By: Ashley Medina, PharmD Candidate c/o 2025

After decades of trial and error, science is ready to offer preventative measures against the respiratory syncytial virus, better known as RSV. Utilizing RSV vaccination tools that have become available will allow for a healthy, fun, and safe transition from winter to spring, often when RSV cases rise. RSV presents similarly to a cold, affecting the nose, throat, and lungs.¹ However, such a lower respiratory tract infection may become fatal for those that make up vulnerable populations including, but not limited to, young children, infants, and older adults. 

The past month has allowed pharmacists to collaborate with other healthcare providers and their communities to administer the new RSV vaccines and make a significant impact. On August 8, 2023, the Department of Health (DOH), in partnership with the New York State Education Department (NYSED), authorized pharmacists to administer RSV vaccines to adults aged 60 years and older.² Under the NYS education law, Chapter 555 of the Laws of 2021, pharmacists were granted permission to administer several vaccines with or without patient-specific orders, and two more have just joined the list.³ This news may sound minor at first glance, but it is quite the opposite!

The role of pharmacists as immunizers dates back to 1997, when the American Pharmaceutical Association (APhA) national training program was established.⁴ APhA’s program aimed to address the prevalence of infectious diseases due to few effective preventative measures, such as available vaccines. In 2008, the New York State Education Laws sections 6527, 6801, and 6909 extended pharmacists’ authority to administer vaccinations to individuals aged 18 years and older.⁵ To date, vaccines approved for those 18 years and older include pneumococcal, meningococcal, tetanus, diphtheria, pertussis, herpes zoster, hepatitis A and B, human papillomavirus (HPV), measles, mumps, rubella, varicella, coronavirus disease 2019 (COVID-19), and RSV vaccinations.⁶ Influenza vaccine is the exception, in which it may be administered to those two years and older. The roles played in pharmacy practice expanded due to the COVID-19 pandemic. Recalling the events may remind us how pharmacies and their teams have stepped up to join other frontline healthcare workers. While cases were skyrocketing, the approval of new COVID-19 vaccinations strongly encouraged the public to get vaccinated to protect themselves. In March 2020, the Public Readiness and Emergency Preparedness (PREP) Act was born. Under this act, pharmacists can prescribe and administer COVID-19 vaccines to expand vaccine accessibility and decrease the risk of outbreaks.⁷ Thus, pharmacists became crucial educators for vaccine-hesitant patients. In less than half a century, the revolution of the pharmacist role has undoubtedly contributed to the frontlines of healthcare. From here, it should only cultivate more helpful practices to optimize patient care and health. 

The RSV vaccines that are currently available are Arexvy, developed by GlaxoSmithKline, and Abrysvo, developed by Pfizer. Arexvy, approved in May 2023 by the FDA, was granted based on information from an ongoing randomized, placebo-controlled clinical study for individuals 60 years and older.⁸ Abrysvo, also approved in May 2023, is indicated for use in older adults and has been in the works for over a year. With robust efficacy data for both vaccines, further approval for remaining vulnerable populations and the public is ongoing. Designed for the same indication, with similar mechanisms both vaccines serve to combat RSV infection.^9,10 They both are considered recombinant subunit vaccines, which means small pieces of the virus are in the vaccine, but not enough to cause illness to the individual. This allows the body’s immune system to be stimulated to respond appropriately, so it may combat infection if and when the time comes. Like other vaccines, they both exhibit similar side effects, such as injection site and/or muscle pain, and headaches. However, slight differences exist between the two, including ingredients that assist their stability and indication for additional populations. Most notably, as of August 21, 2023, Abrysvo has been granted an indication for pregnant individuals within 32 to 36 weeks of gestational age to protect mothers and infants.¹¹ Such events led to the successful implementation and expansion of the RSV vaccines as preventative care this winter.

