Maternal perspectives on the RSV vaccine (Abrysvo): a thematic analysis of survey findings from the first season of implementation in England and Scotland.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of infant hospitalisation due to lower respiratory tract infections. Until 2022, prevention was limited to the costly monoclonal antibody palivizumab. In August 2024, the UK introduced the RSVpreF (Abrysvo, Pfizer) maternal vaccine into its national immunisation schedule. The success of this programme depends not only on vaccine effectiveness, but also on maternal access, acceptance and uptake. OBJECTIVE: To explore maternal perspectives on the RSVpreF vaccine and identify barriers and facilitators to vaccine uptake, to inform antenatal education and public health strategies. METHODS: This qualitative analysis is based on free-text survey responses from 388 vaccine-eligible mothers of infants hospitalised with bronchiolitis, lower respiratory tract infection or acute wheeze, collected between September 2024 and March 2025 across 30 sites, as part of the BronchStop study. RESULTS: Four key themes were identified: (1) access-related barriers to vaccination, (2) insufficient RSV awareness and information to support informed decision-making, (3) vaccine safety concerns and hesitancy and (4) perception of the maternal RSV vaccine as beneficial and protective. These themes were consistent across sociodemographic groups. CONCLUSIONS: Uptake of the maternal vaccine was influenced by barriers to access, informational gaps and perceived safety concerns. Improved vaccine delivery, enhanced awareness and personalised antenatal counselling are essential to increase vaccine uptake. There is an urgent need to address structural inaccessibility and provide tailored antenatal education to address informational gaps. Ongoing qualitative research is crucial to guide targeted public health interventions ahead of future RSV seasons.