Respiratory Syncytial Virus: Vaccination Programme

Lord Rennard Excerpts

Tuesday 9th September 2025 Lords Chamber

[Lord Rennard (LD)]

My Lords, I, too, congratulate the noble Baroness, Lady Ritchie of Downpatrick, on securing this important debate. We have heard from her about the need to ensure that all infants receive an equitable offer of protection from the respiratory syncytial virus, and that the maternal RSV vaccination programme is fairly new, having been introduced in Scotland in August 2024 and in England in September 2024. It is important now, therefore, to monitor its uptake in detail and to assess the protection that it gives.

We are grateful, therefore, to the UK Health Security Agency—UKHSA—for the monitoring undertaken so far, which has already provided vital insights. From this, we are encouraged to see that the level of vaccine uptake has increased, month on month, since its first implementation. For England, the UKHSA’s first annual report on the programme, published in July, showed that 42.8% of all women who had given birth in the six months after 1 September had received an RSV vaccine prior to delivery. Progress is being made, because, for the month of April alone, the figure reached 54%, with most regions showing a pattern of increasing monthly uptake.

However, as we have heard, there were significant differences in uptake in different commissioning regions and among different ethnic groups. For the month of April this year, the UKHSA reported that the highest coverage of the vaccine was in the south-east of England, at 63.4%, while the London commissioning region reported the lowest level of coverage, at 44.8%. For the Midlands, the coverage was 51.3%. The variation across ethnic groups was much wider. The “Other ethnic groups—Chinese” category showed the highest coverage, at 70.6%, while the “Black or Black British—Caribbean” category reported the lowest level of coverage, at just 25.6%. Greater efforts must therefore be made to improve take-up of the vaccine, and they must be targeted effectively.

Will the Minister let us know more about how the Government will help to address the disparity in coverage by region and ethnicity? The figure for “Black or Black British—Caribbean” is alarmingly low. Can the Minister tell us whether any research has been undertaken to see if there is a difference between the point in pregnancy at which people of different ethnicities present themselves to GPs or midwives? What may be the cultural differences or barriers relating to access? Is there an issue about less time being available for a working mother as opposed to one not in employment? The vaccination is most effective when offered around the 28-week antenatal appointment, or within a few weeks of this, to provide babies with the best protection for their first six months of life. Those who present late may be less protected even if they ultimately receive the jab.

I am aware that the UKHSA is planning further investigations. Can we know whether such crucial questions are being looked into? We know that the Parliamentary Under-Secretary of State for Public Health and Prevention, Ashley Dalton, has stated that UKHSA monitoring is a “key tool”. She promised that an update to the UKHSA’s immunisation equity strategy is “forthcoming” to ensure equitable access, but could we possibly know when? Meanwhile, the production of RSV antenatal vaccine information leaflets in over 30 languages and in various formats is a very positive step.

Significant issues about the vaccination rollout have been raised by the Royal College of Midwives. Clare Livingstone of the RCN noted in January that midwives had more work to do to respond to concerns and questions around vaccinations. She acknowledged that it was not always possible for midwives to provide all the information, reassurance and support needed, often due to lack of time to discuss each vaccine in detail. The RCM has suggested that there are more challenges about these issues in some regions than in others. We need to know if that is because of staff vacancies, which may vary by region, or because of the number of patients on each midwife’s list, or both factors, as these issues are obviously connected.

There is an urgent need to recruit more midwives. Some midwives have raised concerns about workforce capacity and training availability. Some maternity services face considerable challenges in implementation, and they are being required to send women to their GPs instead. The Royal College’s previous calls about having the right staff in the right place, with the right education and training, must be heeded. Training materials, including webinars for midwives and patient-facing publications, have been made available in collaboration with the UKHSA and NHS England. Will these now be updated in the light of the questions that are being asked over the first year of the programme?

We need to know if there is any link between hesitation about having the RSV jab and hesitation about having other jabs, such as the Covid and MMR vaccinations. Much seriously damaging misinformation has been circulated about vaccinations, including very recently, and we all, in responsible parties, need to help to counter it.

Eligibility for the RSV vaccination is an issue. NHS England has acted on the recommendation of the Joint Committee on Vaccination and Immunisation. This was based on safety, efficacy, cost and how many people of different groups become really ill with the virus. Initially, the programme is for pregnant women, preferably around the 28th week for maximum efficacy, and for older people aged between 75 and 80. A recent study in The Lancet Child & Adolescent Health journal has shown the maternal RSV vaccination to be 58% effective in preventing hospitalisation of infants. This figure, as we heard, increases to 72% if mothers were vaccinated more than 14 days before delivery. The UKHSA confirms that this evidence clearly shows that the RSV vaccine for pregnant women is highly effective.

However, the criteria for older people, currently set at the ages of between 75 and 80, appears to many people to be arbitrary and questions are being asked about it. Ministers have said that the JCVI will be monitoring the current criteria alongside evidence of serious infections among those not currently eligible. Can the Minister please say when the joint committee’s next investigation will be published? Will it be considering the case of people who are immune-suppressed and who may therefore be at greater risk of serious illness if they catch the virus?