Vaccine advisory panel recommends expanded RSV use, and two new vaccines

A committee of independent vaccine experts voted Wednesday to recommend lowering the age at which adults can get a vaccine against respiratory syncytial virus, potentially opening up access to these vaccines for adults in their 50 s who are at high risk of severe illness from RSV.

Voting in favor of the recommendation, the Advisory Committee on Immunization Practices approved the use of any adult RSV vaccine licensed by the Food and Drug Administration for high-risk adults between the ages of 50 and 59. If the recommendation is accepted by the Centers for Disease Control and Prevention which the ACIP advises insurance companies will have to cover the cost of the vaccine for eligible individuals.

It's not clear how quickly that could happen. ACIP recommendations must be approved by the director of the CDC and at present the agency does not have a director. The Senate's confirmation process has not yet been completed for Susan Monarez, the acting director prior to her nomination for the position. A spokesperson said CDC chief of staff Matthew Buzzelli would take receipt of the six recommendations from the committee that arose from Wednesdays meeting.

Legal experts say that in the absence of a CDC director, health secretary Robert F. Kennedy Jr. could approve of the committee's recommendations, as reported last week by Jeremy Faust, a Boston emergency room physician and public health expert who writes the Substack column for Inside Medicine. In addition to voting for the RSV vaccine, the committee also voted to modify a previous recommendation for another chikungunya vaccine made by Valneva and recommended the use of a new meningococcal vaccine from GSK and Bavarian Nordic. If accepted by the CDC the vote on the use of RSV vaccines in people in their 50 s would initially apply to vaccines sold by GSK and Pfizer. The new policy, if approved, would also cover Moderna's application to the FDA to extend the license for its RSV vaccine to high-risk individuals between the ages of 50 and 59. According to the findings of a cost analysis that was carried out by researchers from the University of Michigan and the Centers for Disease Control and Prevention (CDC), administering these pricey vaccines to selected members of this age group might result in cost savings. In particular it was suggested that people who have undergone lung transplantation, or who have heart failure chronic obstructive pulmonary disease chronic kidney disease or severe obesity should be considered for RSV vaccination in their 50 s.

Michael Melgar a CDC vaccines researcher said around 30 persant of US adults aged 50 to 59 would qualify.

The current CDC recommendation for these vaccines in older adults is that anyone over 75 should get them, and anyone between the ages of 60 and 74 who is at a high risk of severe RSV illness should also get them. The ACIP has been slow to recommend broader use of RSV vaccines for older adults because of a couple of concerns.

Two of the vaccines the Pfizer and GSK products appear to be linked to an elevated risk of Guillain Barre syndrome. There have been no reports of GBS among people who received the Moderna vaccine .

Another concern relates to the fact that it is still not known how often these vaccines will need to be given and whether getting an additional dose at some later date will adequately boost protection. Despite the fact that additional doses do result in an increase in antibodies, the data to date suggest that antibody levels do not return to the levels seen following a first shot with these vaccines. At present the recommendation for RSV vaccines is that they are a onetime shot though it is widely expected that at some point there will be a recommendation for additional shots later.

The committee also voted to recommend use of a new chikungunya vaccine Vimkunya for travelers and scientists who work on the chikungunya virus in laboratories. The Bavarian Nordic vaccine has been approved for use in adults over the age of 12.

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