CS000000-A | 9/1/23

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence & Demand Team, Insights Unit

The findings and conclusions in this report are those 

of the author(s) and do not necessarily represent 

the official position of the Centers for Disease 

Control and Prevention (CDC).

CDC’s State of 

Vaccine Confidence 

Insights Report

RSV Vaccination in Older Adults 

Special Report 

September 1, 2023

Date Range: January 1- June 15, 2023
Page: 2

State of Vaccine Confidence Insights Report | September 1, 2023

Report Summary 

Themes with the potential to impact vaccine confidence and demand:

 Theme 1: Although consumers reported knowing few people affected by respiratory syncytial 

virus (RSV) infection, concern about the virus and interest in the vaccine are high among older 

adults. 

 Theme 2: Many consumers have limited knowledge and high uncertainty about RSV and RSVrelated illness, including its ability for asymptomatic spread, frequency of severe infections, and 

the likelihood of reinfection. 

 Theme 3: Low consumer trust in FDA, CDC, pharmaceutical companies, and vaccines may 

negatively impact RSV vaccine uptake.

Ways public health and partners can take action to improve knowledge about RSV-related 

illness and RSV vaccine for older adults:

 Strong evidence exists that using pre-existing mental models in messaging improves the 

salience and uptake of messages. Consider crafting and disseminating messages that situate 

RSV within the broader category of respiratory viruses such as influenza and COVID-19. This 

approach can help individuals who may be unfamiliar with RSV to grasp its potential severity 

and take appropriate preventive measures.

 Due to low proportions of people knowing someone that previously had RSV, craft messages 

that raise awareness about the prevalence and incidence of RSV in older adults and young 

children. 

 Consider crafting messages that tell the stories of people impacted by RSV. Evidence supports 

the effectiveness of emotional narrative messages in reaching those with message fatigue. 

 Consider crafting messages informing older adults about the benefits of RSV vaccination. 

There is a strong evidence base for “gain-framed” messages (highlighting the health benefits 

of engaging in a particular behavior) compared with “loss-framed” messages (emphasizing the 

negative consequences of failing to engage in healthy behaviors).

 Due to the high proportion of people surveyed by the Annenberg Public Policy Center (APPC) 

who were unsure if a person could get reinfected with RSV (60%), create and share messages 

communicating that people can get infected with RSV multiple times throughout their lives. 

 Consider adapting the process and risk messaging about the FDA’s vaccine approval process 

from a recent APPC study among older adult populations, using the examples from APPC as a 

starting point.

 Due to consumers’ concerns about the RSV vaccine approval process, consider disseminating 

messages that clearly outline how vaccines are developed and approved, such as this 

representation of the Vaccine Life Cycle provided by CDC or these English and Spanish

infographics highlighting FDA’s role in the approval process created by FactCheck.org.

Resources: The following link contains graphics and assets partners can use to address the themes in 

this report: https://centersfordiseasecontrol.sharefile.com/d-s394ec9ecbf484c72845317e525712090 
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State of Vaccine Confidence Insights Report | September 1, 2023

Contents

4

Aims and Methods

5

Theme 1: Although consumers reported 

knowing few people affected by RSV, concern 

about the virus and interest in the vaccine are 

high among older adults. 

5

Perceptions, Concerns, and Threats that Might 

Impact Vaccine Confidence and Demand

7

Commonly Asked Questions

8

Inaccurate Health Information Themes

00

Ways to Take Action

9

Theme 2: Many consumers have limited 

knowledge and high uncertainty about RSV 

and RSV-related illness, including its ability 

for asymptomatic spread, frequency of severe 

infections, and the likelihood of reinfection.

9

Perceptions, Concerns, and Threats that Might 

Impact Vaccine Confidence and Demand

10

Commonly Asked Questions

11

Inaccurate Health Information Themes

11

Ways to Take Action

12

Theme 3: Low consumer trust in FDA, CDC, 

pharmaceutical companies, and vaccines may 

negatively impact RSV vaccine uptake.

12

Perceptions, Concerns, and Threats that Might 

Impact Vaccine Confidence and Demand

13

Commonly Asked Questions

14

Inaccurate Health Information Themes

14

Ways to Take Action

15

References

19

Appendix: Inputs and Sources
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State of Vaccine Confidence Insights Report | September 1, 2023

Aims and Methods

By reviewing and analyzing numerous specific sources and inputs, this State of Vaccine Confidence 

Insights Report emphasizes major themes influencing RSV vaccine confidence and uptake in older 

adults. In addition, by examining how consumers think and feel, social processes, and the practical 

issues around vaccination, this Insights Report seeks to identify emerging issues related to the spread 

of inaccurate health information to help identify where intervention efforts can improve vaccine 

confidence. Data for this report was specially gathered to help analyze themes among adults ages 60 

and older.

