Mitigating health inequalities in Respiratory Syncytial Virus: an OpenSAFELY analysis of RSV burden and impact of potential maternal vaccine programmes

Research question What disparities exist in the burden of Respiratory Syncytial Virus (RSV), and what maternal vaccination strategies could be adopted to mitigate risk factors underlying these disparities? Background RSV is a common virus causing coughs and colds, usually in the winter. RSV-related illnesses generate approximately 450,000 GP appointments, 400,000 prescriptions and 30,000 hospitalisations in children and adolescents. Evidence suggests the burden of RSV is unevenly distributed in the UK. However, such inequalities have not been comprehensively evaluated in large, representative cohorts. A maternal RSV vaccine to prevent severe outcomes from infection in infants has recently shown efficacy in phase III trials and has been submitted for licensure in the UK, it may be recommended by JCVI. However, uptake of existing recommended vaccines in pregnancy (pertussis and influenza) varies, and there is lower uptake among socioeconomically-deprived and ethnic minority groups. Therefore, any unequal burden of RSV, coupled with the potential unequal distribution of the intervention, risks exacerbating possible health inequalities. Determining the magnitude of health inequalities in RSV using representative data is critically important. This project will allow the evaluation of any inequalities and propose mitigations. Aims and objectives All analyses will use OpenSAFELY, a secure research platform with 95% coverage of the England population developed in response to the COVID-19 pandemic. My objectives are to: Quantify socioeconomic and ethnic health disparities in RSV burden Uncover the relative contributions of ethnicity, socioeconomic status and household size/composition toward the risk of RSV Evaluate potential maternal vaccination strategies and estimate the effect on existing RSV inequalities, and identify the best strategy to reduce the burden on minority groups Methods Objective 1: calculate rates of RSV infection/bronchiolitis in different risk groups and analyse differences in rates using survival analysis Objective 2: use causal diagrams and mediation analysis techniques to determine the underlying causal pathways between the exposures (ethnicity, socioeconomic status and household size/composition and the outcomes (RSV infection, bronchiolitis) Objective 3: use transmission models to ascertain the impact of potential maternal vaccination programmes on disparities identified, using the maternal pertussis vaccine uptake as an estimate for uptake of a potential maternal RSV vaccine Timelines for delivery 10/2023 - ethical approval 10/2024 - upgrading seminar 11/2024 - publication 1: descriptive epidemiology 08/2025 - publication 2: causal analysis 05/2026 - publication 3: vaccination modelling 08/2026 - thesis submission Anticipated impact and dissemination This research has the potential to impact minority groups who are at increased risk of poor health outcomes due to RSV by providing evidence of how disparities can be reduced through specific interventions. In addition, by reducing inequalities this research in turn can reduce the overall burden of RSV on the NHS. Papers will be published open access in peer-reviewed publications. Plain English summaries of my results which can be shared on social media and relevant LSHTM web pages. I will present my research findings at academic conferences, as well as to communities with an interest in health equity and a PPIE (Patient and Public Involvement and Engagement) Advisory Panel I have convened.