Early RSV Vaccine Uptake Among Older Adults Reveals Significant Access Gaps

In this interview with Pharmacy Times, Heidi De Souza, MPH, senior data scientist at ADVI Health, discusses early respiratory syncytial virus (RSV) vaccine uptake among adults aged 65 years and older following FDA approval and CDC recommendations. She highlights that fewer than one-quarter of Medicare fee-for-service beneficiaries received an RSV vaccine during the first season, with notable disparities by age, race and ethnicity, and geography. De Souza explains that implementation barriers, including limited awareness, shared clinical decision-making requirements, transportation challenges, and Medicare Part D coverage issues, contributed to low uptake. These barriers disproportionately affected the oldest adults and those with multiple comorbidities, despite their higher risk for severe RSV disease.

Pharmacy Times: Can you introduce yourself?

Heidi De Souza, MPH: My name is Heidi de Souza. I’m a senior data scientist at Advi Health on our strategic analytics and value economics team.

Pharmacy Times: What do first-season RSV vaccination rates among adults aged 65 years and older indicate about early vaccine uptake following FDA approval and CDC recommendation?

De Souza: Fantastic question. I think from our research, the key takeaway was that overall vaccination rates were low, with less than a quarter—only 21%—of Medicare Fee-for-Service beneficiaries receiving an RSV vaccine during the first season of availability. Even with the overall low uptake, we also noticed that rates differed by age, race and ethnicity, and geographic location.

Pharmacy Times: What do the observed racial, socioeconomic, and geographic disparities reveal about gaps in RSV vaccine access and uptake?

De Souza: We have a long way to go. We need more targeted public health efforts to improve RSV vaccination, especially among older adults who are at higher risk for severe RSV disease. In our paper, in the discussion section, we theorized and discussed that one of the leading contributing factors was implementation barriers. Some of those implementation barriers could be limited provider and patient awareness, not only of RSV burden but of the burden specifically among those who are older and at high risk. Another implementation barrier could be the execution of shared clinical decision-making. The recommendation during that first season of availability from the CDC was that, in order to get an RSV vaccine, you had to participate in a shared clinical decision-making process. The third implementation barrier that we discussed was RSV vaccination as part of a Medicare Part D benefit.

Pharmacy Times: Why might RSV vaccination rates be lower among adults aged 85 years and older and those with multiple comorbidities, despite higher risk for severe disease?

De Souza: I think all three of those implementation barriers really contribute to the disparities seen among those who are older and at highest risk. Low patient and provider awareness of RSV as a serious illness, in combination with the shared clinical decision-making recommendation, can make it more difficult for providers and patients not only to have the conversation but also to get the vaccine. The CDC did not change the recommendation away from shared clinical decision-making to a more standard age- and risk-based recommendation until June of last year. Prior to that, providers and patients needed to engage in the shared clinical decision-making process, which was noted to be confusing and time-consuming to implement.

One of the other things noted in the discussion section of the paper was that a National Health Interview Survey found transportation barriers disproportionately affect patients who are older, Hispanic, and those with certain chronic illnesses. Especially for adults aged 85 and older with multiple comorbidities, transportation barriers make it unlikely that patients can get to a provider to have the shared clinical decision-making conversation. There is also the additional implementation barrier of RSV vaccination being a Part D benefit. Not all medical providers covered under Medicare have the ability to bill to a Part D plan. Because the RSV vaccine is covered under Medicare Part D, patients may need to have the conversation with a provider and then be referred to another location, such as a pharmacy, to actually receive the vaccine.