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RSV vaccination barriers
Overcoming the Top Reported Barriers to Adult RSV Vaccination 

Released: June 13, 2025

Expiration: June 12, 2026

Carolyn Bridges
Carolyn Bridges, MD, FACP
Laura P. Hurley
Laura P. Hurley, MD, MPH
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Key Takeaways
  • Among HCP learners, key barriers to adult RSV vaccine implementation are insurance coverage and vaccine stock, knowledge gaps, and safety concerns.

Audience members from a recent webinar on adult respiratory syncytial virus (RSV) vaccine implementation identified the following themes as their top barriers to patient vaccination. Read on to gain expert insights into practical strategies for overcoming these roadblocks.

Vaccine Access in the Clinic
Many healthcare professionals (HCPs) highlighted that a lack of RSV vaccine stock in their clinic pharmacies was a barrier to adults receiving it.

This lack of stock may be tied to insurance coverage, particularly with Medicare. Many patients eligible to receive the vaccine are Medicare beneficiaries. Medicare Part D, a pharmaceutical benefit, covers the RSV vaccine, often making it easier for patients to receive the vaccine at a pharmacy. This may be why clinics have chosen not to stock the vaccine. 

To overcome this barrier, clinics should become more facile at referring patients to a pharmacy to receive their RSV vaccines, as RSV vaccines are readily available at most retail pharmacies. One of the tenets of the CDC Adult Immunization Standards is to refer patients outside the clinic to receive vaccines if the clinic does not offer them. For example, my clinic built an order in our electronic health record to refer patients to the pharmacy to receive the RSV vaccine.

Alternatively, HCPs may influence their clinics to start stocking RSV vaccine. Clinics can bill for vaccines covered by Medicare Part D—like RSV vaccine—through a program called TransactRx.

Knowledge Gaps Concerning RSV As a Cause of Acute Respiratory Illness in Adults
RSV is not a well-known cause of respiratory disease in adults. HCPs indicated that this knowledge gap may contribute to low uptake of RSV vaccine. 

RSV poses diagnostic challenges in adults because there is no distinctive syndrome. For some patients RSV infection may result in exacerbation of an underlying condition like heart failure or chronic obstructive pulmonary disease, but not be recognized as the contributing factor. 

However, surveillance systems like RSV Hospitalization Surveillance Network began tracking RSV-associated hospitalizations in US adults during the 2016-2017 season and heightened our appreciation of RSV-associated morbidity and mortality in adults. A systemic review and meta-analysis of medically attended RSV in the United States estimated that each year among adults 65 years of age and older RSV infection is responsible for roughly:

  • 9500-12,700 deaths
  • 159,000 hospitalizations
  • 119,000 emergency department admissions
  • 1.4 million outpatient visits

In younger individuals 50-59 years of age, RSV is estimated to result in 15,000-20,000 hospitalizations annually. 

Increased HCP and patient awareness of RSV disease in adults may help improve RSV vaccination rates. HCPs should take steps to bridge this knowledge gap with patients, and clinic leadership should facilitate education of HCPs and other clinic staff.

Safety Concerns
Patient concerns regarding adverse events was another top-reported barrier to RSV vaccination. As a preventive measure, it is imperative that vaccinations be safe. Patients should be assured that safety is a priority throughout the vaccine approval process in the United States. Once approved, the CDC’s Advisory Committee on Immunization Practices also thoroughly considers safety of vaccination before making recommendations. Then once vaccines are recommended in the United States they undergo both passive and active surveillance for safety concerns. In fact, policy changes sometimes occur because of safety data.

Aside from reactions common to many vaccinations such as pain at the injection site, fatigue, headache, and myalgias, postmarketing data for 2 RSV vaccines (RSVpreF and RSVPreF3) suggest an increased risk of Guillain-Barre syndrome (GBS) during the 42 days following vaccination. This caused the FDA to require a GBS warning in the prescribing information for both vaccines. Despite this precaution, available evidence is insufficient to establish a causal relationship between GBS and RSV vaccination.

Perhaps of more importance, a key point of discussion with patients is that the risk of developing GBS from a RSV vaccination is believed to be very small, which is fewer than 10 cases per 1 million vaccinations. 

In addition, preclinical trials of RSVpreF and RSVPreF3 reported a numerical imbalance of atrial fibrillation between the intervention and control arms within 30 days of vaccination. However, population-based studies did not confirm an increased risk of atrial fibrillation with RSV vaccination compared with influenza or the tetanus, diphtheria, pertussis vaccination.

Like GBS, atrial fibrillation is a more common condition in older rather than younger populations. Benefits of RSV vaccinations are felt to outweigh any risks of rare serious reactions and should be conveyed to patients. 

Your Thoughts
What barriers to adult RSV vaccination do you observe in your practice? How do they compare with the barriers described here? Leave a comment to join the discussion!