The cost of two newly licensed interventions designed to protect babies against respiratory syncytial virus is blocking their introduction into South Africa’s public health system, according to Wits vaccinologist Professor Shabir Madhi.
Madhi said the national health department was negotiating with manufacturers to secure a lower price for the maternal RSV vaccine, which is available privately but remains beyond the reach of most pregnant women.
“The problem with both of those interventions is the cost. The cost is a big issue,” he told the Mail & Guardian.
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. The antibodies produced by the mother pass through the placenta and help protect the baby from birth to six months.
The second is Beyfortus, the brand name for nirsevimab, a long-acting monoclonal antibody given to infants as an injection. Unlike a vaccine, it does not stimulate the baby’s immune system to produce antibodies but provides immediate, temporary protection against RSV.
Both products have been registered by the South African Health Products Regulatory Authority. 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, depending on the provider and dispensing charge. Madhi said both interventions were too expensive for widespread public use at their present prices.
He estimated that the maternal vaccine would need to cost about $25 to $30 a dose to be affordable and cost-effective for introduction into the public health system.
The National Advisory Group on Immunisation recommended in April last year that Abrysvo be added to the public immunisation programme and offered to all pregnant women from 28 weeks of pregnancy.
No date has been announced for its introduction into the public programme.
The advisory group recommended that the vaccine be offered throughout the year because RSV circulates in South Africa beyond a narrowly defined winter season.
Its assessment said 73% of RSV-associated deaths in South Africa occurred 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 spoke to the M&G after delivering an address marking the 30th anniversary of the South African Medical Research Council/Wits Vaccines and Infectious Diseases Analytics Research Unit, known as VIDA, at the Wits BioHub in Johannesburg on Tuesday.
Madhi, VIDA’s director and a professor of vaccinology at Wits, joined the unit in 1997, shortly after completing his paediatric training. It has since grown from a small research team into 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 the unit’s most important contribution had been its role in the clinical development of vaccines that were subsequently recommended by the World Health Organisation for global use.
But he said the benefits of vaccine development depended on lifesaving products being affordable and on children receiving vaccines that were already freely available.
He said too many African children were still dying from preventable diseases because they were not fully vaccinated.
In South Africa, the problem was not simply a shortage of vaccines. Clinic operating hours, transport costs and the loss of income faced by parents who had to take time off work could prevent children from completing their vaccination schedules.
“If parents are working, they would need to take time off. They would lose income to take the children to the clinic,” Madhi said.
Making vaccination services available after hours and over weekends could improve access, he added.
Madhi also blamed weak public communication, declining confidence in vaccines and complacency created by their success.
Previous generations had direct experience of children becoming seriously ill or dying from measles, he said. Many younger parents had never witnessed that devastation because vaccination had suppressed the disease.
“What we see is that with complacency, there is a decrease in coverage of vaccines. Then you end up experiencing what South Africa is currently experiencing, which is an outbreak of measles.”
The latest World Health Organisation 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 National Institute for Communicable Diseases reported 4,188 laboratory-confirmed measles cases between 29 December 2025 and 30 August this year.
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.
He said taking a vaccine from initial research to the market could cost at least $1 billion, raising the question of who would be prepared to make the investment. African manufacturers also had to compete with large Indian companies producing routine vaccines 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.
“It is something that we aspire towards doing. I think it is something that is needed for a country, for a continent. But it requires the government to come to the party.”
Thirty years after VIDA began its work, the challenge is no longer only to prove that African scientists can contribute to globally important vaccine research. It is also to ensure that new vaccines are affordable, produced closer to the people who need them and delivered through health services that families can reach.