The Dallas observational study in Public Health Reports reveals maternal RSV vaccination (Abrysvo) at 32-36 weeks lowered infant hospitalizations during 2023-2024, yet private insurance drove 37% uptake versus 2% for public coverage. This single-center analysis, likely under 500 participants based on clinic descriptions, is observational and thus prone to confounding by socioeconomic status, unlike the large double-blind RCT in the NEJM MATISSE trial (n=7,358 pregnancies) showing 67% efficacy against severe RSV in infants through 6 months with no major conflicts disclosed. The source underplays how these access barriers echo patterns from Tdap and flu maternal vaccines, where Black and Hispanic women face 20-30% lower rates tied to reimbursement rather than hesitancy alone. A CDC observational analysis of 2023-2024 data across 10 states confirmed 50-60% reductions in RSV admissions among vaccinated cohorts but flagged similar insurance-linked disparities. Synthesis shows the vaccine's one-sentence benefit—fewer winter breathing crises for newborns—remains potent in trials yet diluted by policy gaps, as uninsured multiparous women under 30 were least reached. Equity fixes like expanded federal reimbursement could close the loop faster than new campaigns.