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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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