This year, the Food and Drug Administration approved the first two vaccines that can protect older adults against respiratory syncytial virus, which causes at least 6,000 deaths and 60,000 hospitalizations annually among adults 65 and older.

This winter will be the first opportunity to see how the RSV vaccines work for older adults in the real world – provided those at highest risk get vaccinated.

But while cases have risen nationwide in recent months, only 14.8 percent of adults 60 and older have been vaccinated against the virus. That’s what the Centers for Disease Control and Prevention says this month.

The CDC, citing a need for more data on potential safety issues that have arisen during clinical trials, has not made a blanket recommendation for every person age 60 and older to get the shot this year. Instead, health officials have said vaccination should be targeted at people most at risk of severe disease, including people with underlying medical conditions and people 75 and older, among others.

Still, experts said they hoped vaccination rates would be much higher by now and pointed to a host of obstacles to the new vaccinations. After the prolonged urge for Covid injections, people can feel this “vaccine fatigue” said Dr. Kathleen Linder, an infectious disease specialist at Michigan Medicine. The pandemic has also fueled vaccine hesitancy, she added. In addition, experts noted that some people with private insurance have been billed more than $300 to get the RSV vaccine, which could deter others from seeking the shot.

“We haven’t organized ourselves optimally,” said Dr. William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine. “This first year is a training year. We will have to figure out how to do this better in the future.”

Many older adults may also be unaware of the serious threat RSV poses to them, says Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. “People have this idea that RSV is a childhood disease,” he said. Although the virus usually causes cold symptoms in most people, it can lead to serious lung problems such as pneumonia and even death in older adults, infants, and people with weakened immune systems.

What you should discuss with your doctor

In clinical trials, the vaccines – one developed by Pfizer and another by GSK – reduced the risk of lower respiratory diseases, such as pneumonia due to RSV, in the first virus season after vaccination. Vaccination may be especially critical for people with diabetes conditions such as chronic heart or lung disease or a weakened immune system.

“If you’re at high risk, it’s a no-brainer,” said Dr. Chin-Hong.

The older you are, the greater your risk for severe RSV. The virus is especially dangerous for people 75 and older, said Dr. Camille N. Kotton, an infectious disease physician at Massachusetts General Hospital and a member of the CDC Advisory Committee on Immunization Practices. If you live in an environment like a nursing home, you are also at greater risk.

However, it’s not clear that every healthy 60-year-old with no underlying medical conditions would “really benefit” from the vaccine, said Dr. Kotton.

If you are 60 years or older, experts recommend talking to your doctor or pharmacist about your risk and whether the injection is right for you.

People who get vaccinated can experience fatigue, fever and pain at the injection site. Clinical trials of the vaccines also showed a “very small but somewhat concerning” safety signal, Dr. Kotton.

Of the approximately 38,000 older adults who received either vaccine in clinical trials, 20 experienced atrial fibrillation and six were reported to have developed neurological complications in the weeks after vaccination, including encephalitis and a rare autoimmune disease called Guillain-Barré -syndrome.

“At this time, there is not enough information to determine whether these findings are simply due to chance, or whether they represent an increased risk of neurological side effects,” says Dr. Michael Melgar, a medical officer with the CDC’s Coronavirus and Other Respiratory Viruses. Division, wrote in an email.

So far, however, safety data from the more than five million doses administered to people 60 and older are reassuring, said Dr. Sarah S. Long, a professor of pediatric infectious diseases at Drexel University College of Medicine and a member of the CDC Advisory Committee on immunization practices. “We’ll keep looking and I think it will become clear,” she said.

If you’re interested in the RSV vaccine, you may want to get the shot sooner rather than later, especially as the holidays loom, said Dr. Seth Cohen, medical director of infection prevention at the University of Washington Medical Center.

You may also want extra protection if you are 60 or older and come into contact with young children, who may be more likely to have the virus and also at risk of serious complications.

“Having this vaccine is a major victory in our fight to keep people out of the hospital and protect older people during respiratory virus season,” said Dr. Cohen.

Major outbreaks of diseases that kill mostly children are spreading around the world, a grim legacy of disruptions to healthcare systems during the Covid-19 pandemic, which has left more than 60 million children without a single dose of standard childhood vaccines.

By mid-year, 47 countries reported serious measles outbreaks, up from 16 countries in June 2020. Nigeria is currently facing the largest diphtheria outbreak in its history, with more than 17,000 suspected cases and almost 600 deaths to date. Twelve countries, from Afghanistan to Zimbabwe, report circulating poliovirus.

Many of the children who missed their vaccinations have now forgone routine immunization programs. So-called ‘zero-dose children’ are responsible for almost half of all child deaths from vaccine-preventable diseasessaid Gavi, the organization that helps finance vaccination in low- and middle-income countries.

Another 85 million children have been under-immunized as a result of the pandemic – meaning they have received only part of the standard course of different vaccinations needed to be fully protected against a particular disease.

