If RSV Vaccines Are Approved for Older Adults, What’s Next?

Key Takeaways:

• An RSV vaccine may be approved and recommended within the next year.
• Trust between patients and healthcare professionals is key to increasing the uptake of vaccines in older adults.

The following is a recap of the most common questions from a symposium at the Family Medicine Experience 2022 conference discussing when a respiratory syncytial virus (RSV) vaccine may be approved and how to overcome barriers to the implementation of vaccines for older adults in primary care settings.

Is RSV Vaccine Approval Imminent?

John J. Russell, MD, FAAFP:
When might potential RSV vaccines be available, and when might the Advisory Committee on Immunization Practices (ACIP) make recommendations on their use?

Pamela Rockwell, DO, FAAFP:
The ACIP meets 3 times a year—in October, February, and June—with emergency meetings as needed. I don’t think they will hold off any longer than they have to for RSV because of the overlap with the potential for a concomitant COVID-19 infection. I can foresee the ACIP discussing candidate RSV vaccines in February 2023 or as early as the October 2022 meeting, but it sometimes takes 2 meetings for all of the information to get presented and dissected. They may, however, call a meeting in between if a new RSV vaccine candidate receives FDA approval.

John J. Russell, MD, FAAFP:
This would be a brand new paradigm for us—we’ve never given RSV vaccines in our offices. How do you anticipate the vaccine rollout would go, and who would receive the vaccine first? Will there be early adopters, will our sickest patients receive it, or will only our thought leaders promote the vaccine?

Laura Hurley, MD, MPH:
It can be difficult to go from these trials to implementation. There will always be early adopters, but there will also be conscientious family physicians who want to be sure the vaccine is appropriate for their patient population.

Pamela Rockwell, DO, FAAFP:
Yes, I really think it depends on how the ACIP recommendation is made. If it is made without shared decision-making—that all people older than 60 years of age should receive an RSV vaccine—I think the recommendation will slowly get adopted. I think people who accept vaccines as a modern miracle will want to get the RSV vaccine so they can avoid hospitalization and serious illness.

John J. Russell, MD, FAAFP:
If approved, what do you think the RSV vaccination schedule is going to be? If you had to look into the future, do think this would be an annual vaccine or some other frequency?

Laura Hurley, MD, MPH:
Based on the primary studies, I believe it will be an annual vaccine, and I think that’s why one manufacturer is talking about potentially combining RSV with flu and COVID-19, and another is already looking at coadministration with the influenza vaccine.

Pamela Rockwell, DO, FAAFP:
I agree—and even if these vaccines are not combined, I can envision a recommendation to receive flu, COVID-19, and RSV vaccines at the same time on an annual basis.

John J. Russell, MD, FAAFP:
Do you think we’re going to have a situation where an RSV vaccine is approved and will work for only 6 months or so because of mutations in the virus? Or does it seem to be a little bit different with RSV?

Laura Hurley, MD, MPH:
That is a great question. I think it was known going into this pandemic that coronaviruses mutate quickly, and I don’t believe RSV has that same reputation. Although RSV is susceptible to some mutation, it does not appear to have the same capacity for antigenic drift and shift that we see with the flu virus. For example, an article in Nature says that the RSV F protein “does not undergo substantial antigenic drift.”

John J. Russell, MD, FAAFP:
Switching subjects, might patients be more comfortable with older technology vs the mRNA technology? Which do you think is going to win the race—do you think it’s going to be an mRNA vaccine or one of the non-mRNA vaccines?

Laura Hurley, MD, MPH:
I think it will be a non-mRNA vaccine because one has already been studied in a phase III trial, and the press release reported positive findings. However, we have 5 candidates, and I can’t think of another time, other than with COVID-19, where we have had 5 vaccines potentially coming to market so quickly.

Overcoming Vaccine Hesitancy

John J. Russell, MD, FAAFP:
One thing I’ve heard with regard to vaccine hesitancy is that it takes just 10 minutes to make someone vaccine hesitant but approximately 4 years to undo that thinking.

Pamela Rockwell, DO, FAAFP:
I think the needle really bothers some people—the idea that something is being injected into their body. I also think people are generally afraid of what they don’t know, and many people feel that they don’t understand the mRNA vaccine, as we saw from the release of the COVID-19 vaccine. But it’s amazing how people also will buy supplements that are not tested or approved by the FDA, not realizing they are trusting non–evidence-based sources or sources that have no FDA oversight.

I have had some success in talking with patients, but you really have to have a trustful relationship back and forth, and that is not something that can happen at an urgent care center, unless they’re a frequent flyer there. It’s really about trust, and that’s where family medicine makes the most sense. You develop relationships with people over time, and then they trust you. Indeed, I’ve had many patients get vaccinated because I told them to, and they agreed.

John J. Russell, MD, FAAFP:
Do you think people are vaccine hesitant because of outside influences, such as social media?

Pamela Rockwell, DO, FAAFP:
I’m not completely sure, but I think as healthcare professionals we should all do our part to promote vaccines in our own way, whether it be on a Twitter account or on another type of social media.  I think we need to do more. Although they’re trying, I also think the CDC could do more innovative social media programming for people who are only getting their information off of social media.

Laura Hurley, MD, MPH:
I just want to say that I understand that there is a lot of antivaccine programming in the media, but I’m a believer that if we use the evidence-based practices to vaccinate, they work. This means having standing orders for all routinely recommended vaccines, if that is permitted where you practice. Reminders/recalls for multidose vaccines, such as the recombinant zoster vaccine or a hepatitis vaccine, and immunization information systems also are important.

John J. Russell, MD, FAAFP:
In closing, primary care is the healthcare that America needs. The person our patients will trust the most is not someone on social media—it’s us. Our relationships with our patients is what’s going to matter.

Regarding the RSV vaccine, even if we reach only 50% of the people who need it, that’s still going to be less sadness, fewer people who won’t have a parent there at the holidays, and so forth. I think we need to focus on our successes and not necessarily the people who don’t get the vaccine. I think there will be a lot of people who will be very happy to not have another chronic obstructive pulmonary disease exacerbation next year.

Your Thoughts?
How do you approach vaccine hesitancy in your patients? Join the discussion by posting a comment.