Implement the 3C Model of Vaccine Hesitancy, RSV Risk in Older Adults


The finding highlighted the importance of RSV risks among older adults, and aids pharmacists’ awareness when patients are hesitant to receive the RSV vaccine.

Pharmacists could be the deciding factor that impacts an individual’s decision on whether to receive their RSV vaccination, emphasizing the need for knowledge on vaccination hesitantly among adults. Published in the Canadian Pharmacists Journal, researchers introduced the 3C Model of Vaccine Hesitancy to improve awareness of RSV among older adults and to provide tools for pharmacists to address individuals unsure about the immunization.

Hospital clinic or labortory doctor nurse and scientist inject vaccine body arm protection treatment health care covid-19 rsv corona virus allegy phlegm fever influenza patient medical insurance - Image credit: StreetOnCamara |

Image credit: StreetOnCamara |

The World Health Organization has defined vaccine hesitancy as the “delay in acceptance or refusal of vaccines despite availability of vaccination services.” The 3C Model of Vaccine Hesitancy includes complacency, confidence and connivence, according to study authors, to help address this hesitancy.

To begin their analysis, researchers highlighted the significant morbidity and mortality caused by RSV in older adults. Data have estimated 470,000 hospitalizations and 33,000 annual in-hospital deaths among individuals 60 years and older from RSV in high-income countries.

The study authors noted limitations that could contribute to the number of hospitalizations and death, including under-diagnosis and heightened risk of poor outcomes following RSV infection.

Complacency, the first C in the 3C Model, was defined by study authors as low perceived risk of vaccine-preventable diseases. Because of the strong focus on the burden of RSV among children, the risk among older adults was overshadowed. However, this population has 177,000 hospitalizations and 14,000 deaths annually in the United States.

“A systematic review of studies in the United States found that older adults hospitalized with RSV typically experience a length of stay of 3 to 6 days, with 10% to 31% requiring intensive care and 3% to 17% requiring mechanical ventilation and a mortality rate of 6% to 8%,” said study authors in a press release.

However, following discharge, 23% of older adults need a greater level of care, according to study authors.

The second C in the 3C Model, confidence, entails trust in the effectiveness of vaccines, the system that offers them, the health care provider that administers them, and the policy makers that suggest the needs for vaccines, the researchers said.

To encourage individuals to feel confident in the vaccines, the study authors noted that investigational RSV vaccines are required to demonstrate success in 3 stages of clinical trials that examine optimal dosing, adverse effects, and the efficacy. Following approval, cases of Guillain-Barré syndrome (GBS)—a possible risk that could cause RSV vaccination hesitancy—were reported in 1 to 2 out of every 15,000 to 20,000 individuals.

Other individuals could be unsure about immunization due to the 1960s investigational RSV vaccine which caused the development of enhanced respiratory disease (ERD) and was, therefore, never approved. However, the researchers noted that older adults are at low risk of ERD in their first RSV season after receiving the vaccine because it now provides a stabilized form of the preF glycoprotein antigen.

“While safety is an important consideration affecting confidence, effectiveness is also factored into patients’ risk/benefit evaluation,” noted study authors in a press release.

Convenience, the last C in the 3C Model, was defined as the physical availability, affordability, location accessibility, health literacy, and appeal to receive the vaccine.

The advantage of residing near a pharmacy that administers the RSV vaccine is a benefit that patients could experience. The study authors noted that this emphasizes the need for RSV vaccination to be available in community pharmacies, with pharmacists that can administer the immunization.

“Administration by trained pharmacy students and regulated pharmacy technicians will further enhance the ability of community pharmacies to offer RSV vaccination services. Pharmacy regulatory and advocacy organizations are encouraged to address scope, access and remuneration barriers that may impede RSV vaccination in pharmacies,” said study authors in the press release.

The findings highlight the importance of understanding RSV risk among older adults, and aids pharmacists’ awareness when patients are hesitant to receiving the RSV vaccine.

RSV vaccination in older adults: Addressing vaccine hesitancy using the 3C model. Sage Journals. News release. November 24, 2023. Accessed February 29, 2024.

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