The information in this report is only a snapshot, and specific populations may be underrepresented. 

Images and quotes are illustrative examples and are not meant to comprehensively cover all content 

related to the highlighted themes. 

How do you classify this theme/information? 

High risk Moderate risk Low risk Positive sentiment

 May lead to 

vaccine refusals 

and decreased 

uptake 

 Wide reach, 

pervasive  

 Potential to 

trigger hesitancy 

to vaccination

 Moderate 

reach, modest 

dissemination 

 Concerning, but 

low risk to vaccine 

confidence 

 Limited 

reach, limited 

dissemination 

 Could increase 

vaccine 

confidence, intent, 

or motivation

 Variable reach and 

dissemination

How has this theme/idea changed over time (since last report or over the course of multiple 

reports)? 

Increasing

Information spreading 

rapidly 

Stable

Information remaining 

constant at prior level 

Decreasing

Information is not gaining further traction 

and there has been no indication of additional 

activity 
Page: 5

State of Vaccine Confidence Insights Report | September 1, 2023

Theme 1: Although consumers reported knowing 

few people affected by RSV, concern about the virus 

and interest in the vaccine are high among older adults. 

The US Census Bureau estimates there are 77,565,896 US adults 60 years of age and older.1 According 

to a recently published Morbidity and Mortality Weekly Report (MMWR), RSV causes 60,000–160,000

hospitalizations and 6,000–10,000 deaths among adults aged ≥65 years each year in the US.2

Adults at the highest risk for severe RSV illness include older adults, adults with chronic heart or 

lung disease, adults with weakened immune systems, and adults living in nursing homes or longterm care facilities.3

 In May 2023, two RSV vaccines—GSK’s Arexvy (RSVPreF3) and Pfizer’s Abrysvo 

(RSVpreF)—received FDA approval for individuals aged 60 years and older. On June 21, 2023, the 

Advisory Committee on Immunization Practices (ACIP) voted to recommend that adults aged ≥60 

years may receive a single dose of either RSV vaccine, using shared clinical decision-making.

4

 Shared 

clinical decision-making recommendations are individually based and informed by a decision process 

between the healthcare provider and the patient about whether vaccination is right for them. 

Perceptions, Concerns, and Threats that Might Impact Vaccine Confidence 

and Demand

 A recent MMWR article published in October 2023 analyzed 5,784 adults aged ≥60 years who 

were hospitalized with acute respiratory illness and laboratory-confirmed RSV, influenza, or 

COVID-19 between February 1, 2022–May 31, 2023. Findings indicate that RSV hospitalizations 

were less frequent among this population but were associated with more severe disease than 

COVID-19 or influenza by most measures, including receipt of standard flow oxygen therapy, 

high-flow nasal cannula or noninvasive ventilation, and intensive care unit admission.5

 Similarly, a recently published German study analyzing 1,541 adults hospitalized with PCRconfirmed RSV, influenza, or COVID-19 between 2017–2020 found more severe outcomes 

among older adults hospitalized with RSV compared to influenza A, but less severe outcomes 

compared to COVID-19. 

 In the study sample, chronic obstructive pulmonary disease was more prevalent in patients 

hospitalized with RSV compared to influenza B or COVID-19. Kidney diseases were more 

common in patients hospitalized with RSV compared to patients with influenza A or COVID-19.

 Additionally, the authors found patients with RSV had longer hospital stays than patients with 

influenza A or influenza B, but not COVID-19. 

 The researchers concluded RSV is an important cause of respiratory hospitalizations in older 

adults.

 According to an April 2023 STAT-Harris Poll survey, 46% of respondents said they are familiar 

with RSV.6 Among those familiar with RSV, 57% of respondents were concerned their older 

parents and relatives may contract RSV. 

 A January 2023 KFF poll (N = 1,234) surveyed U.S. adults about their attitudes and behaviors 

regarding the “tripledemic” during the 2022-2023 respiratory disease season.7

 Roughly one in four (26%) respondents aged 65 and older were very or somewhat worried 

that they would get sick from RSV. 
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State of Vaccine Confidence Insights Report | September 1, 2023

 58% of older adults said they became 

more likely to modify their behavior 

in reaction to the news of COVID-19, 

influenza, and RSV spreading during 

the 2022-2023 winter season, including 

43% who were more inclined to wear a 

mask in public and 34% who were more 

likely to avoid large gatherings. 

