APhA: Pharmacists Critical in Advancing RSV Vaccination and Equity Amid Evolving Guidelines

During a satellite symposium at the American Pharmacists Association (APhA) 2026 Annual Meeting in Los Angeles, California, experts emphasized that respiratory syncytial virus (RSV) remains a significant public health priority with substantial morbidity and mortality among older adults. Jacinda Abdul-Mutakabbir, PharmD, MPH, associate professor of clinical pharmacy at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, and Richard Dang, PharmD, associate professor of clinical pharmacy at the University of Southern California, highlighted the evolving landscape of RSV prevention and the essential role of pharmacy teams in identifying at-risk patients and overcoming barriers to vaccination.¹

“These are preventable deaths and hospitalizations that we have an intervention for,” Dang noted, referring to the RSV vaccine. With an array of FDA-approved and Advisory Committee on Immunization Practices (ACIP)–recommended vaccine options that have been proven effective in multiple RSV seasons, pharmacists can play a pivotal role in educating older adults about their risk, informing them of available vaccines, and navigating questions about potential adverse events.^1-3

The Multi-Faceted Burden of RSV

RSV is a common respiratory virus that often causes mild, nonspecific symptoms but can lead to severe lower respiratory tract infections (LRTIs) like pneumonia. While it is widely recognized as a pediatric concern—standing as a top cause of infant hospitalization—the burden in older adults is staggering. In the United States, RSV causes 60,000 to 160,000 hospitalizations and 6000 to 10,000 deaths annually among adults aged 65 and older.^2,4

Dang and Abdul-Mutakabbir explained that risk factors include advanced age, with those aged over 70 at the greatest risk, and chronic medical conditions such as chronic obstructive pulmonary disorder, asthma, and heart failure. Furthermore, social determinants of health (SDOH) play a critical role; data show that patients in the highest social vulnerability tracts face significantly higher incidences of hospitalization. Factors like lacking public health insurance, residing in a minoritized community, or living far away from local health care services can all contribute to higher hospitalization and intensive care unit rates.⁵

Dang took a moment to explain key research from Thomas et al regarding social vulnerability and its relation to RSV risk: “SVI is essentially a composite score that looks at a variety of different socioeconomic factors, like income, their language, their race, ethnicity, their housing types, their transportation availability. The higher your SBI, the more socioeconomic risk factors you might have,” Dang said. “We can see that those with the highest SVIs are also associated with the highest incidence of hospitalizations.”⁵

Pharmacists can play a significant role in closing RSV vaccine uptake gaps among these groups. By conveying updated RSV recommendations and assisting with financial hurdles, pharmacists can turn a hesitant patient into a protected one.

Navigating the New Landscape of RSV Recommendations

A major focus of the session was the stabilization of vaccine recommendations across major health organizations, including ACIP, the American Academy of Family Physicians, and American Medical Association. Current guidance recommends a single dose of the RSV vaccine for all adults aged 75 years and older, as well as adults aged 50 to 74 years at increased risk of severe disease like LRTI. This update supersedes the previous "shared clinical decision-making" model for adults aged 60 and older.^6,7,8

As Abdul-Mutakabbir has observed firsthand in her own experiences, many adults are unaware of these newly expanded population recommendations for the RSV vaccine. This lack of awareness can sometimes extend to pharmacists themselves, necessitating that pharmacists stay aware and educated themselves of updates in immunization recommendations. If a patient isn’t conveyed the most up-to-date and honest vaccine guidance, they may feel a sense of betrayal that is hard to recover from, according to Abdul-Mutakabbir.⁹

“I have individuals aged 50 plus in my community, [and] more than 60% of them said that they had never been told about the RSV vaccine and have never been recommended that vaccine,” Abdul-Mutakabbir recounted. “They actually told me that they felt betrayed because they interact with health care providers frequently, and they had not been given that information.”

Specific qualifying "at-risk" conditions for the age 50 to 74 group include chronic lung disease, advanced kidney disease, severe obesity, and type 2 diabetes—specifically when accompanied by end-organ damage. Importantly, Dang reminded the audience that “the RSV vaccine is not currently an annual vaccine”; unlike seasonal influenza shots, current evidence supports sustained protection across at least 2 seasons. Additionally, maternal vaccination is recommended for pregnant persons at 32 to 36 weeks’ gestation between September and January to protect newborns. Clinical trial evidence shows that maternal RSV vaccination effectively prevents RSV-associated LRTI in infants, making receiving the vaccine a critical component of maternal health.^6,10

By ensuring that adults aged 50 and older—and those with risky comorbidities—are aware of their risk factors, know where to find an RSV vaccine, and have their questions answered throughout the process, pharmacists can show their value to a multidisciplinary care team.

“We as pharmacists can really fill that gap and provide that information,” Abdul-Mutakabbir said.

Clinical Evidence and Addressing Safety Concerns

Pharmacists now have three available options for adult vaccination: 2 recombinant protein vaccines [(Arexvy; GSK) and (Abrysvo; Pfizer)) and 1 mRNA vaccine (mResvia Moderna). Real-world observational data have reaffirmed clinical trial results, showing approximately 80% efficacy in preventing LRTIs in older adults. Regarding safety, Dang and Abdul-Mutakabbir addressed concerns about Guillain-Barré Syndrome (GBS), noting a rare risk of fewer than 10 excess cases per 1 million doses.³

“We do counsel our patients on the risk of GBS, but we do know that compared with the risk of RSV, the risk of GBS is much lower,” Dang explained. “The benefits greatly outweigh the risks.”

