This is a very good op-ed. I knew that seniors over 75 should get the RSV vaccine, but other than that,, I rarely hear or read anything about this respiratory virus. I hope that changes.
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CIDRAP Op-Ed: "RSV—the middle child of respiratory season who deserves more attention"
Jess Steier, DrPh, May 19, 2026
My mother called me from the pharmacy last fall.
"Jessy, is this something I need to get? I saw it at the counter, but I
haven't heard anything about it."
She was talking about the RSV (respiratory syncytial virus) vaccine.
She is in her seventies, immunocompetent, and has a daughter with a
doctorate in public health. If anyone in the country should have heard
about the vaccine by now, it is my mother. And yet there she was in the
CVS aisle, calling me to ask if she should get it.
From the looks of the data, she isn't an outlier.
The
three respiratory virus vaccines we now have all face barriers, and the
barriers are not the same. The flu vaccine fights "it's just the flu,"
and a recurring suspicion that it's not worth the trouble because its
effectiveness varies year to year, depending on how well it matches
circulating strains. (For the record: even a moderately matched flu
vaccine running at 40% is meaningfully better than zero.) The COVID
vaccine fights distrust, much of it inherited from a rollout that looked
rushed because the vaccine trials ran in parallel rather than
sequentially, even though the rigor was the same
Widespread unawareness
The
RSV vaccine is different. It does not have a reputation problem or a
trust problem. It has an awareness problem. Most people do not know what
RSV is, do not know they are at risk, and do not know there is
something they can do about it. It is the middle child of respiratory
season, the one we keep forgetting is in the room.
In a recent international survey of adults 50 and older across four countries, only 40% had heard of RSV. In the US,
a survey of adults 60 and older and adults with chronic heart, lung, or
metabolic conditions found that only 43% had heard of RSV, and among
those who had, only about a third felt they knew much about the disease.
Numbers like these would be unthinkable for the other two.
State
and local health departments have been working hard on RSV awareness,
often with shoestring budgets and shrinking staff. Federal funding has
pulled back, trusted institutions have been destabilized, and the basic
premise of vaccine recommendation has come under public attack. The fact
that uptake has nonetheless climbed is a testament to those state and
local efforts, though the numbers make clear how much ground remains.
The awareness gap shows up in uptake. The RSV vaccine is currently recommended for
all adults 75 and older, and for adults 50 to 74 at increased risk of
severe disease, a group that includes anyone with conditions like heart
disease, chronic lung disease, diabetes with end-organ damage, or severe
obesity. Yet the most recent data
from the Centers for Disease Control and Prevention (CDC) show that, as
of January 2026,RSV vaccination is 40.9% among adults 75 and older and
30.9% among adults 50 to 74 years old who are at increased risk.
That is real progress from the 16 percent of
adults 60 and older who had received the RSV vaccine across the first
two seasons it was available, but it still trails the flu vaccination
rate, which sits at 63.8%
in adults 65 and over, even after several years of decline. We
shouldn't be surprised that a vaccine that has been on the market for
two seasons hasn't yet caught up to a mature, century-old vaccination
program, but that doesn't mean the gap is acceptable.
RSV is not new. Pediatricians have known for decades that it is the leading cause of infant hospitalization
in the United States. The number one cause. But that familiarity lived
entirely within pediatric medicine. In adults, RSV went largely
undetected and unnamed until we started testing for it.
We could prevent scores of hospitalizations
What we found when we started testing was sobering. CDC estimates that RSV causes about 110,000 to 180,000 hospitalizations
every year among adults 50 and older in the United States. For years,
those patients were diagnosed as having viral pneumonia or sent home
with a vague label of "respiratory infection." There is still no
antiviral for RSV, so supportive care is all we have on the back end,
which is why the prevention tools we now have on the front end matter so
much.
The pediatric story is more
complicated, and that complication is part of the problem. We have two
prevention pathways for infants, which is good news but also a source of
confusion. The first is maternal vaccination
with Abrysvo, given to pregnant women from 32 to 36 weeks of gestation,
which transfers protective antibodies across the placenta. The second
is a long-acting monoclonal antibody, nirsevimab or the newly approved clesrovimab, given directly to infants who were not protected through maternal vaccination.
