Maternal respiratory syncytial virus (RSV) vaccine perceptions amongst pregnant women and mothers of infants and toddlers in England: a qualitative study

This qualitative study of 30 mothers in England reveals that while maternal RSV vaccination is generally viewed as beneficial, successful implementation requires early, multi-channel communication and convenient delivery integrated into existing antenatal appointments.

The Gist

Imagine your body is a fortress, and your baby is a precious treasure inside. For the first six months of life, that treasure is too small to build its own defenses against a sneaky, invisible enemy called RSV (Respiratory Syncytial Virus). RSV is like a common cold for adults, but for a tiny baby, it can turn into a severe storm that knocks them out of breath and sends them to the hospital.

This study is like a group chat with 30 moms in England to ask: "Do you know about this storm? Would you let us give you a shield (a vaccine) to protect your baby?"

Here is the story of what they found, told in simple terms:

1. The "What is RSV?" Mystery

Most moms had heard the name "RSV," but it was like hearing a rumor about a monster without seeing it.

• The Knowledge Gap: If a mom worked in healthcare, she knew the monster well. For everyone else, they mostly learned about it from social media (like TikTok and Instagram).
• The Social Media Effect: Moms saw videos of other parents crying because their babies were in the hospital. It was like a "neighbor warning the neighbor" about a fire. It made them aware, but they didn't trust social media for medical advice—they wanted a doctor to tell them the truth.

2. The "Why Get Vaccinated?" Decision

When the researchers showed the moms a simple leaflet explaining the vaccine, the reaction was mostly: "Yes, please!"

• The Superhero Instinct: Most moms said, "I don't care if I get a little sore arm; I want to pass my superpowers to my baby." They saw the vaccine not as medicine for them, but as a gift for the baby.
• The Hesitation: A few moms were like, "Wait, this vaccine is new. I want to see the safety report card first." They were worried because the vaccine hadn't been around for decades like the Whooping Cough shot. They wanted to be 100% sure before handing their baby a "new" shield.

3. The "How Do I Get It?" Logistics

If you are pregnant, your schedule is already packed. You are running around like a squirrel gathering nuts for winter.

• The "One-Stop-Shop" Wish: The moms said, "Please don't make me drive to a different clinic just for a shot." They wanted the vaccine to be part of their regular check-up with the midwife (the pregnancy guide).
• The Convenience Factor: Imagine if you could get your flu shot while you were already there for your baby scan. That's what they wanted. Going to a separate doctor's office felt like a "hassle" (a lot of paperwork and waiting in line).

4. The Trusted Messenger

Who do moms trust? The Midwife.

• Think of the midwife as the "Captain" of the pregnancy ship. If the Captain says, "We need to drop this anchor," the crew listens.
• The study found that moms trusted midwives more than websites or pamphlets. But, the midwives need to have time to talk. If the appointment is rushed like a fast-food drive-thru, moms feel they can't ask their questions. They need a moment to chat, read a leaflet, and feel safe.

5. The "Hybrid" Communication Plan

Moms didn't want just one way to get information. They wanted a mix:

• Online: To read at their own pace (like browsing a menu).
• Paper: A leaflet they could hold and bring home to read again later (like a map).
• In-Person: A chat with the midwife to ask, "Is this safe?" (like a tour guide explaining the path).

The Big Takeaway

The study concludes that to protect babies from RSV, we need to:

1. Tell moms early: Don't wait until the last minute; give them the info when they first find out they are pregnant.
2. Make it easy: Give the vaccine where they already are (at the midwife's office), so they don't have to run around.
3. Be honest: Explain clearly that the vaccine is safe and that it's mostly for the baby's protection.

In short: Moms are ready to protect their babies, but they need the right information, delivered by a trusted friend (the midwife), in a way that fits into their busy lives.

Technical Summary

1. Problem Statement

Since September 2024, the UK Health Security Agency (UKHSA) has recommended routine RSV vaccination for pregnant women in England (from 28 weeks' gestation) to protect infants via transplacental antibody transfer. While quantitative surveys indicated high initial acceptability (approx. 89.5%), there were gaps in understanding:

• Nuanced Drivers: The specific factors influencing acceptability, particularly among minority ethnic groups and those with lower trust in new vaccines.
• Information Gaps: The level of maternal awareness regarding RSV severity and the virus itself compared to established vaccines (e.g., Pertussis, Influenza).
• Implementation Strategy: Preferences for how vaccine information should be communicated and where vaccinations should be delivered to maximize uptake and convenience.