For clinical workflow, pharmacists should know that RSV vaccines can be co-administered with other adult immunizations, such as influenza, COVID-19, and shingles vaccines. While they can be given year-round, the greatest benefit is often seen when administered in late summer or early fall. By counseling patients on the safety and feasibility of vaccine co-administration, pharmacists can capitalize during a single patient visit and ensure they receive protection not only for RSV, but other common respiratory illnesses.^1,9

“In my education sessions, I always have a segment where I talk about coadministration,” Abdul-Mutakabbir explained. “But if you leave here with nothing, leave here with knowing that you can get more than one vaccine in 1 sitting.”¹

Strategies for Equity and the Pharmacy Role

To improve equitable access to RSV vaccination and ensure that no eligible patient is missed, Abdul-Mutakabbir proposed a 3-tiered model of care: engaging faith and community leaders, educating individuals using healthcare professionals from their own communities, and developing low-barrier "pop-up" clinics. She cited success in her own investigation in San Bernadino County in partnership with Loma Linda University, by implementing this tiered approach, Abdul-Mutakabbir and her team successfully increased vaccine uptake by vaccinating hundreds of individuals in the community. By reaching out, providing education, and fostering trust, pharmacists can overcome hesitancy and make a strong recommendation to a patient who may not have originally wanted to receive the RSV vaccine.¹¹

“Individuals who have received the [RSV] vaccine has plateaued over the last year or two, and so those who want to get a vaccine, they've already gotten it,” Dang said. “Everybody else is still in that “maybe” phase, right? That represents opportunity for providers like pharmacists to be able to have a really positive intervention, like educating their patients and administering to those who still need to receive the vaccine prior to the RSV season.”¹

Pharmacists can also utilize the CDC's SHARE framework (Seek, Help, Assess, Reach, Evaluate) to foster vaccine confidence. On a practical level, pharmacy teams should run reports in their software to identify patients aged over 50 with qualifying comorbidities and target outreach to those picking up inhalers or cardiovascular medications. Integrating these processes into a pharmacy’s workflow can go a long way to locating patients who may be eligible for RSV vaccination but have yet to receive counseling or discuss with a provider.^12,13

“Pharmacists get the work done,” Abdul-Mutakabbir concluded, urging the profession to bridge the current stagnation in vaccination rates through proactive strategies and thoughtful care.¹

REFERENCES

1. Abdul-Mutakabbir J, Dang R. “RSV in focus: pharmacists driving vaccine access, confidence, and education. Presented at: American Pharmacists Association (APhA) Annual Meeting; Los Angeles Convention Center; March 28, 2026; Los Angeles, CA.

2. Britton A, Roper LE, Kotton CN, et al. Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR Morb Mortal Wkly Rep. 2024;73(32):696-702. doi:10.15585/mmwr.mm7332e1

3. Surie D, Self WH, Yuengling KA, et al. RSV vaccine effectiveness against hospitalization among US adults aged 60 years or older during 2 seasons. JAMA. 2025;334(16):1442-1451. doi:10.1001/jama.2025.15896

4. RSV in adults. CDC. Updated February 20, 2026. Accessed March 28, 2026. https://www.cdc.gov/rsv/adults/?CDC_AAref_Val=https://www.cdc.gov/rsv/high-risk/older-adults.html

5. Thomas CM, Raman R, Schaffner W, et al. Respiratory syncytial virus hospitalizations associated with social vulnerability by census tract: An opportunity for intervention? Open Forum Infect Dis. 2024;11(5):ofae184. doi:10.1093/ofid/ofae184

6. Britton A, Melgar M, Surie D, et al. Advisory Committee on Immunization Practices (ACIP) Meeting: Evidence to Recommendations Framework (EtR): RSV Vaccination in Adults Aged 50-59 Years; April 15-16, 2025. Accessed March 28, 2026. https://www.cdc.gov/acip/downloads/slides-2025-04-15-16/06-Melgar-Surie-adult-rsv-508.pdf

7. Immunization schedules. American Academy of Family Physicians. Accessed March 28, 2026. https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules.html

8. Vaccine recommendations. American Medical Association. Updated March 2, 2026. Accessed March 28, 2026. https://www.ama-assn.org/public-health/prevention-wellness/vaccine-recommendations#toc-respiratory-syncytial-virus-rsv-vaccine-recommendations-07

9. Overcoming barriers to RSV vaccination in adults. AJMC: Vaccinating Older and At-Risk Adults Against Respiratory Syncytial Virus. Published July 15, 2024. Accessed March 28, 2026. https://www.ajmc.com/view/overcoming-barriers-to-rsv-vaccination-in-adults

10. Kampmann B, Madhi SA, Munjal I, et al. Bivalent prefusion F vaccine in pregnancy to prevent RSV illness in infants. N Engl J Med. 2023;388(16):1451-1464.doi:10.1056/NEJMoa2216480

11. Abdul-Mutakabbir J, Casey S, Jews V, et al. A three-tiered approach to address barriers to COVID-19 vaccine delivery in the Black community. The Lancet Global Health. 2021;9(6):E749-E750. doi:10.1016/S2214-109X(21)00099-1

12. The SHARE Approach. Agency for Healthcare Research and Quality. Last Reviewed February 2026. Accessed March 28, 2026. https://www.ahrq.gov/sdm/share-approach/index.html

13. Grabenstein JD. Pharmacists as vaccine advocates: roles in community pharmacies, nursing homes, and hospitals. J Am Pharm Assoc. 1998;16(18):1705-1710. doi:10.1016/S0264-410X(98)00131-5