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Collaborating for RSV Prevention
Collaborating With Older Adults to Prevent RSV: Discussing Risks and Overcoming Barriers

Released: October 16, 2023

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Key Takeaways
  • Older adults could be at increased risk for severe infections with RSV. Newly available vaccines are available to help protect this vulnerable population.
  • Pharmacists should proactively educate candidates for the RSV vaccines and engage in shared decision-making.
  • Understanding potential barriers to receiving these vaccinations, such as navigating insurance coverage for those 60-64 years of age and for Medicare recipients, can help facilitate access.

As pharmacists, we have a critical role in educating patients on the 2 newly available respiratory syncytial virus (RSV) vaccines, especially among older adults. Using the below case example, you can learn how shared decision-making strategies can promote vaccine confidence and better protect patients aged 60 years and older from severe RSV disease.

Working in a small, independent community pharmacy, one of your regular patients and her son approach the pharmacy counter. She is a resident of a local assisted living facility and is an active member of her community there. Her healthcare team has recently started discussing new RSV vaccines they would like the residents to get soon. The resident and her son would like to know why they need another vaccine in addition to receiving the COVID-19 and flu vaccines: “Is it safe for mom to get one of these new vaccines? Does she really need to have all of these?”

Here are my thoughts on how to provide the most accurate information for this patient and the importance of shared decision-making in this discussion.

Education Strategies for Those in Community Dwellings
When thinking about educating older adults about RSV and its vaccines, one must consider those who reside in community living programs, including assisted living or long-term care facilities. Older adults who reside in these settings are particularly susceptible to respiratory tract infections. Influenza and pneumococcal vaccinations are recommended in this population to prevent these common infections and their negative consequences. Likewise, with the recent availability of RSV vaccines, I think there is an opportunity for pharmacists to establish and implement vaccination protocols to further protect these potentially vulnerable populations.

In community living programs, there is also a need to educate older adults about RSV, emphasizing awareness about their increased risk for complications. Pharmacists have an important role in identifying patients who would most benefit from these discussions and engage with them about their risk, by exploring questions like: Do they have any concomitant history of lung disease, such as asthma or chronic obstructive pulmonary disease? Do they have a history of cardiac disease, especially a history of heart failure? Approximately 14% to 22% of adult patients hospitalized with RSV have complications because of cardiovascular problems, including worsening heart failure, which is a risk factor for RSV. Keep in mind that older adults may experience an age-related decline in immune function, and they may also have underlying medical conditions or use medications that are immunocompromising.

Shared Decision-making Builds Vaccine Confidence
The RSV vaccines are best implemented in practice when there is a patient–healthcare professional (HCP) discussion using shared decision-making. Pharmacists should engage with patients and their families or caregivers in evaluating the benefits and potential risks for RSV and vaccination. This requires a personalized approach to care. When engaging in shared decision-making regarding RSV vaccination, pharmacists (as well as other HCPs) should emphasize the individuals’ specific risks for disease, including potential for severe disease, based on any present, underlying conditions.

There are also other factors to consider when engaging someone in vaccine-related discussions, such as their beliefs and values, concerns about adverse effects, and timing relating to other vaccines, among others. Guidance from the CDC states that people can receive the RSV vaccine at the same time they receive their vaccines for COVID-19 and influenza. Of course, an individual’s preference, willingness, and desire to become immunized will be the determining factor in receiving the RSV vaccine.

Collaborating With Patients to Help Prevent RSV
As HCPs, pharmacists should empower everyone on their team to collaborate with patients in addressing how to best promote vaccine confidence, particularly among older adults who may be susceptible or vulnerable to severe RSV disease. We know that RSV is associated with a significant number of deaths and hospitalizations each year because of infection and associated complications. And in terms of promoting vaccine confidence, we have learned a lot from the COVID-19 pandemic. The same strategies used to support COVID-19 vaccination can be used in the RSV setting.

As HCPs, we should embrace empathy in all interactions to understand and incorporate patients’ goals, concerns, and motivations for seeking or refusing immunization. We should apply motivational interviewing techniques: asking permission to discuss the vaccines with each patient, using open-ended questions, employing reflective listening, exploring why they may be hesitant about or uninterested in getting the RSV vaccine, and developing discrepancy with them about their goals and decisions. We should always respond to patients’ questions, provide information addressing and validating their concerns, and, if applicable, affirm the reasoning why that specific patient should become immunized against RSV.

Barriers to RSV Vaccination for Older Adults
One potential challenge in patients aged 60-64 years who are typically not yet eligible for Medicare coverage is that the RSV vaccines are fairly new and expensive without insurance coverage. The Advisory Committee on Immunization Practices (ACIP) advised that older adults may receive one of the approved RSV vaccinations when discussed with their HCP via shared decision-making, and these vaccines are covered by Medicare Part D and some private payers, excluding those who are uninsured or underinsured. This is different from the influenza and COVID-19 vaccines, which are covered by Medicare Part B, so educating on these differences is key to patients’ understanding of their health coverage.

I find that Medicare Interactive is a great resource to share with patients who are interested in more information about Medicare coverage and their eligibility for the RSV vaccine.

As for Medicaid, all state agencies are required to cover ACIP-recommended vaccines without cost sharing as of October 1. Although ACIP first included the RSV vaccine for adults aged 60 years and older in their June 2023 guidance, and it was not until October 1 (per the Inflation Reduction Act) that Medicaid was required to cover the costs of these vaccines, including RSV.

Your Thoughts?
Do you provide the RSV vaccine to older adults in your clinical practice? Join the discussion by posting a comment below.