A Nuanced Answer: Eligibility, Not a Ban
In the U.S., the premise of the question that people over 80 cannot receive an RSV vaccine is largely outdated. Following a review of real-world data, the Centers for Disease Control and Prevention (CDC) updated its guidance, now recommending a single dose for all adults ages 75 and older. In other regions, like the UK, initial restrictive policies based on early clinical trial data have been reviewed, with new evidence showing strong efficacy even in the very elderly. The issue has been one of evolving eligibility, not an outright denial of access.
Why the Initial Hesitation for the Very Old?
Several factors influenced the initial cautious approach to vaccine rollout, especially for those in their 80s and older:
Limited Initial Trial Data
When the first RSV vaccines, such as Pfizer's Abrysvo and GSK's Arexvy, received approval, the initial clinical trials did not include a proportional number of participants over 80. This underrepresentation meant there was less certainty about the vaccine's specific effectiveness and safety profile in this oldest and often most frail cohort compared to younger seniors aged 60-79.
The Challenge of Aging and Comorbidities
As people age, their immune system naturally weakens. This can lead to a less robust immune response to vaccines. Individuals over 80 are more likely to have multiple underlying health conditions, which can influence both a vaccine's efficacy and a person's participation in a clinical trial.
Conservative Rollout Strategies
Public health bodies often adopt a conservative approach when new vaccines become available. They initially recommended vaccination for younger, at-risk seniors while gathering more real-world evidence for the oldest age groups.
Comparing Older Adults (60-79) and Very Old Adults (80+)
| Feature | Older Adults (60-79) | Very Old Adults (80+) |
|---|---|---|
| Initial Trial Representation | Included in large numbers | Underrepresented, fewer participants |
| Real-World Efficacy (2023-2024) | Strong efficacy demonstrated | Strong efficacy demonstrated, but monitored later |
| Initial Eligibility | Often recommended or based on clinical decision | Initially restricted or delayed in some regions |
| Immune Response | More robust than 80+ but less than younger adults | Often weaker due to immunosenescence |
| Risk of Severe RSV | High risk, especially with comorbidities | Highest risk of severe outcomes |
What Changed? New Evidence and Evolving Guidelines
Recent months have brought significant changes to RSV vaccine recommendations, with updated guidance now supporting vaccination for the very elderly:
Strong Real-World Evidence
Newer studies have provided robust evidence that RSV vaccines are highly effective in older adults, including those over 75. For example, a large study showed approximately 80% effectiveness in preventing hospitalization among adults aged 60 and older during the 2023-2024 season, and effectiveness was consistent across age groups, including the 75+ cohort.
Updated Recommendations from Health Authorities
Based on this new evidence, advisory bodies like the CDC updated their guidelines. As of September 2024, the CDC recommends that all adults 75 and older receive a single dose of an RSV vaccine. In countries like the UK, official committees have also indicated plans to review and potentially expand eligibility.
Ongoing Safety Monitoring
Post-licensure safety monitoring continues to gather data on adverse events in all populations, including the very elderly. While rare neurologic conditions like Guillain-Barré syndrome have been observed, health authorities consistently conclude that the benefits of preventing severe RSV disease significantly outweigh the potential, very small risks.
Conclusion
While it is understandable why many people would ask, "why can't people over 80 get the RSV vaccine?" the situation has dramatically evolved. Initial limitations were a result of the standard, evidence-based approach to vaccine rollout, influenced by underrepresentation of the very old in initial clinical trials. However, with the collection of substantial real-world effectiveness data, public health recommendations have expanded, ensuring that the most vulnerable population can access this important protection. Therefore, people over 80 can, and should, discuss getting the RSV vaccine with their healthcare provider.
Key Factors in Evolving RSV Vaccine Recommendations
- Initial Data Gap: Early clinical trials had smaller sample sizes for participants over 80, resulting in less specific data for this age group.
- Real-World Effectiveness: Subsequent real-world studies provided robust evidence of high vaccine effectiveness against severe RSV disease in adults over 75.
- Revised Public Health Recommendations: Major health bodies, like the CDC, have updated their guidance to universally recommend RSV vaccination for all adults 75 and older.
- Continuous Safety Review: Ongoing safety surveillance confirms that the benefit of vaccination against severe RSV disease far outweighs the potential, rare risks.
- Age and Frailty Considerations: Medical conditions and declining immune function in advanced age contributed to initial cautious strategies but are now considered alongside strong effectiveness data.