 Among respondents with a child under 

18 living in the household, nearly half 

(46%) of parents said they are very or 

somewhat worried about their children getting sick with RSV.

 38% of people surveyed reported their households were sick with either COVID-19 (15%), RSV 

(10%), or flu (27%) over the past month.

 A March 2023 survey from Health Union (N = 3,307) showed that among respondents aged 60 

and older, only 35% had heard of an RSV vaccine, but 60% said they would be extremely likely 

to ask their healthcare professional about the RSV vaccine once it was available.8

 Two-thirds said they would be extremely likely to accept their provider’s vaccine 

recommendation.

 Despite the low perceived risk of contracting RSV, older respondents were still concerned 

about contracting the disease. Less than 25% of respondents were at least somewhat 

concerned about contracting it during 2023, while around 75% were at least somewhat 

concerned about how contracting RSV would impact their quality of life. 

 Nearly 40% of those who have contracted RSV described their experiences as “severe” or “very 

severe.”

 Survey findings (N = 1,601) from the Annenberg Public Policy Center (APPC) of the University of 

Pennsylvania found that 33% were concerned about RSV impacting a family member in January 

2023 and 27% were concerned in June 2023.9

 63% of respondents would be likely to recommend the RSV vaccine to a friend or family 

member aged 65+, although only 6% of the sample reported ever having had an RSV illness.

 Of the respondents who knew someone age 65 or older that had RSV, 77% reported it to be a 

somewhat or very serious case of infection.

 54% of those that knew a child that had RSV reported that it was a somewhat or very serious 

case of infection.

 12% of the sample knew someone who had been hospitalized with RSV, and 3% knew of 

someone who had died of RSV.

 Some social media users are enthusiastic about the RSV vaccine’s approval in older populations 

and are sharing their support on social media.10,11,a

a

Social media posts referenced throughout this report can be found in this online document.
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State of Vaccine Confidence Insights Report | September 1, 2023

Commonly Asked Questions 

 Why are public health professionals concerned about RSV in adults and older adults? 

 Older adults are at greater risk than young adults for serious complications from RSV because 

immune systems weaken with age and older adults are more likely to have chronic medical 

conditions.12 Each year, it is estimated that between 60,000-160,000 older adults in the United 

States are hospitalized and 6,000-10,000 die due to RSV infection. Adults at highest risk for 

severe RSV infection include:

 Older adults

 Adults with chronic heart or lung disease

 Adults with weakened immune systems

 Adults with certain other underlying medical conditions

 Adults living in nursing homes or long-term care facilities13

 How does someone differentiate between RSV, COVID-19 and influenza?

 Because RSV, COVID-19, and influenza share some of the same signs and symptoms, specific 

testing is needed to confirm a diagnosis. To learn more, visit CDC’s website for information 

about COVID-19 symptoms, flu symptoms and RSV symptoms. Although various resources are 

available that compare symptoms of COVID-19, influenza, and RSV, a diagnosis of any of these 

infections requires testing. If you have a respiratory illness, talk to your provider about testing 

and treatment options. 

 Influenza (flu) can cause mild to severe illness, and at times can lead to severe illness, 

hospitalization, and death. Flu symptoms usually come on suddenly, and a person may 

experience symptoms anywhere from 1 to 4 days after infection. People who have flu often 

feel some or all of these symptoms: fever or feeling feverish/chills, cough, sore throat, runny or 

stuffy nose, muscle or body aches, headaches, fatigue (tiredness), and some people may have 

vomiting and diarrhea, though this is more common in children than adults. It’s important to 

note that not everyone with flu will have a fever.14

 People with COVID-19 can have varying degrees of symptoms, ranging from no symptoms 

(asymptomatic) to severe illness. Typically, a person may experience symptoms anywhere from 

2 to 5 days (and up to 14 days) after infection. Possible symptoms include fever or chills, 

cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, 

loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. 

Additional information can be found at CDC’s Similarities and Differences between Flu and 

COVID-19 webpage.

 People infected with RSV usually show symptoms within 4 to 6 days after getting infected. 

Symptoms of RSV infection usually include runny nose, decrease in appetite, coughing, 

sneezing, fever, or wheezing. These symptoms usually appear in stages and not all at once. 

