New RSV jab added to fall vaccine lineup for seniors, but the three-shot regime is hard sell

U.S. officials and drugmakers are starting to promote brand-new vaccines for respiratory syncytial virus, hoping seniors will accept a trifecta of RSV, flu and COVID-19 shots to keep their lungs and hospital rooms clear this fall.

Doctors urge patients to get a flu shot each year, and Dr. Anthony Fauci and pop star Olivia Rodrigo twisted America’s arms so that pharmacists could poke them with COVID-19 shots during the pandemic.

Now, drugmaker GlaxoSmithKline is running ads and enlisting NBA legend Earvin “Magic” Johnson to promote the first vaccine for RSV, a virus that commonly infects infants but can be deadly in older persons — especially those with underlying conditions. Pfizer won approval for its own RSV vaccine weeks later, and both versions will make their debut this fall.

Federal officials are recommending the RSV vaccines for persons 60 and older under a “shared clinical decision-making” framework, meaning patients and doctors should discuss the vaccine instead of treating it as an automatic recommendation.

Medical experts say older patients, particularly those with heart and lung issues, will be prime candidates for all three shots against RSV, flu and COVID-19 — if they’re willing to get them.

“I’d think there will be a substantial number of people who say, ‘OK, two at the same time, but I’ll come back for the third. That third shot is likely to be RSV, and I think we’ll have to be persuasive to get them back for that third visit,” said William Schaffner, an infectious diseases specialist at Vanderbilt University. “This going to be a learning year.”

RSV has been around for a long time, but it hit hard in fall 2022, raising concerns about a “triple pandemic” alongside the flu and lingering coronavirus. The diseases peaked early, around November, though drugmakers released clinical data showing their shots could thwart RSV in adults aged 60 and up.

Now, drugmakers and immunization managers are spreading the word among senior homes and doctors who serve older patients.

“The large amount of disease we had last year definitely spiked some interest. Providers who are aware of the burden of disease from RSV are delighted to have these new vaccines for their 60-and-older patients,” said Litjen Tan, chief policy and partnerships officer at Immunize.org, a group that promotes vaccination through educational materials for the public and health professionals.

He said it is hard to gauge how much public interest there will be, though last year’s rough season put RSV on people’s radar.

All three shots can be administered at once, though Dr. Tan agreed that “most adult patients are unlikely to accept three vaccines at the same time, and so having the patient come back may be necessary.”

While over nine in 10 American seniors got a two-dose primary series for COVID-19, roughly 43% of them bothered to get an updated booster last fall, according to federal data. Flu shot coverage is trending in a better direction and exceeded 70% of seniors as of March, according to the Centers for Disease Control and Prevention.

Adding a third shot will be a key test of seniors’ willingness to roll up their sleeves this fall. Interest in the COVID-19 shots lagged over time, and the pandemic and associated mandates fueled a new era of vaccine hesitancy in activist circles and corners of the internet.

“We anticipate a harder effort to get people to come get vaccinated,” said Claire Hannan, executive director of the Association of Immunization Managers. “I think that’s why it’s so important to educate the providers, really talking to patients about the importance of getting all three vaccines.”

The Food and Drug Administration in May approved the GSK vaccine, which has the brand name Arexvy. The company estimates that nearly 56 million American seniors could benefit from the RSV vaccine.

GSK pointed to federal data showing that RSV causes about 177,000 hospitalizations and an estimated 14,000 deaths among U.S. seniors each year. Pfizer’s version has the brand name ABRYSVO.

The vaccines were granted priority-review status, a designation that directs regulatory attention to drugs and vaccines that would be “significant improvements” over existing pharmaceuticals or treatments.

The CDC endorsed both vaccines in June. Agency spokeswoman Kathleen Conley said doctors and patients should consider whether the patient has any chronic medical conditions or other risk factors that increase their risk of severe RSV disease; possible side effects such as fever or soreness at the injection site; and “the patient’s preference around getting the shot.”

Regulators in August said Pfizer’s version could also be given to pregnant women so they confer immunity to newborns in the first six months of life. It is the first RSV vaccine for maternal use and will draw more attention to the new shots.

“We’re going to encourage Americans to get their updated COVID-19 vaccine, in addition to their annual flu shot,” White House press secretary Karine Jean-Pierre said Aug. 28. “And RSV immunization for people over 60 and for infants. That is something that we’re going to continue to make very clear to Americans across the country.”

To promote its vaccine for older adults, GSK launched a major branded television ad. It is running on all major network stations and online in places like Today Show, GMA, Big Bang Theory and NBC Nightly News.

“RSV can be serious. Talk to your doctor or pharmacist about Arexvy today,” the one-minute ad says, touting its position as the first FDA-approved shot for the virus. “RSV? Make it Arexvy.”

Mr. Johnson, the former L.A. Lakers star, is raising awareness about the disease and vaccine on his social media pages through the “Sideline RSV” campaign. Mr. Johnson previously promoted GSK’s HIV drugs after his battle with the virus.

GSK said their RSV vaccines were thoroughly tested for safety and efficacy, proving 82.6% effective against RSV in older adults over one season and 67.2% over the cumulative course of two seasons. Against severe RSV, it was 94% effective over one season and nearly 79% effective over two seasons.

The company said it will highlight its data and trusted voices to try and overcome vaccine hesitancy that’s lingering from the pandemic era.

“The vast majority of the U.S. public has confidence in the safety and efficacy of vaccines,” the company said. “In recent years the public has been caught up with ‘vaccination fatigue’ following the pandemic, and we are staying committed to ensuring that patients and healthcare providers, such as doctors, pharmacists, nurses, public health officials — have access to accurate information.”

Pfizer told CDC advisers in June that its shot was 78.6% effective against severe RSV through the middle of a second season, compared to nearly 90% effective after the first season.

Experts say health professionals will use the coming year to figure out if the vaccines last long enough so that recipients do not have to take a shot every year.

The “bottom line is both vaccines appear to be effective at preventing serious RSV disease in older adults and individuals ages 60 years and older should talk with their healthcare provider to see if the benefit of getting the vaccine outweighs the risks, based on their individual medical history,” said Michelle Fiscus, the chief medical officer at the Association of Immunization Managers.

Pfizer is also a main player, alongside Moderna, in providing COVID-19 vaccines and boosters that match circulating strains.

The companies told Congress this year they plan to roughly quadruple the list price of the shots, to about $130, because they are entering the private market and the government is no longer backstopping purchases.

“We have priced the vaccine to ensure the price is consistent with the value delivered and with the goal of uninterrupted access for every American,” Pfizer said. “We expect that most people will continue to pay nothing out of pocket as the COVID-19 vaccine transitions to the traditional market.”

Pfizer said it will have booster shots that combat the XBB lineage ready for distribution by the end of August, pending regulatory guidance.