What does this mean for the practice of pharmacy? Many will agree that this is another public health triumph, as expanding vaccine administration to pharmacists will educate and protect community members from illnesses, including RSV. Not only is this a chance to teach others, but it is also an opportunity to improve accessibility. Many patients frequent their local pharmacies to pick up everyday medications, building relationships with their staff and pharmacists. With the trust between patients and their pharmacists, older adults are more likely to receive the RSV vaccines, lowering their risk for infection and recommending their loved ones do the same. Nationwide, this trend will lead to an increased overall vaccination rate.¹² As we have seen with the flu, COVID-19 vaccinations, and several others, a higher vaccination rate provides a healthier environment. 

One may be wondering now, should I get the vaccine? The answer ultimately comes down to eligibility. The vaccine was developed to prevent health complications that may arise from contracting RSV. There are three main groups identified by the American Lung Association that are considered high risk for severe cases of RSV.¹³ This categorization consists of adults with chronic lung or heart disease, adults with a weakened immune system, and all older adults predominantly above 65 years old. At the moment, according to physicians, those who will benefit the most from receiving the vaccine are older adults aged 60 years and older. It is also recommended that those vulnerable to severe infection or who can transmit it to these individuals should ask their provider if they are eligible to receive the vaccination. The DOH and SED have announced that the vaccine will fall under Medicare Part D, ensuring that those covered can receive their vaccination without out-of-pocket costs.² Ideally, such coverage will inspire higher vaccination rates. Until then, to defend not just those 60 years and older from RSV, the DOH and CDC recommend practicing good hygiene to protect ourselves and others. For more information and updates, visit CDC.gov/rsv or the Department of Health’s website.¹

References

1. Respiratory syncytial virus (RSV). Centers for Disease Control and Prevention. Updated August 4, 2023. Accessed August 20, 2023. https://www.cdc.gov/rsv/index.html.
2. New York State Department of Health, in partnership with State Education Department, takes steps necessary to ensure RSV vaccine for adults over age 60 will be administered in pharmacies statewide. News release. New York State Department of Health. August 8, 2023. Accessed August 12, 2023. https://www.health.ny.gov/press/releases/2023/2023-08-08_rsv.htm. 
3. Proposed amendment to section 63.9 of the regulations of the commissioner of education relating to the administration of immunizations by pharmacists. New York State Education Department. Published January 5, 2022. Accessed August 17, 2023. https://www.regents.nysed.gov/sites/regents/files/122ppca1.pdf. 
4. APhA-ASP operation immunization. American Pharmacists Association. Accessed August 31, 2023. https://www.pharmacist.com/apha-asp-operation-immunization
5. Pharmacists as immunizers. New York State Department of Health. Updated August 2023. Accessed August 22, 2023. https://www.health.ny.gov/prevention/immunization/providers/pharmacists_as_immunizers.htm.
6. Administration of immunizations. New York State Education Department. Accessed September 1, 2023. https://www.op.nysed.gov/professions/pharmacist/frequently-asked-questions/administration-of-immunizations.
7. Public Readiness and Emergency Preparedness (PREP) Act. Administration for Strategic Preparedness and Response. Accessed August 28, 2023. https://aspr.hhs.gov/legal/PREPact/Pages/default.aspx.
8. FDA approves first vaccine for pregnant individuals to prevent RSV in infants. News release. U.S. Food & Drug Administration. August 22, 2023. Accessed August 23, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants. 
9. Arexvy (respiratory syncytial virus vaccine, adjuvanted). Prescribing information. GlaxoSmithKline; 2023. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Arexvy/pdf/AREXVY.PDF.
10. Abryvso (respiratory syncytial virus vaccine). Prescribing information. Pfizer Inc.; 2023. https://labeling.pfizer.com/ShowLabeling.aspx?id=19589.
11. FDA approves first respiratory syncytial virus (RSV) vaccine. News release. U.S. Food & Drug Administration. May 4, 2023. Accessed August 19, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine.
12. Tak CR, Marciniak MW, Savage A, Ozawa S. The essential role of pharmacists facilitating vaccination in older adults: the case of Herpes Zoster. Hum Vaccin Immunother. 2020;16(1):70-75. doi:10.1080/21645515.2019.1637218 
13. RSV in adults. American Lung Association. Accessed October 19, 2023. https://www.lung.org/lung-health-diseases/lung-disease-lookup/rsv/rsv-in-adults.

Published by Rho Chi Post