Respiratory syncytial virus, known as RSV, is a common virus that most adults mistake for a mild cold when affected. Common symptoms such as a runny nose, slight cough, or a low-grade fever rarely cause concern. But for babies under 12 months of age, RSV can turn deadly. In newborns, severe RSV infection attacks the lungs, causing excessive breathing difficulty and leading to serious illness such as pneumonia and bronchiolitis. As RSV appears more or less harmless in older children and healthy adults, it is frequently underestimated, allowing the virus to spread unnoticed until a baby becomes critically ill.
In early 2025, a premature 10-week-old in Dhaka was rushed to the hospital, struggling to breathe. What began as a mild cold quickly became a medical emergency. Doctors diagnosed RSV, and the baby required oxygen support and intensive care to survive. In one of many similar cases, a six-week-old baby girl in rural Bangladesh fought the virus and narrowly survived after prolonged hospitalisation. These are not isolated cases. Across hospitals in Bangladesh, infants are repeatedly admitted with severe RSV infection, raising serious concern among healthcare providers, yet remaining largely unnoticed beyond hospital walls.
From October to April each year, RSV circulates widely across the country. During this peak season, hospitals admit thousands of infants with severe respiratory illness. Many arrive too late. RSV is now one of the leading viral causes of pneumonia, which remains the leading cause of death among children under five in Bangladesh.
Evidence clearly shows the scale of the problem. Globally, a major international health study published in 2024 by The Lancet, one of the world’s leading medical journals, estimates that RSV infects about 33 million children under five, leading to 3.6 million hospitalisations and more than 118,000 deaths every year. In Bangladesh, the latest Global Burden of Disease estimates indicate that RSV contributes to more than 500 child deaths annually and accounts for over 47,000 years of healthy life lost. Even more concerning is that RSV-related deaths among Bangladeshi children have increased steadily over the past three years.
This virus is especially dangerous because it strikes babies before they are old enough to receive routine childhood vaccines, creating a critical gap in protection. The question, therefore, is not whether RSV is serious, but how we can protect infants during this most vulnerable period of life.
One proven solution is maternal immunisation. When a pregnant woman is vaccinated, her body produces protective antibodies that pass to her baby before birth, providing immediate protection from day one. This approach is not experimental. Bangladesh has already used maternal vaccination to nearly eliminate newborn tetanus. Additionally, many high and low-middle income countries now offer maternal vaccines for whooping cough, influenza, Covid, and, most recently, RSV. Maternal immunisation has become standard public health practice, not an exception.
After decades of research, we now have new tools to prevent RSV. In 2023, the first RSV vaccine for 32-36-week pregnant women was approved for use. In 2025, the World Health Organization (WHO) prequalified this vaccine, confirming that it meets global standards for safety and effectiveness. This creates an important policy opportunity for Bangladesh, with potential financial support from the Global Alliance for Vaccines and Immunization (Gavi), which works to expand access to life-saving vaccines in low-income countries.
Some may also be concerned about whether Bangladesh can deliver vaccines at the correct stage of pregnancy. But Bangladesh already delivers time-sensitive antenatal interventions every day. For example, pregnant women receive tetanus vaccines at specific stages, and antenatal corticosteroid injections are given to mothers at risk of preterm birth to help mature a baby’s lungs before delivery. These services rely on accurate timing and existing antenatal care systems. With appropriate guidance and digital tracking, the same systems can safely support maternal RSV vaccination.
Evidence from real-world settings is compelling. In Argentina’s 2024 RSV vaccine rollout, where about 60 percent of pregnant women were vaccinated, severe RSV illness in infants fell by nearly 75 percent. Hospital admissions dropped sharply, intensive care admissions declined by more than three-quarters, and, notably, all RSV-related infant deaths occurred among babies whose mothers had not been vaccinated. The message is simple and clear: vaccinating mothers saves babies’ lives.
Bangladesh is not starting from scratch. The country is globally well recognised for its Expanded Programme on Immunization (EPI), which has achieved high childhood vaccine coverage and dramatically reduced diseases like measles and polio. The delivery platforms, cold chain systems, trained health workers, and public trust already exist. What is missing is a coordinated maternal immunisation platform that brings pregnancy-based vaccines into routine antenatal care across both public and private sectors.
Digital systems under Bangladesh’s national Health Management Information System (HMIS) are already in place. These systems can register pregnancies, schedule vaccines, and send reminders. With better use of these tools, maternal and child immunisation services can remain closely connected, ensuring no woman or baby is missed. Public awareness is equally important. Expectant parents need to know that maternal vaccines are safe, carefully tested, and designed to protect both mother and child. Bangladesh has shown sustained leadership in public health, from pioneering oral rehydration therapy to achieving high childhood immunisation coverage. Maternal immunisation is the next step in the trajectory.
Policymakers must establish a dedicated platform and formally include RSV vaccination within national immunisation guidelines for pregnancy. Health managers must integrate maternal vaccination into routine antenatal care. Development partners, including Gavi, should align financing to support rapid introduction. Healthcare providers must be trained and supported to counsel and vaccinate pregnant women, even in busy and resource-constrained settings. Delay will cost lives. With the systems, evidence, and experience already in place, Bangladesh has a real chance to protect its newborns and infants before serious illness takes hold. When we vaccinate a mother, we protect two lives and secure the promise of tomorrow.
Dr Ridwana Maher Manna is study physician at icddr,b.
Aniqa Tasnim Hossain is associate scientist at icddr,b.
Views expressed in this article are the author's own.
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