For older adults, maintaining independence and avoiding hospitalization are defining health priorities — yet a highly preventable respiratory threat remains dramatically underaddressed. Respiratory syncytial virus causes severe illness and death in adults over 60 at rates comparable to influenza, but public awareness, clinical emphasis, and vaccination infrastructure have lagged far behind the disease's actual burden in this population.
This expert review in Expert Review of Vaccines synthesizes clinical trial data and real-world evidence across all three currently approved RSV vaccines for adults, evaluating their efficacy, effectiveness, and safety profiles. The analysis identifies a convergent set of structural and behavioral barriers suppressing uptake: inadequate reimbursement pathways, fragmented guidance across health systems, persistent vaccine hesitancy amplified by misinformation, and a fundamental awareness gap — both among patients and clinicians — about RSV's severity in older populations. The authors argue that vaccination's benefits extend beyond infection prevention to encompass reduced antibiotic use (and thus lower antimicrobial resistance pressure) and measurable contributions to functional independence and healthy aging trajectories.
The broader research landscape on adult immunization consistently shows that supply-side solutions — approving effective vaccines — do not automatically translate into population-level protection. Structural access barriers and trust deficits require equally deliberate policy responses. What distinguishes this review is its framing of adult RSV vaccination not merely as infectious disease management but as a longevity and healthspan intervention. The link between severe RSV illness and accelerated functional decline in older adults is underappreciated; avoiding a single serious respiratory hospitalization can meaningfully alter a person's aging trajectory. The life-course immunization framework proposed here aligns with emerging geroscience thinking that preventive interventions compound over decades. The primary limitation is that this remains a narrative expert review rather than a meta-analysis, and real-world effectiveness data for adult RSV vaccines, while promising, are still accumulating. Overall, this is a useful synthesis for clinicians and health systems navigating implementation, though the core public health argument is incremental rather than paradigm-shifting.
