Protecting infants from respiratory syncytial virus

Approximate read time: 10 minutes

On 9 September 2025, the House of Lords is scheduled to consider the following question for short debate:

Baroness Ritchie of Downpatrick (Labour) to ask His Majesty’s Government what assessment they have made of the adequacy of the respiratory syncytial virus vaccination programme in ensuring all infants receive an equitable offer of protection from the virus.

1. Respiratory syncytial virus

Respiratory syncytial virus, or RSV, is one of the common viruses that cause coughs and colds in winter.^[1] It is in the same family as the human parainfluenza viruses and mumps and measles viruses.

RSV infection is common in children.^[2] The UK Health Security Agency (UKHSA) has estimated that over 60% of children have been infected by their first birthday, and over 80% by the age of two. For most people, RSV infection causes a mild respiratory illness. However, for a small number of people who are at risk of more severe respiratory disease, RSV might cause pneumonia or even death. Ear infections and croup (a barking cough caused by inflammation of the upper airway) can occur in children. RSV is the leading cause of bronchiolitis in babies and infants, an infection of the small airways in the lung which can make breathing harder and cause difficulty feeding.

Analysis published in April 2025 by the Health Foundation, a UK health charity, estimated that weekly hospital admissions for RSV in winter 2024/25 in England for all patients were similar to previous winters.^[3]

For children, recent UKHSA data showed there were 2,149 RSV hospital admissions (excluding admissions to intensive care units or high dependency units) in those aged under five years of age between early September 2024 and early April 2025.^[4] Of these hospitalisations, 58.8% were in children aged under one, including 879 cases in children aged six months or younger. For intensive care unit or high dependency unit RSV admissions, the UKHSA reported 214 hospitalisations in the same period. Of these, 76.6% were in children aged under one, including 132 cases of children aged less than six months. Additionally, the UKHSA estimated there were 31 RSV-related deaths of those aged under 18 between 6 October 2024 and 6 April 2025.

Vaccination programmes to protect against RSV began on 1 August 2024 in Scotland and on 1 September 2024 in England, Wales and Northern Ireland.^[5] In England, the NHS launched two RSV vaccination programmes: a maternal programme and an older adults programme.^[6] As health services are a devolved matter, this briefing focuses on the maternal RSV vaccination programme in England.

2. Maternal RSV vaccination programme

To protect infants from RSV, the NHS recommends anyone who is pregnant be vaccinated during every pregnancy.^[7] This is to help ensure infants are protected for the first six months after they are born, a time when they are at the highest risk of becoming seriously ill if they get an RSV infection.

The maternal programme offers pregnant women a free vaccine in each of their pregnancies.^[8] Pregnant women should be offered the vaccine around the time of their 28-week antenatal appointment. According to NHS guidance, having the vaccine in week 28 or within a few weeks of this will help provide babies with the best protection against the virus. Pregnant women can still have the vaccine later in their pregnancies but it may be less effective.

On 31 July 2025, the UKHSA published its first annual report on the RSV vaccination programme.^[9] For England, this showed that 42.8% of all women who had given birth between 1 September 2024 and 28 February 2025 had received an RSV vaccine prior to delivery. The report said RSV vaccine uptake in women giving birth had increased in each month since the start of the programme. Despite some month-on-month variation, the UKHSA said most regions shared a similar pattern of increasing monthly RSV vaccine uptake as the programme had progressed.

Once a child is born, the NHS also offers nirsevimab—an RSV monoclonal antibody immunisation—to premature babies or those with certain medical conditions to give them extra protection.^[10]

3. Maternal vaccine uptake by region and ethnic group

Although there has been a general upward trend in RSV vaccine uptake across regions, the UKHSA’s monthly data has shown there is variation in RSV vaccination coverage across NHS commissioning regions and ethnic groups.^[11] For April 2025, the UKHSA said the highest coverage was reported in the South East commissioning region (63.4%) and the lowest in the London commissioning region (44.8%). Figure 1 shows coverage by NHS commissioning region in April 2025:

Figure 1. RSV vaccine coverage (%) in pregnant women by NHS commissioning region, April 2025

The UKHSA reported a larger variation in vaccine coverage across ethnic groups in April 2025, with the highest coverage reported amongst the ‘Other ethnic group—Chinese’ category (70.6%) and the lowest amongst the ‘Black or Black British: Caribbean’ category (25.6%).^[12] The reason for this variability in vaccine coverage remains unclear. Figure 2 shows coverage by ethnic group in April 2025:

Figure 2. RSV vaccine coverage (%) in pregnant women by ethnic group, April 2025

In January 2025, Clare Livingstone, professional advisor for policy and public health at the Royal College of Midwives (RCM), highlighted the important role that midwives played in protecting women’s health.^[13] She noted how midwives were often the first point of contact for information and advice on a range of health issues such as vaccinations.