The costs of the inability to reach these children are quickly becoming apparent. The number of deaths from measles increased by 43 percent (to 136,200) in 2022 compared to the previous year a new report from the World Health Organization and the Centers for Disease Control and Prevention. The figures for 2023 indicate this the total could be twice as high again.

“The decline in vaccination rates during the Covid-19 pandemic has led us directly to this situation of rising disease and child mortality,” said Ephrem Lemango, UNICEF deputy director of immunization, who is responsible for the supply of vaccines to almost half of children in the world every year. . “With each new outbreak, the toll on vulnerable communities increases. We must act quickly now and make the investments needed to catch up with the children who have been missed during the pandemic.”

One of the biggest challenges is that the children who missed their first vaccinations between 2020 and 2022 are now older than the age group typically seen routinely in primary health care centers and in normal vaccination programs. Reaching them and protecting them from diseases that can easily become fatal in countries with the most vulnerable healthcare systems will require an extra boost and new investments.

“If you were born within a certain time, you will be missed, period, and you will not be caught just trying to restore normal services,” said Lily Caprani, UNICEF’s chief of global advocacy.

UNICEF is asking Gavi for $350 million to buy vaccines to reach these children. Gavi’s board of directors will consider the request next month.

UNICEF is urging countries to carry out a catch-up vaccination blitz, an exceptional, one-off program to reach all missed children between the ages of 1 and 4.

Many developing countries have some experience in conducting catch-up campaigns against measles, targeting children aged 1 to 5 years, or even 1 to 15 years, in response to outbreaks. But now those countries must also supply the other vaccines and train staff – mostly community health workers who are only used to vaccinating babies – and procure and distribute the actual vaccines.

Dr. Lemango said that despite the urgency of the situation, it had been a struggle to put plans in place for such campaigns and that he hoped most of them would come together by 2024.

“When we came out of the pandemic there was a hangover – no one wanted to run campaigns,” he said. “Everyone wants to return to normality and regularly strengthen immunization. But we already had unfinished business.”

In some countries, such as Brazil, Mexico and Indonesia, healthcare systems have recovered from the severe disruption caused by Covid-19 and have returned to or even exceeded pre-pandemic vaccination rates. But others – especially countries where vaccination rates were already significantly lower than UNICEF targets – have not caught up to their previously lower levels.

The countries with the most zero-dose children are Nigeria, Ethiopia, India, the Democratic Republic of Congo and Pakistan. Many with the lowest coverage levels are facing mounting challenges, such as the civil conflicts in Syria, Ethiopia and Yemen, the growing population of climate refugees in Chad, and both issues in Sudan.

Ghana’s experiences are representative of the challenges of many lower-income countries. Parents were unable to take their children for routine shots when communities went into lockdown to protect against Covid, and when those restrictions were lifted, many parents still stayed away for fear of infection, said Priscilla Obiri, a community nurse in charge of vaccinations. in low-income fishing communities on the outskirts of the capital Accra.

Of the children Ms. Obiri sees today at a typical pop-up vaccination clinic, where she sets up a table and a few chairs in the shade at an intersection, as many as a third will receive incomplete vaccinations, or sometimes no vaccinations at all. , she said. She agrees with their mothers on a plan to close the gap.

But some parents cannot or do not want to take their children to a clinic. “We have to go to the community and hunt them,” she said.

As Ms. Obiri and her colleagues try to regain that lost ground, they face a new challenge: misinformation campaigns and hesitancy about Covid vaccines have overcome and eroded some of parents’ traditional eagerness to get their children routine immunizations, according to the Vaccine. Confidence Project, a long-term research initiative at the London School of Hygiene and Tropical Medicine.

“Across 55 countries, there was a steep decline in the number of people who said routine immunization is important for children between 2015 and 2022,” said the project’s director, Heidi Larson, whose team collected what she described as “robust global polling data.” ” in more than 100 nationally representative surveys.

Even as people around the world looked for information about vaccines, there was a rise in misinformation and disinformation, she said, and people with low trust in officials and official guidance were particularly vulnerable to believing alternative sources of information.

Dr. Kwame Amponsah-Achiano, who oversees Ghana’s child immunization programme, said he did not believe confidence had dropped during the Covid pandemic. Demand remains high and has exceeded the program’s supply in some areas, he said.

Ms Caprani said UNICEF had discovered that both problems were occurring in parallel.

“You can see that demand is not only outpacing physical supply, but also outpacing access – easy, affordable, accessible access – and at the same time seeing declining confidence,” she said. “They’re not necessarily the same people.”

Last year, 22 million children missed the routine measles vaccination given in their first year of life – 2.7 million more than in 2019 – while another 13.3 million did not receive their second dose. To achieve herd immunity and prevent outbreaks, 95 percent of children must receive both doses. Measles acts as an early warning system for immunization gaps because measles is highly transmissible.

“There are communities where a measles outbreak is a bad thing, and there are communities where it is a death sentence, due to the combination of other risk factors such as poor malnutrition, poor access to healthcare and poor access to clean water.” Mrs. Caprani said.