Most
babies need one or the other, not both, but the existence of both gives
families two opportunities to opt in to protection. Some parents will
prefer the maternal route and want their baby born already covered. Some
will prefer nirsevimab, either because they did not vaccinate during
pregnancy or because they would rather their infant receive the
immunization directly. Either choice protects the baby.
Both
tools are recent. Neither existed when my kids were born in 2016 and
2018, but I would have taken either one if they had been.
Modeling suggests
that if RSV vaccine uptake matched flu vaccine uptake, we could prevent
up to 60% of RSV hospitalizations and deaths in older adults in a
single season. The tools deserve more than they have gotten. Real-world
studies find RSV vaccines to be 73% to 83% effective against RSV-associated hospitalization in older adults, with protection holding through a second season for some vaccines. Abrysvo cuts neonatal RSV hospitalization by roughly two-thirds. Nirsevimab, based on data from the 2024-25 season, is around 80% effective
against RSV-associated hospitalizations in infants. Whatever the
awareness problem is, it is not a "the product doesn't work" problem.
A CDC analysis
drawing from immunization information systems across 33 states and
Washington, DC, found that only 29% of infants born during the 2023-24
respiratory season were protected against RSV through either pathway,
with state-level coverage ranging from 11% in Nevada to 53% in Vermont.
The geographic spread tells you the system is not failing uniformly. It
is failing where infrastructure and access are thinnest, in the same
patterns we see for every other vaccine.
Preliminary
data from the 2024-25 season suggest national coverage among infants
younger than 8 months, through maternal vaccination or nirsevimab,
increased to about 57%, which is real progress but still leaves more
than four in ten American infants unprotected against the leading cause
of infant hospitalization in the United States.
Need for ‘one-and-done’ messaging
One
important difference between RSV and flu vaccination rarely gets
mentioned. The flu and COVID vaccines are annual. The RSV vaccine is not.
For now, it is a single dose, full stop. Surveillance is ongoing to
determine whether revaccination will eventually be recommended, but, as
of today, an eligible older adult who gets the shot has done the thing
once and is done. That is an easier ask than an annual shot. "Get it
once, and you are done" should be everywhere in the messaging right now,
and it isn't.
You have to introduce a
vaccine before you can defend it. That is a different kind of work than
the one science communicators usually train for.
The
flu vaccine's footprint took generations to build: seasonal campaigns,
school messaging, workplace clinics, and the slow installation of "flu
season" as a calendar event. The goal is not to take any of that down.
The goal is to give the RSV vaccine the same kind of footprint, and to
do it without a century to spare and without a pandemic to do the
awareness-building for free.
The lever is
the one we already have for flu. Bundle the conversations. Every flu
shot for an eligible older adult should include mention of an RSV shot,
including the part about it being one-and-done. Every prenatal visit at
the right gestational window should include the maternal vaccine. Every
birthing hospital should have a default workflow for nirsevimab when the
pregnant woman has not received the vaccine. Obstetric and pediatric
practices need handoff protocols, because pediatric problems are
clinical workflow problems.
Pharmacies are
where adult vaccines are administered now, so that is where the
conversation about older adults belongs. Public health departments need
the resources to treat RSV vaccination the way they treat flu
vaccination, with fall campaigns, school-adjacent messaging, and
employer-facing nudges.
There are early signs that the catch-up is starting.
RSV vaccine uptake among adults 75 and over has more than doubled over
two seasons, and pharmacies are quietly stocking combination respiratory
virus tests that screen for flu, COVID, and RSV in a single swab, which
means more people will leave the pharmacy with a name for what they
have. The disease is becoming legible, and the vaccine is following.
When
my mother called me from the pharmacy, I told her yes. Get it. She is
in the recommended age-group, the vaccine has held up well in trials and
in real-world data, and the RSV season she would otherwise be
unprotected through was starting to bear down on us.
She
got the shot, and she is fine. Most people will never make that call
because they do not have a daughter with a DrPH to ask. The work is
making sure they do not need to.
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Dr. Steier is a public health scientist and scientific communicator. She is the founder of Unbiased Science,
an organization that uses data visualizations, real-world analogies,
and human voice to communicate complex scientific concepts for public
understanding via multiple media modalities.
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