In very young infants with RSV, the only symptoms may be irritability, decreased activity, and 

breathing difficulties.15

Inaccurate Health Information Themes 

 Older adults are using social media to share their belief that RSV does not cause them serious 

illness.16,17
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State of Vaccine Confidence Insights Report | September 1, 2023

Ways to Take Action

 Messaging should aim to improve awareness of RSV and its complications, improve awareness of 

RSV vaccine availability, and encourage discussions between patients and providers about RSV 

vaccination.

 Strong evidence exists that using pre-existing mental models in messaging improves the 

salience and uptake of messages.18 Consider crafting and disseminating messages that situate 

RSV within the broader category of respiratory viruses such as influenza and COVID-19. This 

approach can help individuals who may be unfamiliar with RSV to grasp its potential severity 

and take appropriate preventive measures.

 Consider working with partners that serve people 60 years and older with chronic obstructive 

pulmonary disease, kidney diseases, and other chronic illnesses that increase the risk of severe 

RSV to create and disseminate messages highlighting the increased likelihood of severe 

outcomes in these populations if they get RSV and the availability of a vaccine.

 Due to a perception that RSV only impacts or seriously impacts children, work with community 

partners and partners that serve older adults to create and disseminate messages encouraging 

to talk to their providers about RSV vaccination.

 Due to low proportions of people knowing someone that previously had RSV, craft messages 

that raise awareness about the prevalence and incidence of RSV in older adults and young 

children. 

 Consider crafting messages that tell the stories of people impacted by RSV. Evidence supports 

the effectiveness of emotional narrative messages in reaching those with message fatigue.19

 Consider crafting messages informing older adults about the benefits of RSV vaccination and 

talking with your provider about RSV vaccine. There is a strong evidence base for “gain-framed” 

messages (highlighting the health benefits of engaging in a particular behavior) compared 

with “loss-framed” messages (emphasizing the negative consequences of failing to engage in 

healthy behaviors).20

 Due to difficulties in distinguishing between RSV, influenza, and COVID-19, create or disseminate 

messages that describe the symptoms of each and recommend people talk to their healthcare 

provider about testing and treatment options if they feel sick.

 When creating social media messages, due to social media users’ support for the RSV vaccine, 

include a request to social media followers to share messages and advocate for local and state 

partners to do the same.

 Work with partners that serve long-term care residents to create and disseminate messages for 

staff and residents of long-term care facilities that address their RSV vaccine-related questions 

and concerns.

 Since evidence suggests that in-person attendance of long-term care residents at educational 

sessions is high, work with community partners to offer small educational sessions for 

residents in long-term care facilities.21
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State of Vaccine Confidence Insights Report | September 1, 2023

Theme 2: Many consumers have limited knowledge 

and high uncertainty about RSV and RSV-related 

illness, including its ability for asymptomatic spread, 

frequency of severe infections, and the likelihood of 

reinfection.

Although RSV was first identified in 1956 and serious outcomes are common,22 the April 2023 StatHarris Poll survey found that 54% of Americans are unfamiliar with RSV.6

 Additionally, the March 2023 

survey from Health Union found that 65% of respondents aged 60 and older had not heard of an RSV 

vaccine.8 Low knowledge of RSV and the vaccine has the potential to influence risk perception and 

vaccine seeking.

Perceptions, Concerns, and Threats that Might Impact Vaccine Confidence 

and Demand

 Findings from the June 2023 APPC survey (N = 1,601) found 18% of individuals accurately stated 

that RSV usually causes mild cold-like symptoms, compared with 38% who thought RSV usually 

caused serious breathing problems, and 44% who were unsure.9 (RSV usually causes mild, coldlike symptoms, though some young children or older adults may be at increased risk of severe 

illness.)

 17% of all respondents accurately indicated that RSV can survive on surfaces for many hours, 

9% believed it could not survive, and 75% were unsure. (Per CDC’s RSV transmission page, RSV 

can survive for many hours on hard surfaces such as tables, and typically lives on soft surfaces 

such as tissues and hands for shorter amounts of time.)

 60% of all respondents were unsure if a person could get RSV multiple times. (Per CDC’s RSV 

transmission page, repeat infections may occur throughout life, and people of any age can be 

infected.)

 54% of all respondents were unsure if RSV was contagious before symptoms appeared. (Per 

CDC’s RSV transmission page, people 

infected with RSV are usually contagious 

for 3 to 8 days and may become 

contagious a day or two before they start 

showing signs of illness.)

