Immunization, Vaccines and Biologicals

PATH announces new collaboration to advance maternal immunization in low- and middle-income countries

The Advancing Maternal Immunization collaboration will create a roadmap to help infants survive and thrive by making immunization available to pregnant mothers

A mother smiles while carrying her young child

A newly launched collaboration is bringing together stakeholders from around the world to improve infant health and survival through maternal immunization, particularly in low- and middle-income countries (LMICs). The newly assembled Advancing Maternal Immunization (AMI) collaboration is meeting an urgent need for pregnant mothers in LMICs to be able to protect their babies from infectious diseases by getting vaccinated themselves—an option not used to its full potential in many parts of the world, especially in resource-limited settings where it is not widely available.

With a current focus on respiratory syncytial virus (RSV)—which is estimated to cause more than a quarter of global respiratory deaths (nearly 120,000) among children younger than five years of age annually—AMI aims to ensure that a successful RSV vaccine is made available to women in LMICs without delay. No licensed vaccine exists to prevent RSV, but a number of vaccine candidates are advancing, including a maternal vaccine in late-stage development that may be available in the next few years.

Coordinated by PATH in collaboration with the World Health Organization (WHO) and funded by the Bill & Melinda Gates Foundation, AMI will start by developing a roadmap to facilitate informed global, regional, and country decisions around RSV maternal vaccines. It will also identify requirements to enable rapid launch and uptake in LMICs.

When a mother is vaccinated during pregnancy, her protective antibodies can pass to her child. This protects the baby from certain diseases for the first few months after birth by bridging the gap when infants’ immune systems are immature and need time or multiple doses to respond to direct vaccination. This lifesaving approach is receiving focus at a critical moment when more than 4.5 million infants die before their first birthdays each year—60 percent in the first month of life.

Many of these deaths are due to infectious diseases that may be preventable through maternal immunization. RSV is one such promising target. Globally, it causes an estimated 30 million cases of disease in children less than five years of age each year, and can also lead to chronic health complications. Symptoms are often mild like a cold but can be deadly for infants, particularly in the first six months of life. While the full disease burden picture is incomplete in LMICs, almost all RSV-related deaths are estimated to occur in these settings.

Maternal immunization is already used safely and effectively to prevent several diseases. For example, it has helped more than 40 LMICs around the world eliminate maternal and neonatal tetanus in recent years. Routine maternal immunization, however, remains largely out of reach in LMICs because evidence to inform decision-making is incomplete and a way of effectively delivering vaccines to pregnant women in places where immunization and/or antenatal care resources are limited needs to be identified.

“Every mother deserves to see her child survive and thrive, no matter where she lives,” said Dr. Cyril Engmann, PATH global program leader/director of Maternal, Newborn, and Child Health and Nutrition and member of AMI’s strategic leadership team. “AMI’s comprehensive analysis will identify information required for countries to decide how best to integrate maternal immunization into programs serving mothers and infants.”

“We need an inclusive strategy to speed maternal immunization availability and accessibility in LMICs—especially for RSV, which carries a high burden on infants, and has been flagged by WHO advisory committees,” said Dr. Joachim Hombach, senior advisor at WHO’s Department of Immunization, Vaccines, and Biologicals and AMI strategic leadership team member. “The AMI collaboration brings together strong and experienced partners that will help to establish a favorable environment for vaccine decision-making and introduction. Beyond the focus on averting infant deaths and illness from RSV, AMI’s work will be useful for informing maternal immunization efforts for other diseases as well.”

AMI is bringing diverse stakeholders together to identify and assess the requirements for successful RSV vaccination through maternal immunization in resource-limited settings. AMI members hail from across immunization and maternal, child, and newborn sectors, and include expected participants from more than 20 public and nonprofit organizations, as well as government and academic institutions.

These thought leaders and technical experts will provide guidance and input to advance maternal immunization—from understanding the disease and calculating the economic impacts of maternal immunization to administering the vaccine in the hardest-to-reach corners of the planet. In addition to producing a comprehensive framework that the global health community will use to inform, coordinate, track, and contribute to advancing RSV maternal immunization, AMI’s work will also provide a helpful precedent for broader efforts around maternal immunization going forward.

“With prevention tools in the pipeline and a potentially licensed vaccine in the next few years, RSV is a timely focus for AMI and the global health community in general. But, we need all hands on deck to be successful. Collaboration now is important to speed access to maternal vaccines, especially in LMICs, so that mothers and infants can benefit when these tools become available,” said Dr. Bruce Innis, global head of Respiratory Infections and Maternal Immunization for PATH’s Center for Vaccine Innovation and Access and AMI strategic leadership team member.