The government announced a national vaccination programme for the respiratory syncytial virus (RSV) vaccine for some groups, starting from September 2024. RSV infections are common and can cause coughs and colds. RSV infections are not usually serious, although some groups have a higher risk of serious infection, including babies under six months and adults over 75 years.
This Insight explains how the government decided the eligibility criteria for the RSV vaccination programme, and why it has chosen not to include people aged 80 and over.
Health policy is devolved, so the information in this Insight applies to England only.
Who is eligible for the RSV vaccine?
Eligibility criteria for the RSV vaccine is set out by NHS England. It recommends the RSV vaccine for people aged 75 to 79 and for people who are more than 28 weeks pregnant (to help protect the baby from infection after it has been born).
People who turned 80 on or after 1 September 2024 are eligible for the RSV vaccine until 31 August 2025. People who turned 80 before 1 September 2024 are not eligible for the RSV vaccine.
The RSV vaccine programme is year-round, rather than being offered seasonally during the autumn and winter months like the influenza vaccine.
The UK Health Security Agency (UKHSA) is a government agency that prepares for and responds to infectious diseases. It said that in clinical studies, the RSV vaccine provided “good protection for at least 2 years and is expected to last longer”.
How did the government decide the RSV vaccine’s eligibility criteria?
Government decisions about vaccination programmes are based on the advice and recommendations of the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI is an independent expert scientific advisory committee which advises the UK Government on vaccinations and immunisation.
In September 2023, the JCVI published an independent report on advice about an RSV immunisation programme for infants and older adults. The JCVI advised the government to develop an RSV immunisation programme that is cost effective to protect infants and older adults.
The JCVI considered several factors when creating its advice on an RSV immunisation programme, including:
- how safe the vaccine is (for example, what side effects it has)
- how long the vaccine protects against RSV (or ‘duration of protection’)
- how many people become infected with RSV each year, and how ill they become (or ‘disease incidence’)
- the cost of purchasing the vaccine and administering it
The JCVI collected information on these factors from manufacturers of the vaccine, emerging real-world evidence from immunisation programmes in different countries, data from clinical trials, and modelling of different immunisation strategies from the London School of Hygiene and Tropical Medicine and other academic groups.
Why didn’t the JCVI recommend the vaccine for people aged 80 or over?
Several MPs have asked parliamentary questions about why people aged 80 and over are not eligible for the RSV vaccine and whether the government will consider extending its criteria to include this group, including PQ 19592, PQ 7797 and PQ 4583.
The JCVI’s independent report suggested an initial vaccination programme for people aged 75 to 80 years old. The report suggested that the programme could be extended when there was more certainty about the efficacy of the vaccine’s protection for the very elderly and the real-world impacts of the programme in 75-to-80-year-olds.
The committee’s report also considered the cost-effectiveness of the vaccine and noted that the cost of administration would be reduced if a single dose of the vaccine gave multi-year protection. The report concluded:
The committee was strongly in favour of having an impact on RSV and advised a programme for those aged over 75 years. The committee suggested an initial programme to potentially vaccinate a cohort aged from 75 to 80 years old, and then for those turning 75 years in subsequent years. Advice for the programme would be guided by emerging evidence on duration of protection and disease incidence. An extension to the initial programme would be considered when there is more certainty about protection in the very elderly and the real-world impact of the programme in the 75 to 80 year olds.
In its committee meeting on 2 October 2024, the JCVI noted the ongoing discussions around people aged 80 and above not being eligible for the RSV vaccine. It reiterated its initial reasons for not recommending vaccination for people in this age group, saying it was continuing to monitor emerging evidence on the duration of protection and disease incidence.
It said would need to conduct a detailed review of the evidence for a potential extension to the programme for “the very elderly and risk groups”.
Other risk groups
The JCVI’s independent report discussed widening eligibility to other specific clinical groups who may be at similar risk of severe RSV infection. It said widening the eligibility would require a more formal assessment of potential at risk populations. The committee agreed that their efforts should be concentrated on formulating advice for introducing a universal vaccination programme that would cover all risk groups as soon as possible.
Evidence about risks for premature infants
In its committee meeting on 2 October 2024, the JCVI said there had been various concerns that premature infants may remain unprotected from RSV, particularly those born under 32 weeks. This lack of protection is because vaccination is not offered until people are more than 28 weeks pregnant. As a result, there may be lower antibodies that help protect against the virus transferred across the placenta from the mother to infant.
The JCVI said there was a need to consider infants born prematurely. The UKHSA has been analysing the cost effectiveness of offering a specific antibody directly to the infant to protect those born prematurely.
Further reading
About the author: Devyani Gajjar is a researcher at the House of Commons Library, specialising in health policy.
Photo by: zinkevych, via Adobe Stock