A half-century ago, freshman Barney Graham rolled onto the Rice University campus in a new 1971 Ford Mustang. To blow off steam that year, he launched water balloons off the dorm roof with his new roommate Bill Gruber, who drove a hand-me-down Dodge Monaco.

Barney, a top high-school athlete and valedictorian from a family farm in Kansas, starred in intramural sports at Rice. Bill, a high-school academic star from a Houston suburb, said Barney made up for his own athletic deficiencies when they played football and softball.

Parallel tracks

Barney recalled thinking when they met that Bill probably “knew a lot more than I did, and I was going to have to work hard to catch up.” He turned to Bill for help keeping pace with math and science courses, while at the same time trying to outdo his roommate. “We were very competitive, but I think in a good way,” Bill said, “We wanted to be the best, frankly, at knowing everything related to science.”

Last year, the two men returned to competition, this time in a race to stop the pandemic.

When Moderna Inc. announced in November that its vaccine had proved highly effective against Covid-19, Dr. Barney Graham, a government scientist who helped design the shot, emailed his old pal. Dr. Bill Gruber ran the clinical trials of the vaccine from Pfizer Inc., which had announced its own similarly impressive results a week earlier.

“I’m glad we were able to keep up with you,” Dr. Graham, a laconic 67-year-old, wrote the fast-talking Dr. Gruber, 68.

The two men recalled their time together as 18-year-old freshmen, spanning various areas of competition, grades, and collaboration, studies and mischief.

One of their first trial-and-error experiments came from trying to wring more space from their cramped dorm room. Their idea: drill holes in the concrete ceiling and hang their beds up high with metal chains. “I had just come from a farm, and I thought I could rig up just about anything,” Dr. Graham said.

They hoisted the beds on the chains and slept soundly for weeks. One night, Dr. Gruber’s bed came untethered, sending him crashing into his desk below. The roommates made some design tweaks, and the beds remained suspended through graduation four years later.

The two men lost track of one another after leaving Rice for medical school, Dr. Graham at the University of Kansas, Dr. Gruber at Baylor College of Medicine.

At a 1986 medical conference in New Orleans, Dr. Gruber, then a pediatrician at Baylor, was setting up a display of research findings for an illness called respiratory syncytial virus, known as RSV, that can kill infants and the elderly. He was shocked to see his former roommate standing next to him, showing his own research on the same virus.

“It was a pretty remarkable coincidence,” said Dr. Graham, who was an assistant professor at Vanderbilt’s vaccine research center at the time. The two men caught up, and Dr. Gruber soon joined Dr. Graham at Vanderbilt.

They remained in Nashville through the 1990s and occasionally co-wrote papers on virus research, a field they had found independently.

“We’re almost like the double helix,” Dr. Gruber said, not surprisingly using a DNA analogy. “We spread apart and come back together, spread apart and come back together.”

In 1999, Dr. Gruber left to pursue vaccine development at drugmaker Wyeth (later acquired by Pfizer). A year later, Dr. Graham joined a new vaccine research center at the National Institutes of Health. Again, years passed with little contact.

Dr. Graham’s lab made a breakthrough in 2013 regarding the structure of an important protein in RSV, a finding that laid the groundwork to understanding the spike protein in the new coronavirus.

He couldn’t present his findings at a planned medical conference because of a two-week government shutdown that kept federal employees from traveling. He and his wife instead used the time for a road trip that took them close to Dr. Gruber’s house in upstate New York. Dr. Graham left a voice mail. Dr. Gruber called back and invited the couple to his house for dinner.

Sitting at the kitchen table, Dr. Gruber said he heard about his former roommate’s breakthrough research. Dr. Graham opened his laptop and flipped through the PowerPoint slides on RSV he had prepared for the conference. “I can kind of hear the echo of my wife saying, ‘Why are we talking about this during dinner?’ ” he recalled.

Dr. Gruber sent a team from Pfizer to visit Dr. Graham’s government lab in Maryland to discuss the research. Pfizer relied on the lab’s advances to develop its own RSV vaccine, which is now in human testing.

The Covid-19 pandemic brought the two men together one more time.

Dr. Graham’s lab joined with Moderna to design a vaccine using a new and unproven gene-based technology called mRNA. The day after the Moderna vaccine began human trials in March, Pfizer announced its own vaccine partnership with BioNTech SE, also using mRNA.

They spoke by phone a few times each month, discussing the biology of the virus and its impact on their lives. They exchanged emails and texts as the global death toll rose into the hundreds of thousands.

The Pfizer and Moderna vaccines started late-stage, or Phase 3, trials the same day in July. In early November, Pfizer announced its positive results, and a month later was cleared for use by the Food and Drug Administration. Moderna’s authorization followed by a week.

