To prevent a repeat of last winter’s “tripledemic” of respiratory illnesses, Americans will be encouraged to receive vaccinations for flu, Covid, and respiratory syncytial virus (R.S.V.). These three vaccines have the potential to reduce hospitalizations and deaths later this year. However, there are uncertainties surrounding the optimal administration of the vaccines, who will benefit the most, and the potential risks involved.
For older and immunocompromised individuals, all three vaccines are considered a “godsend.” Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital and a Food and Drug Administration adviser, emphasizes the significant impact these vaccines can have in preventing viral infection-related deaths among older adults.
Although there is uncertainty surrounding the uptake of these vaccines, the high number of deaths caused by the flu and Covid during the past winter may change people’s minds. The flu alone resulted in up to 58,000 deaths, while Covid claimed roughly 50,000 lives between November and March. R.S.V., which is responsible for 10,000 deaths annually, poses a particular threat to older adults.
While the Covid and flu vaccines were available last fall, R.S.V. vaccines for adults are new but have proven highly effective in clinical trials. In May, the FDA approved Pfizer and GSK’s R.S.V. vaccines for older adults, with the CDC recommending their use for individuals aged 60 and older.
Bundling all three vaccines into a single visit to a clinic or pharmacy may increase vaccination rates. However, some scientists express concerns about administering all three at the same time due to limited data on safety and effectiveness in such cases.
The majority of individuals at risk for severe illness and death from these viruses are those aged 75 and older. The benefit of the vaccines outweighs any safety concerns for this age group. The CDC recommends older adults receive a high-dose flu vaccine or one with an adjuvant to enhance immune response.
Hospitalizations and deaths from Covid primarily affect older adults and people with weakened immune systems. Recently, the FDA advised Pfizer, Moderna, and Novavax to manufacture Covid shots targeting the Omicron variant. However, a newer variant, XBB.1.16, is now emerging.
R.S.V. is a leading cause of infant hospitalizations and a top killer of young children in low- and middle-income countries. The virus also threatens adults, leading to thousands of hospitalizations and deaths each year. Vaccinating one million adults aged 65 and older could prevent 25,000 outpatient visits, 2,500 hospitalizations, and 130 deaths, according to analyses.
Designing effective R.S.V. vaccines has been challenging but recent breakthroughs have brought hope. The GSK vaccine, to be marketed as Arexvy, has shown promising potency and efficacy. Pfizer’s vaccine, called Abrysvo, is still under evaluation, but if both vaccines prove effective over an extended period, yearly R.S.V. vaccinations may not be necessary.
While trials for the R.S.V. vaccines did not include enough immunocompromised individuals or those aged 75 and older, the benefits of these vaccines for these groups are clear. Adverse events related to the vaccines were reported, but the risk-benefit balance still favors vaccination.
The CDC’s panel recommends that individuals aged 60 and older may choose to receive the R.S.V. vaccine after consulting with a doctor. However, experts raise concerns that this decision may deepen racial disparities in vaccination rates and put the burden on healthcare providers to assess risks and benefits.
Fortunately, most Americans will not have to pay out of pocket for these vaccines. Insurance companies will cover the costs, although the specific prices for the R.S.V. vaccines from Pfizer and GSK are still being negotiated.
Ongoing research will provide more information on the new R.S.V. vaccines, including the efficacy of a second dose. As more data becomes available, healthcare professionals will be better equipped to make informed decisions regarding the vaccination strategy against respiratory illnesses.
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