Since their approval in 2023, new vaccines to protect older adults against respiratory syncytial virus (RSV) have proven highly effective, but uptake remains surprisingly low. In a recent commentary published in The Lancet, Dr. Angela Branche, an infectious diseases expert at the University of Rochester Medical Center, reviewed the RSV Vaccines real-world impact and emphasized the urgency of broader public adoption.
Strong Protection for High-Risk Adults: RSV Vaccines
RSV is a significant cause of severe respiratory illness among older adults, especially those with chronic health conditions. Globally, RSV is responsible for millions of infections and tens of thousands of deaths annually in adults aged 60 and older. In the United States, adults over 65 account for a significant number of RSV-related hospitalizations, intensive care unit admissions, and deaths — even outpacing flu and COVID-19 in severity for this age group.
In 2023, the U.S. Food and Drug Administration (FDA) approved RSV vaccines from Pfizer, GSK, and Moderna for adults over 60. Large-scale studies demonstrated that these vaccines prevented RSV-related pneumonia and bronchitis in more than 80% of participants. A subsequent real-world analysis using CDC-supported electronic health record networks confirmed that the vaccines were 80% effective at preventing hospitalization, ICU admission, and death across multiple subgroups, including individuals aged 75 and older and immunocompromised.
Uptake Falls Short of Expectations
Despite strong clinical evidence, only about 24% of U.S. adults aged 60 and older received the RSV vaccine during the 2023–2024 winter season. This contrasts with influenza vaccination rates, which regularly approach 50% for the same age group.
Dr. Branche pointed to several causes for the low uptake, including uncertainty among healthcare providers regarding shared decision-making guidelines and a widespread lack of public awareness about RSV’s risks. “Providers were not sure how to apply the shared clinical decision-making recommendations in the first season, and there remains a general lack of knowledge… on who needs to be protected,” she said.
Updated Recommendations and New Vaccine Research
In response to mounting evidence, the U.S. Advisory Committee on Immunization Practices (ACIP) updated its guidance in June 2024. The panel now recommends RSV vaccination for all adults aged 75 and older and those 60 and older who live in long-term care facilities or have chronic or high-risk medical conditions.
“These more definitive recommendations will build public confidence in the effectiveness of these vaccines and make implementation a lot easier for providers and pharmacies,” Branche stated.
Looking ahead, researchers are developing next-generation RSV vaccines that could offer longer-lasting protection. In a study recently published in the New England Journal of Medicine, a bivalent RSV vaccine from Pfizer — designed to target multiple virus strains — demonstrated over 80% efficacy in preventing severe lower respiratory tract illnesses over two RSV seasons. The trial showed powerful results in adults aged 60 to 79. As RSV season approaches again, experts stress that the risk to older adults remains significant — but preventable with timely vaccination.
Reference: Angela R Branche. Real-world effectiveness studies of the benefit of RSV vaccines. The Lancet, 2024.