2. Methodology

• Study Design: Qualitative, semi-structured interview study.
• Participants: 30 mothers (youngest child <2 years) recruited from a prior UKHSA survey (June–July 2023).
  • Sampling: Purposive sampling to maximize diversity in ethnicity, self-reported disability, and geographical location.
  • Demographics: 12 participants from minority ethnic backgrounds; 18 White British. Ages ranged from 18–44. Most were first-time mothers. Two were currently pregnant; 28 had recent post-partum experience.
• Data Collection:
  • Interviews conducted via Zoom or telephone (approx. 30 mins) between July and November 2024.
  • Protocol: Interviewers used a topic guide based on survey results. Mid-interview, participants reviewed an NHS information leaflet on maternal RSV vaccination to gauge reactions to specific messaging.
  • Analysis: Thematic analysis using NVivo (Release 1.6.1) following the Braun and Clarke (2006) framework. Coding was performed by two researchers with reliability checks and team consensus discussions.
• Ethical Considerations: Written informed consent obtained; participants received £20 vouchers.

3. Key Contributions

This study is the first qualitative investigation into maternal RSV vaccine perceptions in England. Its primary contributions include:

• Differentiation of Risk Perception: Distinguishing between vaccines perceived as protecting the mother (Flu, COVID-19) versus those perceived as protecting the infant (Pertussis, RSV).
• The Role of Social Media: Identifying social media (TikTok, Instagram) as a primary driver of awareness regarding RSV severity, despite mothers explicitly stating they do not trust it for medical advice.
• Implementation Roadmap: Providing specific, evidence-based recommendations for communication channels (hybrid model) and delivery settings (antenatal integration) to optimize the rollout of the new RSV program.

4. Key Results

A. Awareness and Knowledge

• General Awareness: Most mothers had heard of RSV, but deep understanding was low. Awareness was significantly higher among those with healthcare backgrounds.
• Sources of Information:
  • Social Media: Cited as the primary source for initial awareness (e.g., stories of infants in hospital, warnings against kissing babies).
  • Personal Experience: Awareness often stemmed from a child's or friend's child's severe RSV infection.
  • Comparison: RSV awareness was significantly lower than for Pertussis, Influenza, or COVID-19.

B. Vaccine Acceptability

• High Overall Acceptance: Most mothers expressed a high likelihood of accepting the vaccine, driven by the desire to protect the infant during the vulnerable first six months.
• Primary Motivator: "Infant protection" was the dominant driver. Mothers were willing to accept minor side effects for themselves if it guaranteed infant safety.
• Barriers to Acceptance:
  • Newness/Safety: Concerns regarding the lack of long-term safety data for the new vaccine (paralleling concerns about the COVID-19 vaccine).
  • Perceived Risk: Some mothers felt personal precautions (breastfeeding, limiting social contact) were sufficient, reducing perceived need for vaccination.
  • Information Needs: Skeptical mothers requested more granular data (e.g., live vs. inactivated, specific side effects, duration of protection).

C. Communication Preferences

• Hybrid Approach: Mothers preferred a multi-modal strategy:
  • Online: NHS website for detailed research.
  • Offline: Physical leaflets to review at home.
  • In-Person: Discussions with midwives.
• Timing: Information should be provided early in pregnancy to allow time for processing and decision-making, rather than only when the appointment is due.
• Trust: Midwives were identified as the most trusted healthcare professionals. However, rushed appointments and inconsistent staffing hindered effective communication.

D. Delivery Preferences

• Convenience is Paramount: The majority preferred receiving the vaccine within the maternity/antenatal setting (integrated into existing midwifery appointments) rather than visiting a General Practice (GP) or pharmacy separately.
• Rationale: Reduces logistical burden (travel, booking separate appointments) and reinforces the link between the vaccine and pregnancy.

5. Significance and Implications

• Policy Implementation: The findings support integrating RSV vaccination directly into antenatal care pathways to improve uptake, particularly for working mothers or those with mobility constraints.
• Communication Strategy: Public health campaigns must address the "newness" of the vaccine by providing transparent, accessible safety data early in pregnancy. Messaging must emphasize that the vaccine is primarily for infant protection, similar to the Pertussis vaccine, to leverage existing high trust in that program.
• Equity: While the study highlighted high overall acceptability, it noted disparities in uptake by ethnicity and region in national data. The qualitative insights suggest that tailored communication and trusted community/midwife engagement are critical to addressing these gaps.
• Future Research: The study calls for deeper investigation into the specific reasons for lower uptake in minority ethnic groups and different geographical regions.

Conclusion: The study concludes that while maternal RSV vaccine acceptability is generally high, maximizing uptake requires a convenient delivery model (antenatal integration), early and hybrid communication strategies, and trusted midwife-led dialogue that addresses safety concerns while emphasizing infant protection.