveillance.
• Enhance real-world evidence.

Health professionals

Health professionals have a critical role in integrating RSV and PCV prevention into care pathways and advocating for national action.

They should:

• Integrate RSV and PCV into antenatal, neonatal and pediatric pathways as appropriate.
• Advocate for NITAG and HTA consideration.
• Engage professional societies and trusted voices.
• Monitor hesitancy toward long-acting monoclonal antibodies.
• Strengthen training.
• Combine RSV and PCV advocacy in every vaccination engagement.

Experience from Murcia, Stanford and Zurich demonstrates how health-system integration, continuous training, parent education, eligibility checks and opportunities for discussion can support high uptake and reduce equity gaps.

Funders, industry and interest groups

Funders, industry and interest groups should:

• Fund country-level economic analyses and budget impact models.
• Invest in production capacity when appropriate.
• Finance surveillance and real-world data.
• Close access gaps through tiered pricing, expanded LMIC regulatory filings, and manufacturing and supply commitments.
• Ensure RSV and PCV financing fit coherent investment strategies.

Access depends on functioning markets and predictable supply. Clear demand forecasting, healthy markets, multiple products, appropriate manufacturing capacity, and market-shaping mechanisms are important to ensuring that children can benefit from available prevention tools.

Civil society and community leaders

Civil society, community leaders, and community health workers can translate evidence into accessible language, build awareness and acceptability, and elevate the prioritization of infant pneumonia prevention.

They should:

• Amplify demand for infant pneumonia prevention.
• Counter misinformation with accessible and culturally appropriate narratives.
• Advocate to elected representatives through patient associations.
• Engage faith and community leaders.
• Champion equity so no child is unprotected by geography, income, or ethnicity.

Measure the burden. Measure the impact. Make success visible.

Surveillance is not universal, making robust RSV and PCV surveillance an immediate priority.

Countries should:

• Build baseline burden estimates.
• Establish standardized reporting, case detection, and laboratory confirmation.
• Monitor serotypes where appropriate.
• Conduct post-introduction monitoring.
• Collect first-season impact data.
• Maintain pharmacovigilance.
• Share national data globally.
• Communicate results publicly.
• Advocate for RSV to be included on notifiable disease lists where appropriate.
• Maintain virological surveillance, including monitoring of mutations.

A practical eight-step framework can support implementation:

1. Know your burden.
2. Assess your system.
3. Check product access.
4. Run the numbers.
5. Gauge community readiness.
6. Engage your NITAG.
7. Integrate and launch.
8. Measure and adapt.

Equity must remain at the center

Science alone does not drive policy. Advocacy requires clear, emotionally resonant narratives.

Every child, wherever born, deserves a first birthday free from vaccine-preventable disease.

RSV and PCV prevention together are a statement of equity. The burden falls hardest on families vulnerable to structural disadvantage, including differences related to ancestry, economic status, and other social factors.

Long-acting monoclonal antibodies are a new therapeutic class that parents and caregivers may not understand. For some hesitant families, this can also become a communication asset when the approach is explained clearly.

The data are strong. The tools exist.

Every day without action means preventable deaths.

This is a rare, urgent and timely opportunity to protect countless children from severe respiratory disease.

The WFPHA and those who recognize the importance of this opportunity call on all organizations, professionals and citizens who seek fairer, healthier and more equitable societies to join us by signing this document and committing to drive the changes outlined in the Call to Action.

Learn more: WHO: Respiratory syncytial virus (RSV) | UNICEF: Pneumonia in children

Read the original call to action

Watch an interview with Immunization Taskforce Chair, Michael Moore