When We Talk about RSV Vaccines, We Need to Remember COVID-19, Says Public Health Leader

Respiratory syncytial virus (RSV) and SARS-CoV-2 may have more in common than vying for space in the air humans breathe and in our lungs during respiratory virus season.

Low awareness of and understanding of a pathogen and misperceptions about the goal of vaccination aren't new challenges, says Kelly Moore, MD, MPH, Immunize.org president and CEO. That's where we started with COVID-19 and RSV presents some similar barriers when it comes to public health messaging about the infection itself and the new vaccines against it. Moore discusses that issue in this excerpt of a recent interview with Patient Care.^®

Patient Care: RSV has really only entered the broad public conversation as a threat to health within the last couple of years. What do you believe will be the particular challenges to communication about RSV and the vaccinations and are there lessons to be taken from the COVID-19 experience?

Kelly Moore, MD, MPH

Moore: Yes; this is going to be one of the challenges of RSV. The virus is most well recognized in infancy. When you talk to young families with small kids, almost everyone is going to know someone whose family has been touched by an infant hospitalized with RSV. When you imitate the wheezing, even if somebody hasn’t heard the name of the virus, they understand the disease. A good friend of mine has a grandson who spent 9 days in an ICU last winter. He's doing great, but it was terrible. And I remember saying to her afterward, “With any luck, he may be among the last infants hospitalized with RSV because we have the hope of new ways of preventing this in infancy that will be coming out over the next year, year and a half.”

But last RSV season was extremely severe. And I think for a lot of people that was the first time they'd really thought about RSV. The frail elderly are quite vulnerable to this virus and there are as many as 100 000 RSV-related hospitalizations each year in older adults. Yes, we have a lot to do to help people understand the specifics about RSV and how valuable the vaccine against it will be.

When it comes to lessons from COVID, one of the important ones is that we’ve discovered that people struggle with the concept of a vaccine that may in some cases prevent infection, but in many cases its primary role will be to reduce the severity of illness once an infection is contracted. For a number of specific immunologic reasons, vaccines often mitigate the severity of illness rather than preventing infection entirely. This concept is not clear or comfortable for many people.

Preventing hospitalization is really the most important goal of vaccination for those of us in the immunization world. We want to prevent illness that puts an elderly person’s health in a downward spiral, to keep them at home, out of the ICU. In many cases, a vaccine that can do that is a huge success. That really is our goal vs prevention of infection in its entirety. So, with COVID, we saw millions of people trying to get their heads around this concept. With RSV, we're going to need to help them understand the same thing.

Patient Care: If respiratory virus season is on time this year, we are about 4 weeks away from the earliest days. When it comes to introducing the RSV vaccine, do you think uptake might be helped by the age-limited indication, ie, for adults aged 60 years or older?

Moore: We have to be realistic about the rollout of any new vaccine. There's an enormous amount of education that goes on with both health care professionals and members of the public. But if we're targeting those at highest risk, the most vulnerable, particularly those frail elderly, we have seen that they are among those who are very accepting of new vaccines. When you think about COVID vaccination, who's getting it and who's not, the people aged 65 years and older who are clearly at the highest risk of COVID illness and death have been very willing to come out and get these vaccines. By focusing our efforts on those at the highest risk, we will see greater acceptance. But there is still a lot we need to learn about integrating this vaccine in with all the other vaccines we're giving these days.

Overall, though, the immunization community is really excited about seeing the new vaccines against RSV – for older adults and now for infants. For infants there is also the new monoclonal antibody for treatment of RSV and before long, we’ll probably have one for pregnant people.

We are going to be spoiled for choice over the next couple of years and it's an exciting time for us to see another pathogen taken down by vaccination.

Kelly Moore, MD, MPH, is the president and chief executive officer of Immunize.org, a nonprofit immunization education and advocacy organization that supports state and local immunization coalitions and front-line immunization providers. She also is adjunct associate professor of health policy at Vanderbilt University School of Medicine. Until 2018, Moore served as the director of the Tennessee Immunization Program at the state's department of health. She has served as a voting member of the Advisory Committee on Immunization Practices of the Centers for Diseaes Conrol and Prevention and is an advisor to the World Health Organization. Moore is board certified in preventive medicine and public health.