“The fact is that we both want everybody to win here,” said Dr. Graham, deputy director of the National Institute of Allergy and Infectious Diseases Vaccine Research Center.

Looking back, Dr. Graham said, he and Dr. Gruber “marvel at how over 50 years this all transpired.”

When the topic of their competitive spirit came up during a Rice alumni panel last year, Dr. Gruber joked how Dr. Graham had reminded him how Pfizer’s trial started several hours behind Moderna’s.

Dr. Gruber also offered this advice to the students listening in.

“Get along with your fellow roommates,” he said, “you just never know where that path is going to lead.”

BY the age of 3, virtually every American child has had at least one respiratory infection caused by a virus that few people have heard of and fewer still take seriously. It is respiratory syncytial virus, or R.S.V., which was first discovered in chimpanzees in 1956 but was soon recognized as a nearly universal cause of a cold-like illness in people.

Regardless of its relative obscurity and usually benign nature, R.S.V. is not an organism to be taken lightly. An R.S.V. infection can result in serious, even fatal, respiratory illness when it infects very young infants or any children with medical conditions like congenital heart or lung disease or respiratory damage after premature birth.

R.S.V., a highly contagious virus, is the leading cause in young children of severe lower respiratory illness -- bronchiolitis and pneumonia -- which often requires hospital treatment. Each year, 90,000 children are hospitalized with R.S.V., and the virus is responsible for an estimated 4,500 childhood deaths. It can be a very expensive illness, costing more than $5,000 a day to treat infants who need respiratory assistance and a total of $77,600 for a two-week hospital stay. In addition, after recovering from R.S.V., some children develop an asthmatic condition that can persist throughout childhood and occasionally into adulthood.

Adults too sometimes become very ill with an R.S.V. infection. In most adults, the virus causes a mild respiratory infection that is clinically indistinguishable from any other common cold. But British researchers reported last year that in elderly people R.S.V. might be as important as influenza viruses in causing serious and even fatal respiratory illness. The virus's symptoms in the elderly often mimic those of influenza, Dr. D. M. Fleming and Dr. K. W. Cross of the Birmingham Research Unit in England reported in The Lancet, a medical journal published in Britain. In fact, the researchers suggested that R.S.V. infections might be one reason flu vaccine appears to be less effective in older people; such people may think they have the flu but actually have R.S.V.

The "season" for R.S.V. infections in the temperate zone starts in December, peaks in January and February and peters out in April. There is no better time than now to learn how best to protect very young and high-risk children and how to recognize and deal with a serious R.S.V. infection should it occur. Is It R.S.V.?

Dr. Susan Brugman, a pediatric pulmonologist at the National Jewish Center for Immunology and Respiratory Medicine in Denver, said R.S.V. typically started like any cold: in the upper respiratory tract, causing a runny nose, slight fever and fussiness. But the infection can then move into the lower respiratory tract -- the bronchioles and lungs. She explained that although "the majority of babies are not at risk of developing severe R.S.V., infants under 6 months of age have much smaller airways that are more likely to become plugged up, making breathing difficult."

Dr. William C. Gruber, a specialist in pediatric infectious diseases at Vanderbilt University in Nashville, said the virus spread to the lower respiratory tract in about 20 percent of infected children. Signs of such spread include wheezing, a sinking of the chest between the ribs when the child inhales, rapid breathing and halted breathing for periods of time.

Dr. Brugman cautions parents to be on the alert for a serious infection. "The infection has become severe if the baby begins to breathe faster, has difficulty breathing, wheezes and coughs and stops drinking fluids," she said. "That's the time to see a physician right away. And especially if the baby was born prematurely, has congenital heart disease or cystic fibrosis, the sooner the baby gets to the doctor the better."

Babies with such respiratory symptoms should always have their blood checked to see if they are getting enough oxygen. Even if the baby does not look blue, more oxygen may be needed, Dr. Brugman said. Although a 20-minute antibody test for the viral infection can be performed in a doctor's office, the test is complex and the diagnosis of R.S.V. is more often made in a hospital laboratory, Dr. Gruber said.

Reinfection is common, but the severity of the illness nearly always diminishes with age. Other less serious complications of R.S.V. infection in young children include tracheobronchitis, middle ear infection and reactive airway disease, a tendency to wheeze when exposed to any respiratory irritant. Most children outgrow wheezing by the time they are 3 to 5 years old, but some develop persistent asthma. Dr. Brugman said those at high risk of developing asthma included babies with a family history of asthma, those who already had allergies and babies exposed to cigarette smoke or other environmental irritants at home. How It Spreads

There may be no virus more efficient at finding hosts than R.S.V. The organism can live on surfaces and clothing for hours, sometimes days, Dr. Brugman said. "Good, frequent hand washing is the single most important thing to do to curb the spread of this disease," she noted. "You can easily infect yourself after touching a contaminated surface and then touching your nose or eyes."

