The high cost of two newly-licensed interventions that protect babies against respiratory syncytial virus (RSV) is blocking their introduction into South Africa’s public health system, says Wits vaccinologist Professor Shabir Madhi, and despite the Health Department trying to negotiate a lower price for the maternal RSV jab, which is available privately, that is also too expensive for most pregnant women.
“The pricing is a huge issue,” he told the Mail & Guardian this week.
RSV is a common respiratory virus, but it can cause severe pneumonia and other lower respiratory tract infections in babies.
The first intervention is Abrysvo, an RSV vaccine given during pregnancy, and the second is Beyfortus (nirsevimab), a long-acting monoclonal antibody injection for infants. Unlike a vaccine, it does not stimulate the baby’s immune system to produce antibodies but provides immediate, temporary protection against RSV.
Both are registered by the South African Health Products Regulatory Authority (SAHPRA). Abrysvo was approved in December 2024 and Beyfortus in September 2025, but neither is available through the public health programme.
Abrysvo costs about R3 700 to R4 200 in the private sector, and Madhi said that both were simply too expensive for widespread public use.
The maternal vaccine would need to cost about $25 to $30 a dose to be cost-effective for public health system use, he added.
Last year the National Advisory Group on Immunisation recommended Abrysvo be added to the public immunisation programme and offered to pregnant women from 28 weeks, but no date has yet been announced.
Most (73%) RSV-associated deaths in this country are among babies younger than six months.
A major clinical trial found that maternal vaccination reduced severe RSV-related lower respiratory tract illness in babies by 69.4% during their first six months.
Madhi, who spoke to the M&G at the 30th anniversary of the SA Medical Research Council/Wits Vaccines and Infectious Diseases Analytics Research Unit (VIDA), at the Wits BioHub this week, said the benefits of vaccine development depended on lifesaving products being affordable and on children receiving vaccines that were already freely available.
As VIDA’s director (and a professor of vaccinology at Wits), he had joined the unit in 1997, shortly after completing his paediatric training, and what was a small research team is now a unit employing about 400 people.
Over three decades, VIDA has been involved in research supporting the development and global use of vaccines against pneumococcal disease, rotavirus and influenza, as well as the newer interventions against RSV.
Madhi said its most important contribution had been its role in the clinical development of vaccines subsequently recommended by the WHO for global use.
The problem in South Africa, he added, was not simply a shortage of vaccines. Clinic operating hours, transport costs and lost income for parents taking take time off work could disrupt children’s vaccination schedules.
He said making vaccine services available after-hours and over weekends could improve access.
The latest WHO and Unicef estimates show that South Africa’s coverage for the first dose of the diphtheria, tetanus and pertussis vaccine fell by 20 percentage points between 2019 and 2025.
The anniversary also highlighted a wider weakness in Africa’s position in the vaccine industry. Although the continent has become capable of conducting major clinical trials, it has not developed the same capacity to produce vaccines from beginning to end.
“We do have pockets of excellence that can contribute to developing vaccines, but we don’t have the full vaccine ecosystem,” Madhi said. Taking a vaccine from initial research to the market could cost at least $1bn, raising the question of who would be prepared to make the investment.
African manufacturers also had to compete with large Indian companies producing routine jabs at enormous scale and comparatively low cost.
Building an African vaccine industry would require governments to provide incentives for early research, development and manufacturing, he said.
Mail & Guardian article – Cost Blocks Public Access To RSV Protection For Babies
See more from MedicalBrief archives:
NDoH considers vaccine to protect infants from RSV
Respiratory virus killing 100,000 children a year – systemic analysis
Infant RSV jab better protection than maternal jab – French study