Expert discuss access barriers for the COVID-19, respiratory syncytial virus, and influenza vaccines, and ways to facilitate uptake.
PermanenteDocs Chat, a live webinar and podcast, and the American Medical Association (AMA) recently co-hosted a discussion around the current COVID-19 variants, influenza, and respiratory syncytial virus (RSV), as well as vaccines offered for the 2023-2023 respiratory illness season. Hosted by Alex McDonald, MD, the podcast included Sandra Fryhofer, MD, an AMA liaison to the CDC’s Advisory Committee on Immunization Practices, who gave an update on the vaccine rollout of respiratory immunization for the 2023 season and why it is important for patients to get vaccinated.1
“For the first time ever, we now have vaccines to protect against all 3 of these viruses: [COVID-19], flu, and now RSV. NFID, which is the National Foundation for Infectious Diseases, just released the results of its annual adult immunization survey,” Fryhofer said in the webinar. “This survey found that many adults underestimate the seriousness of these viruses, they don't have confidence in the safety of vaccines, [and] they don't have confidence in the effectiveness of vaccines. As a result, many say they don't plan to get vaccinated.”1
According to the survey, approximately 22% of US adults are worried about themselves or a family member getting infected with influenza, whereas 23% were worried about COVID-19 and 19% about RSV. Although 65% of respondents agreed that vaccination is the best way to prevent against influenza, 43% did not get vaccinated or were unsure about getting a flu vaccination, compared with 40% for a COVID-19 vaccine, and, for individuals aged 60 years of age and older, 40% for an RSV vaccine.2
Currently, for the 2023-2024 respiratory illness season, the FDA has approved updated COVID-19 vaccine formulations for the mRNA vaccines by Moderna Inc (Spikevax; 2023-2024 formulation) and Pfizer-BioNTech (Comirnaty; 2023-2024 formulation) for emergency use in the United States. The updated vaccines include monovalent components against the Omicron variant XBB.1.5.3
On October 3, the FDA also granted emergency use authorization to NVX-CoV2601, which is Novavax’s COVID-19 vaccine 2023-2024 formula, for those 12 years of age and older. The Novavax vaccine is protein-based, instead of mRNA, like the ones from Moderna and Pfizer-BioNTech.1,3,4
For RSV, GlaxoSmithKline (Arexvy) and Pfizer (Abrysvo) offer vaccines that are recommended for those aged 60 years and older.1 Fryhofer said that only Abrysvo is approved for pregnant individuals who are at 32- to 36-weeks of pregnancy to protect the infant when born during the RSV season.1 She added that the CDC also recommends the use of nirsevimab-ali for the prevention of RSV-related lower respiratory tract disease in newborns and infants aged younger than 8 months before or during their first RSV season and aged 8 to 18 months who are at increased risk before or during their second RSV season.1
For the flu vaccines, Fryhofer said that all vaccines are now quadrivalent, but the latest news for the vaccine is for those with an egg allergy. The extra safety measures are no longer recommended, beyond what other patients would get, and that population can obtain any vaccine without it being egg-based.1
For those that are interested in getting a vaccination before the 2023 respiratory season, it might be difficult to find availability at a physician’s office or a pharmacy. Fryhofer said that the federal government is no longer funding COVID-19 vaccines, as they are now being rolled out commercially. Most individuals will have to sign up online to get the vaccine at a pharmacy. She added that there has been a greater demand compared with availability of the vaccines in Atlanta, Georgia, where more patients are coming into the pharmacy looking to get vaccinated, but there are none available for administration.1
Fryhofer added that the updated COVID-19 vaccines can be given at least 2 months after an individual’s last dose of the vaccine, and if a patient was recently infected with COVID-19, there is no longer a 3-month waiting period after infection.1
Further, Fryhofer expanded on the vaccine schedule. All 3 vaccines (COVID-19, flu, and RSV) can be co-administered; the only exception is that COVID-19 vaccines cannot be administered with a monkeypox virus vaccine. She said that several of her patients have received the vaccines at the same time, and she has not heard about any complications. Fryhofer said that if there are barriers to access of the vaccines, if patients can get all 3 at once instead of 3 separate appointments, it is better to do that.1
Additionally, Fryhofer said that answering patients’ questions is the best way to address misconceptions and raise awareness about vaccines. She said her approach is to use the AIMS method: announce that the pharmacy has vaccines; inquire why the patient is hesitant about getting a vaccine; mirror the question and understand what the patient is asking and responding in a non-confrontational manner; and secure the patient’s trust.1
She added that health care providers are the most trusted source of vaccine information, and she urged professionals to keep the conversations going with their patients by answering their questions.
“We've got to raise awareness and address any misconceptions. These vaccines are safe and effective, and they've gone through extensive safety testing before they're licensed or authorized,” Fryhofer added in the webinar. “Understanding these vaccines can keep you out of the hospital, they can save your life, and this is a message we've got to make sure that our patients understand.”1