Why is the RSV vaccine not offered to over-80s?

Last week, we told you about the potentially life-saving RSV vaccination, which is being offered to people aged 75 to 79, as well as those who have just turned 80. For most people, RSV causes cough and cold symptoms, but for some older adults it can lead to more serious illnesses, including pneumonia. One study estimated that it causes just under 8,000 deaths in over-65s in the UK each year.

The vaccine is now available for the first time for some older people, as well as women in late pregnancy to protect their babies. But the big question is: why is it not available for the over-80s? And that’s a question many Saga readers asked.

Why can’t over-80s get the RSV vaccine?

The cut-off point for those eligible for the RSV vaccine is stark. People who were aged 75 to 79 on 1 September are offered it, but that’s no comfort for Saga reader Len Parsons, who had his 80th birthday in June.

“I’m just outside the age range,” he told Saga Magazine. “My neighbour is 78 and he told me he’d just had a text to go for the RSV vaccine and I wondered why my wife and I hadn’t had one. So I got in touch with my surgery, who are very good. But NHS England say I’m not eligible.”

Len says he would pay for the vaccine, but he can’t find anywhere that offers it. He’s written to his local MP, as well as health secretary Wes Streeting, to ask the kinds of questions many people of his age have, including: “Is it for financial or medical reasons?”

Dr Mary Ramsay, Director of Public Health Programmes at the  UK Health Security Agency (UKHSA), told Saga: “Based on expert advice from the JCVI, Government decide which groups will be eligible for free NHS vaccines.

"Their decision was based on the latest available evidence at that time, including how long protection lasts and how common RSV infection is within different age groups, and they concluded that there is limited evidence of the vaccine being effective in those aged over 80.

"The JCVI will continue to keep the evidence under review.”

The problem is, there weren't many people over 80 in the trials of the RSV vaccines, which is why there isn't much evidence of how well it works in this age group.

“My neighbour is 78 and he told me he’d just had a text to go for the RSV vaccine and I wondered why my wife and I hadn’t had one. So I got in touch with my surgery, who are very good. But NHS England say I’m not eligible.”

The JCVI (Joint Committee on Vaccination and Immunisation) is made up of a group of experts who advise the government on vaccination programmes and they set up a sub-committee to specifically discuss RSV.

The committee advised that people over 75 should be offered the vaccine, with an initial catch-up programme for those aged 75 to 79. The committee did say an extension would be considered once there’s more certainty that the initial vaccinations have had an impact. Making the vaccine available for over-65s is also under review. 

A Department of Health and Social Care spokesperson said: “Decisions on eligible groups are guided by the independent Joint Committee on Vaccination and Immunisation’s evidence-based recommendations. The JCVI will continue to review the data on who should be offered an RSV vaccination.”

The RSV vaccine being used in the UK is Abrysvo, a protein subunit vaccine, manufactured by Pfizer. It contains isolated proteins from the virus which help the immune system to fight it, but don’t contain any live pathogens (nor is it an mRNA vaccine). The Shingrix vaccine, given to prevent shingles, works in a similar way (although the RSV vaccine is one dose, not two like Shingrix).

 Why aren’t there more over-80s in clinical trials?

One thing stands out: more research is needed on the effects of the RSV vaccine on people who are over 80. 

One placebo-controlled trial, of the Moderna RSV vaccine (which is not the vaccine which is being used in the UK, although the JCVI advice is that any of the new RSV vaccines would be suitable), showed that efficacy was “maintained with increasing age”, with people in their 70s seeming to have greater protection after the vaccine than those in their 60s.

So if it’s more effective at 75 than 60, would it be even more so for people who are 80 and older? It’s hard to tell, because only 5.6% of the 35,000 trial participants were over 80, and none of them caught RSV.

The over-75s and over-80s are under-represented in medical research ... part of the issue is reluctance of over-80s to volunteer for the trials, but often they are less likely to be eligible to volunteer or the trial may be designed in a way that’s harder for an older person to take part

Similarly, the trial for the Pfizer vaccine covered 35,000 people and only 5.6% were over 80. Among the 1,928 over-80s in the Pfizer study, five who had been vaccinated caught RSV, compared with 17 who were in the placebo arm.

These figures suggest a higher effectiveness in over-80s than in over-60s or over 70s, but because the numbers are fairly small it is hard to be sure.  

Unfortunately, the over-75s and over-80s are under-represented in medical research in general. Only 1.7% of people in Covid vaccine trials were over 75, even though they went on to become one of the first age groups to be vaccinated.

In the past, over-75s were specifically included from many trials, although that has recently changed and the United States has a new law that promotes diversity (of age and other characteristics) in research trials.

Research suggests that part of the issue is reluctance of over-80s to volunteer for the trials, but often they are less likely to be eligible to volunteer (for example because of other health conditions) or the trial may be designed in a way that’s harder for an older person to take part in.

“Exclusion of the elderly”

Meanwhile, there is little comfort for over-80s who are left out of the RSV vaccine programme. Helen Penney, 83, felt excluded when she saw the news. “It’s the principle that really gets me: that when you turn 80 you are of no interest and importance and basically just a nuisance.

“In my 80s, I’m more aware of the exclusion of the elderly from so many things. I find it very sad how little respect is given to the older generation and I think European countries are much more respectful of their elderly people.”

Cynthia Lewis, a sculptor from London and a member of the Society of Women Artists, is particularly concerned, since she is classed as very vulnerable for health reasons. She says: “I am not eligible for the free RSV, as I’ve been an octogenarian for some years! I feel that it ought to be based on need and/or vulnerability, not just age.

"As I’m classed as ‘very vulnerable’, perhaps I ought to be eligible, as for over 40 years I haven’t had – and I never will have – a working immune system and I’ve no protection against germs and infections. But the government is not giving us the protection of the RSV vaccine, even though it would be of equal benefit to my age group and to me, so that I can carry on living well, to create my sculptures."

Ivan Holder, 80, from Welwyn Garden City, says: “The RSV vaccine is not a lot of use to me and many other people over 80. It is cut off to save money, and will probably cost a lot more when and if older persons get the illness. It seems to me that when you get old the government wants to not bother with us.”

Some over-80s have said they would be happy to pay for the vaccine. A number of clinics and pharmacies offer the RSV vaccine at a charge for over-60s, so ask your nearest travel clinic or pharmacy if you are interested.

Charities have come forward to say they understand the frustration of the excluded group.

Caroline Abrahams, Charity Director of Age UK, said: “The risks associated with RSV are less known about for older people. In some older people it may cause symptoms that are much like a cold, but this respiratory virus can also lead to more serious infections such as bronchiolitis or pneumonia. 

“We understand that those who are not eligible at the moment may be frustrated. This particular age range aren’t eligible as there isn’t yet enough evidence on the effectiveness in the older age groups. But there may be potential for an extension of eligibility in the future, depending on the outcome of this initial vaccine roll out.”

Find out more about the RSV vaccine and if you’re eligible