Expert: How Awareness and Access Shape RSV Vaccine Uptake in Medicare Populations

In an interview with Pharmacy Times, Heidi De Souza, MPH, senior data scientist at ADVI Health, discussed findings from a descriptive analysis examining respiratory syncytial virus (RSV) vaccine uptake among older adults. Continuing her conversation, she highlighted how coadministration patterns shifted over the course of the respiratory virus season and emphasized the role of billing flexibility in improving access to vaccines. De Souza also explained how lower uptake among individuals with certain comorbidities points to gaps in patient and provider awareness. She noted that targeted public health efforts focused on education and modifiable social determinants of health are essential to increasing RSV vaccination among high-risk Medicare populations.

Pharmacy Times: What does the 38.4% coadministration rate suggest about opportunities to improve RSV vaccine uptake?

Heidi De Souza, MPH: As a descriptive research paper, we were really interested in truly understanding all the different aspects of vaccine uptake. We know that it's really convenient when you go to your doctor or pharmacy to get a flu vaccine and might as well also get the COVID vaccine, with RSV being a Part D–covered vaccine. We wanted to understand whether there were differences in coadministration and whether it was easier or harder.

RSV vaccines changed over time with what they were coadministered with. At the beginning of the cold and flu season in October of 2023, the most commonly coadministered vaccines were influenza and COVID-19, whereas at the end of the cold and flu season, the most commonly coadministered vaccine was shingles.

There are opportunities to improve vaccine uptake by increasing provider awareness and patient awareness. If pharmacies have the ability to bill both Part D and Part B drugs, it makes it a lot easier to receive all vaccines at the pharmacy. The same applies to a doctor’s office. If a doctor’s office can bill both Part B and Part D, it becomes much easier to provide access to all covered vaccines.

Pharmacy Times: How do variations in uptake by comorbidity—particularly lower rates among those with liver or neurologic conditions—inform targeted vaccination efforts?

De Souza: That's a great question. In the first season of availability under the shared clinical decision-making process, both neurologic and liver conditions were listed as chronic conditions that would put someone at higher risk of RSV. A lot of this comes down to the number one implementation barrier discussed in the paper, which is patient and provider awareness.

Improving awareness and education around having these chronic conditions and being at higher risk for severe RSV outcomes increases the likelihood of someone being aware of the risk and bringing it up with their doctor. One recommendation that has already changed is that the CDC moved from a shared clinical decision-making model to an age- and risk-based model. Now, for people with these chronic conditions, they already know they can access the vaccine.

Pharmacy Times: Based on these findings, what strategies are most critical to increase RSV vaccination among high-risk Medicare populations?

De Souza: That's a very interesting question for a researcher to answer. I'm not a clinician, pharmacist, or doctor, so clinically meaningful strategies are different from my perspective as a researcher. I think more targeted public health efforts are important, especially efforts that dig into understanding social determinants of health and which determinants are modifiable.

Knowing that someone lives in Georgia and is less likely to be vaccinated than someone in California is not modifiable. We can't change where people live or their socioeconomic or demographic characteristics. But if we understand that lower vaccination rates are driven by low health literacy or low awareness and education, those are things we can target. Increasing patient and provider awareness, not only about RSV risk but also about the availability of a vaccine that can mitigate those risks, is critical.