As the Trump administration moves to restrict access to a highly effective vaccine against respiratory syncytial virus (RSV), mounting evidence confirms the dramatic reduction in infant hospitalisations the jabs provide.
Policy Shift Ignores Clear Clinical Benefits
Last week, US health officials, led by prominent vaccine critic and Health Secretary Robert F Kennedy Jr., announced new limits on a third of all routine childhood immunisations. This includes recommending the RSV shot only for babies deemed high-risk, rather than for all infants. This decision comes as infections from the virus, particularly dangerous for young children, begin to rise this respiratory season.
Four new studies published in the Journal of the American Medical Association (JAMA) confirm real-world observations, showing a significant decline in hospitalisations thanks to the vaccines. Prior to their approval in 2023, RSV hospitalised 2-3% of all US babies, making it the most common reason for children under five to be admitted.
"It's easy to see in real life. We can really tell that hospitalisations are down," said Professor Richard Rupp of the University of Texas Medical Branch, who was involved in the RSV shot trials. "It's made a big difference."
Universal Healthcare Context Explains Different Approaches
The administration has pointed to policies in the UK, Australia, and Denmark, which also recommend the shot only for high-risk newborns. However, experts note a critical difference: those nations all recommend and provide the vaccine during pregnancy through their universal healthcare systems.
In the fragmented US system, only about a third of pregnant people receive the shot, according to the Centers for Disease Control and Prevention (CDC). This leaves a vast majority of infants unprotected without a postnatal option.
Furthermore, 81% of babies hospitalised with RSV have no underlying conditions. Restricting the shot to children with existing health issues will "miss a large majority of the potential cases," warns Dr Kevin Ault, an obstetrician-gynecologist and former member of the CDC's RSV working group.
Safety, Efficacy, and the Risk of Confusion
The data on the shots' performance is compelling. One study found the RSV vaccination during pregnancy is 70% effective at preventing infant hospitalisation, while the monoclonal antibody shot given directly to newborns was 81% effective. A follow-up study confirmed the vaccines are safe to administer during pregnancy, finding no link to preterm birth.
The shots for infants are not traditional vaccines but monoclonal antibodies, lab-made proteins that provide protection for several months. Similar RSV antibodies have been used safely in children for decades.
Experts expressed shock at the political intervention. "I was caught flat-footed," said Professor Rupp. Dr Ault called the decision one "made by political appointees without a scientific basis."
The new restrictions are expected to cause significant confusion and access problems. With no clear definition of "high-risk," hospitals and paediatricians must scramble to establish new protocols during peak RSV season. Dr Ault warns that fragmentation could lead to clinics not stocking the shot, making it unavailable even for eligible babies.
Over half of US children receive vaccines through the federal Vaccines for Children programme. While officials state the restricted shots will remain available through Medicaid, experts fear coverage could be withdrawn abruptly. "Those are the people who really will not be able to afford to have this for their children," Rupp said.
As doctors recall wards once filled with infants struggling to breathe, the consensus is clear: limiting this preventive tool risks a dangerous backslide. "All babies in the first few months of life are at high risk for RSV," Dr Ault concluded.