Likewise, an adult whose hands become contaminated by a child's virus-laden secretions can readily spread the infection to other children. Dr. Brugman noted, for example, that "almost 100 percent of children in a day care center will get R.S.V. if one child does." The infection often becomes epidemic in hospital settings, presumably spread by health professionals from child to child. Dr. Brugman said the risk of R.S.V. was the primary reason for avoiding elective pediatric surgery at this time of year.

About the only effective treatment for infection by the virus is the antiviral agent ribavirin (Virazole). When administered as an aerosol to hospitalized children, it can reduce the severity of lower respiratory infections.

Although antibodies to the virus form after an R.S.V. infection, they are not very protective, and no lasting immunity develops. A previous attempt to develop a vaccine against R.S.V. ended in disaster, with vaccinated children developing very serious and even fatal disease.

Researchers have also experimented with passively immunizing babies at high risk of severe R.S.V. infection by giving them intravenous injections of antibodies extracted from the blood of people, like pediatric nurses, who have high antibody levels.

Dr. Gruber and Dr. Kathy Neuzil, an infectious disease specialist, are exploring the value of extra doses of vitamin A in reducing the severity of infections from the virus. He explained that levels of vitamin A in the blood dropped after an R.S.V. infection, and that this might interfere with the repair of respiratory lining cells damaged by the infection, leading to more severe disease.

Pfizer Inc. PFE 3.40%▲ said its Trumenba meningitis B vaccine showed positive results when administered with meningitis vaccines approved for other strains of the disease met its goals in a Phase 2 study for children ages 10 through 12.

The pharmaceutical company also said data from a recent a Phase 3 study further demonstrated the safety and tolerability of Trumenba for ages 10 through 25. The company said the latest results were consistent with data that supported the vaccine receiving accelerated approval in October from the U.S. Food and Drug Administration for Trumenba for ages 10 through 25. The approval was for active immunization to prevent invasive disease caused by Neisseria meningitidis serogroup B in individuals 10 through 25 years of age.

William Gruber, senior vice president of Vaccine Clinical Research and Development for Pfizer, said the results in the Phase 2 study provide evidence that the company has shared with the Centers for Disease Control and Prevention’s advisory committee on immunization practices to review as they consider recommendation of meningococcal B vaccination for adolescents and young adults.

Meningitis, a life-threatening bacterial disease spread by respiratory secretions, affects about 500 mostly young Americans a year; vaccines already exist for the four other known strains, A, C, Y and W. About 160 cases were caused by meningitis B in 2012.

Pfizer had been racing with Novartis, which has a similar meningitis B vaccine. The Novartis vaccine is among the products GlaxoSmithKlineis buying from its European peer. Bexsero—which has been approved in Canada, the EU and dozens of other countries—has gotten FDA breakthrough-therapy designation, and an approval decision is expected by March 24. Some analysts predict Bexsero’s efficacy could help it catch up and capture a good chunk of the market.

After Covid-19, vaccine makers’ next big target is a respiratory virus that kills up to 500 children a year nationwide and has been among the leading causes of U.S. hospitalizations for decades.

The respiratory syncytial virus, or RSV, infects nearly everyone at some point, causing mild, cold-like symptoms for most people. But it can lead to serious health problems such as difficulty breathing and pneumonia for infants and older adults.

The virus has for decades eluded efforts to develop a vaccine, including a major setback in the 1960s when an experimental shot harmed some children in testing. RSV is one of the last remaining childhood diseases without an approved vaccine.

Now several drugmakers including Pfizer Inc., Johnson & Johnson, Moderna Inc. and GlaxoSmithKline PLC are testing shots that infectious-disease specialists say show promise at safely preventing RSV disease. Initial development of most of these vaccines predated the current pandemic, but the rapid success in finding effective Covid-19 vaccines has energized the RSV effort, according to analysts.

If large studies under way in tens of thousands of subjects validate safety and effectiveness, Pfizer, J&J and GlaxoSmithKline say they plan to file for regulatory approval later this year. That could lead to one or more of the shots becoming available next year, according to the companies and analysts.

The shots could be given to older adults or to pregnant women to protect their newborns from RSV in the first few months of life. Sanofi SA and AstraZeneca PLC are developing an antibody-based drug that could be given directly to newborns to prevent RSV disease.

