Uptake of the respiratory syncytial virus (RSV) vaccine among U.S. adults 60 years of age and older remains limited, despite high levels of underlying risk factors for severe disease in this population.
The findings highlight the urgent need for improved awareness, accessibility and clinical engagement to protect older adults from RSV ahead of the upcoming respiratory virus season, according to the researchers (Hum Vaccin Immunother2025;21[1]:2535755).
Many Forgoing Shots, Even Those at Risk
The study, which analyzed medical and pharmacy claims data from August 2023 through February 2025, revealed that just 16.4% of adults 60 years of age and older had received an RSV vaccine. Strikingly, nearly two-thirds of the study’s sample had at least one risk factor for severe RSV disease, such as chronic heart or lung conditions.
“These findings suggest that there are still a large number of increased-risk adults who have not received an RSV vaccination ahead of the upcoming respiratory virus season,” said lead researcher Elizabeth M. La, PhD, the director of U.S. Health Economics and Outcomes Research, Vaccines, at GSK.
Cautious Recs May Cause Confusion
Experts point to a number of reasons why RSV vaccination has lagged among older adults.
A key reason, according to William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, in Nashville, Tenn., is that the initial rollout of vaccine recommendations was overly cautious.
When the RSV vaccine was first licensed, the CDC’s Advisory Committee on Immunization Practices (ACIP) advised routine vaccination for adults 75 years of age and older, while those 60 to 74 years were advised to consult with their physicians through a “shared clinical decision-making” process if they had underlying conditions.
“The committee was a bit cautious, and provided a limited recommendation,” Dr. Schaffner said.
Although ACIP has since broadened the recommendation, Dr. Schaffner noted that the initial hesitancy constrained early uptake.
Another barrier involves how the vaccine is covered under Medicare. Unlike influenza or COVID-19 vaccines, which fall under Part B and are available widely at doctors’ offices with first-dollar coverage, RSV vaccines were placed under Medicare Part D: the prescription drug benefit.
“Lots of doctors’ offices don’t like to deal with Part D, and so they don’t stock Part D vaccines,” Dr. Schaffner explained. “That means all these vaccination sites, all these doctor’s offices are not actively engaged in vaccination, and indeed, the vast majority of RSV vaccines have been given in pharmacies. Patients had to be self-motivated to seek out the vaccine.”
Barriers Exacerbating Disparities
The study also found that adults who received other vaccines, such as influenza, COVID-19 or pneumococcal shots, were far more likely to get an RSV vaccine as well.
“There was a striking 24-times higher rate of getting RSV vaccine if patients during this interval had received other vaccines,” Dr. Schaffner noted. “These are people who are already very prevention-oriented, got the word either through the media or from their own physicians, and they went to pharmacies and got these vaccines.”
This pattern suggests that barriers in accessibility and financing may be disproportionately affecting those less accustomed to seeking preventive care, thereby exacerbating disparities.
To address disparities and increase vaccination uptake, Dr. La emphasized the importance of consistent clinical engagement.
“The CDC currently recommends RSV vaccination for all adults 75 years and older and for adults aged 50 to 74 years who are at increased risk for severe RSV disease,” she said. “Given the importance of healthcare professional recommendations, it will be important for all types of healthcare professionals—including primary care providers, specialists and pharmacists—to treat each interaction with eligible patients as a potential opportunity to educate patients about RSV disease and prevention options.”
She also highlighted the need for research on disparities in uptake.
“Ensuring that these discussions about RSV vaccination are occurring consistently among all eligible patients may also help to address the disparities in vaccination uptake that were observed in this study by race, ethnicity and other social determinants of health,” she said.
Better Job of Promoting Vaccination
Both experts agreed on the importance of lowering barriers to access.
“The authors conclude that we have to do a better job of promoting vaccination and making it easier for people to get vaccine for whom it’s indicated,” Dr. Schaffner said. “They’re right on the mark with that.”
Dr. La added that further investigation is needed to inform targeted interventions.
“Additional research is also needed,” she said, “to identify targeted interventions and educational initiatives that can help to support access to RSV vaccination among eligible patients.”
Dr. La reported that she is an employee of GSK, which produces an RSV vaccine. Dr. Schaffner reported no relevant financial disclosures.
This article is from the October 2025 print issue.