Why Are So Few Older Adults Getting the RSV Vaccine?

The virus can be dangerous for older adults; a shot can help provide protection

Rachel Nania,

AARP

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En español

Published October 02, 2023

/ Updated February 27, 2024

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For the first time, adults 60 and older have a way to lower their risk of getting sick with RSV, or respiratory syncytial virus, a common bug that sends as many as 177,000 Americans 65-plus to the hospital each year.

Over the summer, the Food and Drug Administration (FDA) approved two RSV vaccines for adults 60 and older, and the shots became available in pharmacies and doctors’ offices in time for RSV season, which typically begins in the fall and peaks in the winter. (Under 60? The FDA also approved an RSV vaccine for pregnant women and two RSV monoclonal antibodies for infants.)

But so far, few adults have rolled up their sleeves for the vaccine. About 22 percent of Americans 60 and older had received the shot as of Feb. 23, the Centers for Disease Control and Prevention (CDC) reports.

A few reasons could be contributing to the low uptake, says William Schaffner, M.D., an infectious disease specialist and professor of medicine at Vanderbilt University School of Medicine in Nashville.

“The first is, it’s new,” Schaffner says. “It’s new to practitioners, and it’s new to patients. And they’re having to learn about RSV in older adults and how important it is.”

While often thought of as an illness that affects mostly babies and young children, RSV can be dangerous for older adults too — especially those with underlying health conditions. The CDC reports that as many as 10,000 older Americans die each year from an RSV infection, which is comparable to the number of deaths we see from flu.

During the 2022–23 flu season, about 15,400 adults 65 and older died from influenza; the previous year, 4,115 older Americans succumbed to the flu, according to CDC data. So far this season, nearly 74 percent of adults 65 and older have received a flu shot.

“I think that people don’t always recognize the actual burden of disease in older adults from RSV,” says Hilary Marston, M.D., chief medical officer of the FDA. Indeed, research from AARP found that the most common reason survey respondents gave for not getting vaccinated against RSV was that they didn’t need it. “There really is quite a bit of both morbidity and mortality in older adults from RSV,” Marston points out.

Health insurance coverage may be another factor feeding the low vaccination rates, Schaffner says. Unlike the flu and COVID-19 vaccines, which are covered under Medicare Part B, the RSV vaccine is covered under Part D. “And not every Medicare recipient has elected Part D,” Schaffner adds. Part B covers doctor visits and other outpatient services while Part D helps pay for prescription drugs mostly dispensed at pharmacies.

Even for those who do have the prescription drug plan, Part D vaccines are not always offered at the doctor’s office, so patients have to make a separate trip to a pharmacy to get the shot, Schaffner explains.

For those ages 60 to 64, private insurance plans are required to cover the RSV vaccine, but “not every medical insurance program has yet integrated RSV into their benefits packages,” Schaffner says.

The RSV vaccines cost around $300 on the commercial market.

Who should get the vaccine?

The recommendation isn’t universal, like it is for the influenza and COVID-19 vaccines. Rather, the CDC says older adults should talk to their doctor about whether they need the RSV vaccine.

There are people “who are going to most benefit from this vaccine,” says Chad D. Neilsen, an infectious disease epidemiologist at University of Florida Health in Jacksonville — and it’s individuals who are at higher risk for severe illness from an RSV infection.

This population includes people who live in nursing homes and other group settings, individuals who are immunocompromised and adults who have underlying health conditions, such as:

Diabetes
Diseases that affect the heart and lungs, including COPD (chronic obstructive pulmonary disease) and asthma
Kidney disorders
Liver disorders
Neurologic or neuromuscular conditions
Blood disorders

A recent study from the CDC looked at 1,634 adults age 60 and older who were hospitalized with RSV between July 2022 and June 2023 and found that most patients had at least one underlying health condition, such as obesity, COPD, diabetes or congestive heart failure.

The CDC says adults who are frail and those of advanced age are also at high risk, since the immune system weakens as you get older.

“Most healthy 60-year-old individuals who don’t live in group settings, are not immunocompromised, don’t have underlying health factors — their bodies can probably handle fighting off RSV without a vaccine,” Neilsen says, although it’s important to discuss the decision with your doctor. The CDC estimates that nearly 86 percent of adults 65 and older have at least one chronic health condition; more than half have at least two.

“All adults over the age of 60 should really be talking to their provider about whether they should get the vaccine,” Marston says.

If you’re under 60 and have risk factors for severe RSV, your doctor may choose to give you a vaccine “off-label.” However, it’s important to note that the data for this age group has not been reviewed by the FDA, Schaffner says. And because the shot hasn’t been approved for this age group, your insurance likely won’t cover it.

Another consideration: If you spend a lot of time around children, you may want a vaccine to help protect yourself and the youngsters in your life, says Michelle Prickett, M.D., associate professor of medicine in pulmonary and critical care at Northwestern University Feinberg School of Medicine.

What about side effects of RSV vaccines?

Both of the approved RSV vaccines were found to be “very effective in preventing illness,” Prickett says, which could mean less time spent sneezing, wheezing and feeling miserable.

Arexvy, the single-dose RSV vaccine from drugmaker GSK, was 82.6 percent effective against lower respiratory tract disease (coughing, wheezing, shortness of breath) in the first season; while Abrysvo, the single-dose RSV vaccine from Pfizer, was nearly 89 percent effective.

When it comes to side effects, RSV vaccine is similar to other respiratory virus vaccines, Prickett says. “[It can cause] some minor pain, swelling in the injection site, maybe a little bit of fever, but it’s been very well-tolerated,” she says.

In the clinical trials testing Arexvy, 61 percent of study participants reported pain at the injection site; 34 percent reported fatigue; 29 percent reported muscle aches; and 27 percent reported a headache. The most common side effects among trial participants who received Abrysvo were fatigue (16 percent), headache (13 percent) and pain at the injection site (11 percent).

A small number of clinical trial participants (six out of more than 38,100) who received the vaccine experienced neuroinflammatory reactions such as Guillain-Barre syndrome, a rare disorder that can lead to weakness or even temporary paralysis. A handful of cases of atrial fibrillation, or an irregular heart rhythm, were also reported.

Researchers are conducting additional safety studies to determine whether the vaccines triggered these reactions or if they occurred at random, the CDC says. In the meantime, Prickett says people who have had neuroinflammatory reactions to other vaccines should talk to their doctor and weigh the risks and benefits of RSV vaccines. “In most patients, though, that’s probably less of a concern,” she adds.

When should you get the RSV vaccine?

It’s not too late to get the RSV vaccine, Schaffner says. “But don’t linger.” The same advice goes for this year’s flu and COVID-19 vaccines.

Though RSV’s winter peak is receding, respiratory illness activity remains elevated across the U.S., the CDC reports, and surveillance data shows that it’s not uncommon to experience a smaller spring resurgence of RSV.

You can get the RSV vaccine at the same time as your flu shot and COVID-19 vaccine; however, if you prefer to space it out from the other two, that’s fine. Studies suggest that you may experience more of the common side effects if you get your flu shot alongside an RSV vaccine. It’s also possible that RSV and flu vaccines won’t produce as strong of an immune response when given together, though more research is needed.

“It’s really your preference in terms of convenience,” CDC Director Mandy Cohen, M.D., said at a briefing with the National Foundation for Infectious Diseases.