“The impact would be huge,” said Dr. Janet Englund, a respiratory-virus specialist at Seattle Children’s Hospital who has focused on RSV research. “It would change hospitalization rates. Young babies wouldn’t have to come to the hospital so much.”

RSV vaccines could be a significant new source of revenue for drugmakers. SVB Leerink analysts have estimated that the RSV vaccine market could reach at least $10 billion in global revenue. Pfizer this month agreed to acquire ReViral Ltd., which is developing treatments for RSV.

Each year RSV infections result in about 58,000 hospitalizations of children under 5 years old and 177,000 hospitalizations of adults 65 and older, according to the Centers for Disease Control and Prevention. While most children survive, RSV kills up to 500 children in the U.S. each year and about 14,000 older adults each year—a toll that approaches that of influenza.

In the elderly, “If a person has chronic lung disease or if they’ve had a heart attack or some underlying condition, they are at increased risk of dying from an RSV infection,” said H. Cody Meissner, chief of the division of pediatric infectious disease at Tufts University School of Medicine.

As with the flu, RSV season typically runs from late fall to spring. The Covid-19 pandemic disrupted that pattern, as distancing and masking suppressed RSV in the normal 2020-21 season. But cases jumped abnormally last summer as people took fewer precautions.

In the absence of a vaccine, certain infants at high risk of serious RSV disease, such as premature babies, have been given a preventive drug called Synagis since the late 1990s. While it has been shown to reduce the risk of RSV-related hospitalizations, doctors say it is expensive and must be administered frequently during RSV season.

In the 1960s, an experimental RSV vaccine made some infants and toddlers more susceptible to severe disease after they were exposed to the illness, including two who died. Researchers cited the design of the vaccine, which used a killed version of the virus and triggered a type of immune response that can enhance disease rather than preventing it.

The newer vaccines have designs different from the one that failed in the 1960s, helped by a research breakthrough a decade ago at the U.S. National Institute of Allergy and Infectious Diseases’ vaccine-research center.

The government scientists homed in on a shape-shifting protein—the fusion, or F, protein—found on the RSV’s surface that helps the virus attach to and enter human cells to replicate. They found that a vaccine containing the F protein—engineered to stay locked in a “prefusion” structure—could induce immune-system antibodies against the virus in animal testing, said Peter Kwong, chief of structural biology at NIAID’s vaccine-research center.

“The major breakthrough has been a better understanding of the actual structure of the F protein,” said Dr. Kathryn Edwards, scientific director of Vanderbilt University’s vaccine-research program.

The advance paved the way for vaccine companies to develop shots that contain some version of the protein and to test them in people.

To mitigate safety risks in infants, most companies have opted for an indirect route of immunization: vaccinating pregnant women in hopes they would pass antibodies to their unborn babies, which could then protect infants for several months after birth.

Pfizer’s experimental, protein-based RSV vaccine, known as RSVpreF, generated what the company said were promising results in a midstage study of pregnant women in 2020.

The drugmaker is now running a large study of up to 10,000 pregnant women and expects initial results by the end of June. Researchers are tracking whether children born to vaccinated mothers show reduced rates of lower-respiratory infections than those born to mothers who get a placebo in the study.

Pfizer expects that every pregnant woman would routinely receive the vaccine, similar to how the Tdap vaccine is recommended during pregnancy to protect newborns from pertussis, or whooping cough, said Bill Gruber, senior vice president of vaccine clinical research and development at the company.

Safety concerns still loom over the efforts. GlaxoSmithKline in February stopped enrollment in a large study of its vaccine in pregnant women, citing an unspecified safety signal from the trial.

GlaxoSmithKline is investigating that issue, said Roger Connor, president of the company’s vaccine unit. He declined to describe the nature of the issue.

The study pause doesn’t affect a separate trial of a GlaxoSmithKline RSV vaccine in older adults, which is continuing, Mr. Connor said. The company expects results for that study, in people 60 and older, by midyear.

J&J’s RSV vaccine was 80% effective in protecting against lower-respiratory disease caused by RSV in a midstage study of adults 65 and older. The company is testing the vaccine in a larger, late-stage study and expects to have results later this year.

J&J also is exploring the use of an RSV vaccine to protect children but hasn’t brought one into large-scale testing, said Penny Heaton, global therapeutic area head of vaccines at J&J’s Janssen R&D unit.

Moderna is developing an RSV vaccine that, unlike some of the others, doesn’t contain the F protein from RSV. Instead, similar to the design of its Covid-19 vaccine, Moderna’s RSV shot contains the genetic material messenger RNA, which is coded to instruct human cells to make the F protein, in turn inducing an immune response.

Moderna is also exploring a vaccine that could target RSV and the flu and provide a Covid-19 booster in a single injection.