New vaccinations now recommended for adults

August 25, 2023

Illustration by Dall-E 

Roll your sleeves up!

Not only is there a new influenza vaccine available now and a new COVID-19 vaccination available next month, but the FDA has approved, and the CDC has recommended, multiple respiratory syncytial virus (RSV) vaccines as well.

The newly formulated COVID-19 vaccine is supposed to be available by late September and is recommended for anyone who has not had COVID-19 or a vaccination in the last three months. The evidence that COVID-19 vaccinations prevent severe illness, hospitalizations and deaths continues to grow; I’ll be getting mine as soon as the vaccine becomes available. Those who have had COVID-19 this summer can probably wait until later in the fall to be vaccinated. This vaccine is targeted to XBB.5, an Omicron strain that is the forerunner of the variants that are now most prevalent.

This is the first COVID-19 vaccine that will be the financial responsibility of employer-sponsored health plans and is expected to cost $110-$130 per dose.

The COVID-19 vaccine can be administered with the influenza vaccine, preferably in different arms. There is a laboratory study suggesting an immunity benefit from getting the COVID-19 vaccinations consistently in the same arm, but that’s a lot less important than getting the vaccine. It’s convenient to get the influenza and COVID-19 vaccinations together, and this eliminates the possibility of forgetting the second shot.

For adults 60 years and older, there are two new RSV vaccinations available, Arexvy and Abrysvo. RSV causes 60-160,000 hospitalizations and 6,000 to 10,000 deaths in the elderly each year. This vaccine should be given separately at least two weeks before or after the flu and COVID-19 vaccinations as it is new and individuals don’t know how they will be affected by it.

And there’s more!

Beyfortus, an RSV monoclonal antibody (not technically a vaccine) is recommended by the CDC for infants under 8 months - which is great news because RSV causes 50-85,000 hospitalizations among young children each fall. This injection is expected to become available in the next month or so to be given with influenza vaccinations. At the same time, there is a new vaccine available for pregnant women which will offer immunity to their babies at birth. This vaccine has been shown in clinical trials to prevent 82% of cases of severe RSV in the first 3 months of life, and 69% of cases of severe RSV in the first six months of life. The FDA approved this vaccine this week, and the CDC’s Advisory Committee on Immunization Practices is expected to endorse this in the coming weeks.

Implications for employers:

-        Costs for vaccination will be up substantially this year, from the end of federal procurement of COVID-19 vaccines and the development of new vaccines that can prevent severe respiratory illness.

-        Costs of preventable respiratory diseases will be down. Childhood vaccines are one of the few medical interventions that consistently save more money in the medical budget than they cost.

-        These vaccinations can also reduce time away from work due to respiratory illness in employees and their families.

-        With ready availability of vaccines at many pharmacies, many employers will likely stop offering “flu shot clinics.” Those that offer immunization clinics this fall should include COVID-19 as well as influenza vaccinations.

Influenza, COVID-19, and RSV vaccinations for adults and RSV monoclonal antibodies for infants are recommended by the Advisory Committee on Immunization Practices (ACIP), so must be covered without cost sharing. ACIP has not yet recommended the RSV vaccine for pregnant women, but is expected to review this in the near future