Referring to UKHSA data published the same month that showed variable RSV vaccine coverage across ethnic groups, Ms Livingstone said midwives had more work to do to ensure they could respond to concerns and questions around vaccinations during antenatal care.^[14] However, she acknowledged that sometimes it was not always possible for midwives to provide all the information, reassurance and support needed, and there was not always time to discuss each vaccine in detail. She said while the RCM appreciated the RSV vaccination programme had been rolled out at “breakneck speed”, some midwives and RCM representatives had raised concerns over workforce capacity and training availability to deliver new vaccinations at pace. She stated the RCM had worked with the UKHSA and NHS England to ensure resources, including patient-facing publications and training in the form of webinars, were available to better support staff. However, Ms Livingstone added some maternity services had faced “considerable challenges” in implementing vaccination programmes and had been required to send women to their GPs instead. She said this reinforced the RCM’s previous calls for having “the right staff, in the right place with the right education and training”. But overall, she highlighted that the care midwives provided during the entire perinatal period continued to make a difference to women’s lifelong health and was “something we should all be very proud of”.

In June 2025, Will Forster (Liberal Democrat MP for Woking) asked the government what action it was taking to reduce the variation in RSV vaccine uptake across regions, ethnic groups and socioeconomic backgrounds.^[15] Responding on behalf of the government, Ashley Dalton, parliamentary under secretary for the Department of Health and Social Care, said the UKHSA’s monitoring of vaccine uptake by ethnicity and NHS region was a “key tool” in identifying disparities across diverse populations. To support programme accessibility and reduce inequalities, the minster said the UKHSA had produced RSV antenatal vaccine information leaflets in over 30 languages and in various formats. Additionally, the minister said an update to the UKHSA’s immunisation equity strategy was “forthcoming” and would “ensure that everyone can access vaccination at the right time, irrespective of where they live, their ethnicity and their socioeconomic background”.

4. Effectiveness of the maternal vaccine

According to a recent study published in the Lancet Child and Adolescent Health journal, the first five months of the RSV maternal vaccination programmes in England and Scotland were effective in reducing the risk of hospitalisation of infants with RSV-associated acute lower respiratory infections.^[16] The research, led by NHS paediatricians, showed the maternal RSV vaccination was 58% effective in preventing hospitalisation of infants with RSV whose mothers were vaccinated at any time before delivery. This effectiveness increased to 72% for those mothers who were vaccinated more than 14 days before delivery. The researchers highlighted strengths and limitations of the study. For example, they said the large number of sites involved in the study had meant their findings “probably captured a population that was representative of England and Scotland as a whole”. However, limitations included the study’s assessment taking place shortly after the national programmes were introduced. The researchers said this meant the study’s findings may not apply to all settings and may not fully reflect future outcomes once the programmes became more established. The National Institute for Health and Care Research, the Wellcome Trust and Imperial College London funded the study.

Responding to the findings, Dr Conall Watson, immunisation consultant at the UKHSA, said “’the evidence clearly shows the RSV vaccine for pregnant women is highly effective and will give much reassurance to parents knowing their newborn is protected from birth, when they are at much greater risk from RSV”.^[17]

5. Read more

• House of Lords Library, ‘Respiratory syncytial virus and its impact on the NHS’, 6 June 2022; and ‘Adding new vaccinations to the NHS national immunisation programme’, 4 January 2024
• House of Commons Library, ‘Who is eligible for the RSV vaccine?’, 7 January 2025
• NHS England, ‘NHS urges pregnant women to protect their ‘winter babies’ against RSV’, 5 August 2025
• UK Health Security Agency, Collection: ‘Respiratory syncytial virus (RSV) vaccination programme’, updated 27 August 2025

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Cover image from Freepik.