RSV Vaccination Rates Remain Low Among US Veterans

Key Clinical Summary

• Among 3.5 million vaccine-eligible veterans in the US, only 9.8% received a respiratory syncytial virus (RSV) vaccine during the 2023-24 season; uptake dropped to 3.0% in the first 4 months of 2024-25.
• Lower uptake was associated with age 60-74 years (vs ≥ 75), rural residence, current smoking, housing instability and virtual-only visits; higher uptake was seen among veterans with cardiovascular, pulmonary disease or immunocompromise.
• Veterans using only telehealth had significantly lower vaccination rates (4.7% vs 9.9% in 2023-24; 1.3% vs 3.0% in 2024-25) compared with those with at least 1 in-person visit.

A recently published cohort study in Open Forum Infectious Diseases evaluated uptake of the newly approved RSV vaccines among the US veteran population served by the Veterans Health Administration (VHA). The study addresses critical gaps in real-world vaccination behavior among a high-risk older adult cohort now eligible under US guidelines.

Study Findings

The authors included veterans aged 60 years or older as of September 1, 2023, who had at least 1 primary-care visit in 2020-21, across the 2023-24 and 2024-25 RSV seasons. Vaccination was defined as at least 1 dose of either of the approved RSV adult vaccines (Arexvy or Abrysvo) provided free or under medical benefits at VHA.

In the 2023-24 season, out of 3 497 851 eligible veterans, only 342 818 (9.8 %) received an RSV vaccine. Of the 3 155 033 veterans who remained unvaccinated that season, 2 757 249 were eligible in the 2024-25 season, and only 82,237 (3.0 %) received the vaccine during the first 4 months.

Regression analyses demonstrated that in 2023-24 uptake was lower in veterans aged 60-74 years (risk ratio [RR] 0.69; 95 % CI 0.68-0.69), rural residents (RR 0.77; 95 % CI 0.76-0.77), current smokers (RR 0.55; 95 % CI 0.54-0.56), and individuals with housing insecurity (RR 0.46; 95 % CI 0.44-0.47). Conversely, uptake was higher among those with cardiovascular disease (RR 1.40; 95 % CI 1.39-1.42), pulmonary disease (RR 1.41; 95 % CI 1.39-1.42), and immunocompromise (RR 1.31; 95 % CI 1.28-1.33).

The virtual-only care group had markedly lower uptake: 4.7% vs 9.9% among those with at least one in-person visit in 2023-24; 1.3% vs 3.0% in early 2024-25.

Clinical Implications

For pharmacists working with the US veteran population or with older adult outpatient cohorts, these findings highlight a significant gap in preventive care for RSV in older adults. The low uptake (single-digit percentages) despite free or benefit-covered vaccines underscores the need for active vaccine promotion, system-level reminders, and tailored outreach. The disparities linked to social determinants (rural residence, smoking, housing insecurity) suggest that standard vaccination workflows may not sufficiently reach the most vulnerable. Pharmacists in outpatient settings, community-based clinics or within the VHA system should focus on identifying eligible individuals (≥ 75 years or 60-74 years with high-risk comorbidities per US Centers for Disease Control and Prevention guidance) and implementing strategies such as opportunistic in-person counselling, standing orders and in-clinic reminders during visits.

The association with in-person visits further signals that vaccination efforts may falter in telehealth-only encounters, so virtual-care pathways should be enhanced with follow-up in-person touchpoints or referral to on-site vaccination. Pharmacists should also partner with care managers to flag patients with multiple comorbidities or immunocompromise (who had higher uptake) and those with neurologic diseases or Guillain–Barré syndrome (with lower uptake) to provide targeted education and dispel misconceptions around eligibility.

“Among individuals with social risk factors, vaccine uptake remained lower, underscoring the need for targeted strategies,” said the authors.

The commentary highlights that even within a coordinated health system such as the VHA, socio-demographic and behavioral barriers persist, reinforcing that elimination of cost or coverage alone does not ensure uptake.

Conclusion

While the availability of new RSV vaccines offers a major preventive opportunity for older adults, uptake among US veterans remains disappointingly low. Pharmacists and health care teams serving this population must act now to optimize delivery, address social-comorbidity barriers, and integrate vaccination into routine care workflows in both in-person and telehealth settings.

Reference

Kim HS, Lo NC, Boscardin WJ, et al. Low uptake and disparities in respiratory syncytial virus vaccination among US veterans. Open Forum Infect Dis. 2025;12(11):ofaf434. doi: 10.1093/ofid/ofaf434