Why haven’t more older adults gotten the RSV vaccine?

Toby Gould was an early adopter. In September, Mr. Gould, 78, went to a pharmacy in Hyannis, Massachusetts, to get one of the new vaccines for the respiratory syncytial virus, known as RSV. He has asthma, which would increase his risk of serious illness if he were to become infected.

Carol Kerton, 64, knew RSV could be dangerous: Her three-year-old granddaughter had such a serious illness that she was taken to the emergency room. Ms. Kerton was vaccinated at a local grocery store in Daytona Beach, Florida, in September.

Sam Delson, 63, received the RSV vaccine last month in Sacramento. His doctor recommended it, he said, “because I am over 60 and have a somewhat weakened immune system” after a long-ago battle with cancer.

They are the exceptions. Only so far about 15 percent of Americans over 60 have received one of two new RSV shots, which the Food and Drug Administration approved in May, which are the first-ever vaccines against the disease. Only 16 percent more said they definitely planned to do so, according to the Centers for Disease Control and Prevention.

In contrast, more than 62 percent of adults over 65 received the recommended flu shot this fall, and a third received the updated Covid-19 vaccine.

“It’s a new vaccine and people are trying to figure out whether they need it or not,” said Dr. Preeti Malani, a geriatrician and infectious disease specialist at University of Michigan Health.

That is, if they know anything about the RSV vaccines at all. a national survey This summer it turned out that almost half of people between the ages of 60 and 80 had never heard of it.

The CDC recommends the RSV vaccines for people over 60, after individual discussions with their healthcare providers, something called ‘shared clinical decision making’. Medicare Part D, Medicaid, and most private insurers cover the full cost.

The fact that elderly people are vulnerable to RSV is an unknown concept for many people. For decades, the virus was mainly considered a threat to infants and young children. Most doctors “were taught when they went to medical school that RSV was a childhood disease,” says Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “It is still the leading cause of infant hospitalizations in the US”

But the FDA estimates that the virus sends 60,000 to 160,000 people over 65 to hospitals every year and causes 6,000 to 10,000 deaths. Other published estimates are even higher.

“It is a highly contagious virus,” said Dr. Malani. Although children can get quite sick, “a four-year-old with a runny nose may have RSV more often and not get very sick; it looks like a common cold,” she said. However, she added: “The grandparents could get pneumonia.”

The risk of becoming seriously ill from RSV increases significantly with age. The number of hospital admissions among people between the ages of 70 and 80 is rising sharply, especially among people with chronic heart and lung diseases such as asthma, heart failure and chronic obstructive pulmonary disease. Older adults with diabetes or liver and kidney disease, or a weakened immune system, are also at greater risk. Adults can become infected repeatedly, and there is no medicine that alleviates the disease, as there is with the flu and Covid-19.

A study published in The New England Journal of Medicine in 2005 followed patients over four winters and reported that among high-risk patients (their average age was 70 years) with heart failure or lung disease who contracted RSV, 16 percent required hospitalization. In another cohort of older patients hospitalized with respiratory symptoms (with a mean age of 75 years) and diagnosed with RSV, 15 percent ended up in intensive care.

The new RSV vaccines are very effective. Clinical trial results showed that Arexvy, the shot made by GSK, was 94 percent effective against serious disease in older adults. Pfizer’s shot, called Abrysvo, was 86 percent effective against severe disease.

So why haven’t the vaccines achieved more success among their intended recipients?

One reason: A joint decision-making recommendation from the CDC could lower vaccination rates, said Dr. Schaffner, because “you can’t promote it with the same intensity and certainty as you would with a blanket recommendation” – like the one recommending flu shots. anyone over 6 months old.

Seniors are also now receiving multiple public health messages about seasonal vaccinations. “A few years ago we all recommended one vaccine every winter: flu,” said Dr. Schaffner. “We haven’t yet organized ourselves to be convincing in getting people to accept three seasonal vaccines,” for flu, Covid-19 and now RSV (getting two or three at a time is fine, the CDC says).

When R. Jessica Jones, 76, who lives in Haiku, Hawaii, texted her doctor about seasonal vaccinations, he responded that she should get the Covid-19 booster and a flu shot, but that getting an RSV vaccine was “optional.” used to be.

Mrs. Jones asked in surprise why. He told her he thought the data on their safety and efficacy was “limited” (the FDA disagreed), so she skipped getting it.

“When healthcare providers are confused, patients are confused too,” says Dr. Malani of University of Michigan Health. “If we really want inclusion in the population that could benefit, we need to provide clear information to doctors and others.”

While some health care providers hope to improve vaccination rates among older Americans, vaccine manufacturers are apparently thrilled with the number of people who are seeking the shots so quickly after shipping them to pharmacies, hospitals and doctors’ offices last summer. The manufacturers are collecting data on the effectiveness and side effects of the vaccines and – a central unanswered question – how often people need to be revaccinated to maintain protection.

“For a new class of vaccines, this is really fantastic,” says Dr. Len Friedland, who leads public health for GSK Vaccines.

“There will always be setbacks,” he said. “But overall things are going very well and we are not hearing of any access issues for patients.”

Dr. Nathaniel Hupert, co-director of the Cornell Institute for Disease and Disaster Preparedness, was more cautious. Fifteen percent is “a lot better than zero,” he said, noting that no prevention was available against RSV until last summer. But, he said, “if you want to eradicate RSV, it’s not going to happen with this level of coverage.”

Other manufacturers have RSV vaccines in development, and older Americans may eventually enjoy greater protection as more pregnant women and babies are immunized, as the CDC recommends. “Children have the distribution franchise for these respiratory viruses every winter,” said Dr. Schaffner of Vanderbilt University Medical Center.

Over time, “we will likely see less RSV transmission from children to their grandparents,” said Dr. Hupert. “But we’re not there yet.”