 Many public health professionals and 

healthcare workers are answering common questions about RSV disease and the vaccine.23,24

 Some experts agree it might be difficult to vaccinate older individuals due to limited knowledge 

about RSV risk, especially because there is a low perceived sense of urgency and need for 

vaccination among older adult populations, and since CDC recommends shared clinical decision 

making.25
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State of Vaccine Confidence Insights Report | September 1, 2023

Commonly Asked Questions 

b

This is the most common RSV question from CDC-INFO.

 Which RSV vaccines are available for older adults?b

 There are two RSV vaccines—Arexvy and Abrysvo—licensed by the U.S. Food and Drug 

Administration for use in adults 60 and older in the United States.26 CDC recommends adults 

60 years and older may receive a single dose of either RSV vaccine, based on discussions 

between the patient and their healthcare provider.27

 What are the possible side effects of the RSV vaccines?

 Side effects such as pain, redness, and swelling where the shot is given, fatigue, fever, 

headache, nausea, diarrhea, and muscle or joint pain are possible after RSV vaccination. These 

side effects are usually mild.26

 A small number of participants in clinical trials developed serious neurologic conditions, 

including Guillain-Barré syndrome (GBS), after RSV vaccination. GBS is a rare condition in which 

your immune system attacks your nerves, causing symptoms such as weakness. However, 

given the small number of cases in the trial, it is unclear whether the vaccine caused these 

events, or whether they occurred due to chance.26

 People who experience side effects from RSV vaccination should report them to the Vaccine 

Adverse Event Reporting System (VAERS). Anyone can report to VAERS, including patients and 

healthcare providers. Reports can be filed through the VAERS website or by calling 1-800-822-

7967.26

 Were RSV vaccines made using mRNA technology? 

 No. Both Abrysvo and Arexvy are protein subunit vaccines, meaning they contain a part of the 

RSV virus. Both vaccines work by causing an immune response that can prevent respiratory 

disease if infected with RSV in the future.26

 Are RSV vaccines approved for infants and toddlers?

 There are currently no RSV vaccines approved for infants or toddlers. However, two 

monoclonal antibody products—nirsevimab (Beyfortus) and palivizumab (Synagis)—can help 

protect babies and young children from severe disease from an RSV infection. Monoclonal 

antibodies are not vaccines; they are proteins that the body’s immune system uses to 

help fight RSV infections and protect children from getting very sick. The protection these 

antibodies provide wanes over time. These products are not treatments for a child who already 

has RSV infection.28

 Abrysvo received FDA approval in August 2023 and was subsequently recommended by 

ACIP and CDC in September 2023 for use in pregnant individuals to prevent lower respiratory 

tract disease (LRTD) and severe LRTD caused by RSV in infants from birth through 6 months 

of age. Abrysvo is approved for use at 32 through 36 weeks gestational age of pregnancy.29

Vaccination during pregnancy has been shown to reduce the risk of RSV-related illness in 

infants during their first months of life. 
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State of Vaccine Confidence Insights Report | September 1, 2023

 Are RSV vaccines approved for immunocompromised adults 60 years old of age and older?

 Older adults with immunocompromising conditions are recommended to receive the RSV 

vaccine under shared clinical decision-making given the potential for significant benefit. 

Adults with immunocompromising conditions are at risk of severe RSV associated disease and 

death. They may benefit from RSV vaccination but were not included in the clinical trials, so 

vaccine efficacy in this population is unknown. These individuals, including those receiving 

immunosuppressive therapy, may have a diminished immune response to RSV vaccination.30

Inaccurate Health Information Themes 

 Some experts have stated their belief that some doctors and consumers incorrectly assume RSV 

is strictly a pediatric disease.31

 The belief that infection-induced immunity is a more effective method to prevent illness from 

RSV, rather than vaccines,32 is circulating on social media.33,34

 22% of people in the RSV survey by APPC incorrectly believed the time of year that a person was 

most likely to contract RSV was not the fall and winter, while 34% were unsure.9

Ways to Take Action

 Consider crafting and disseminating messages that dispel the belief that RSV only seriously 

impacts children by explicitly calling attention to RSV being a virus that significantly affects older 

adults.

 Since COVID-19, influenza, and RSV have been discussed in the news and on social media as a 

“tripledemic,” consider conducting a survey that investigates the possibility that perceptions of 

COVID-19 and the COVID-19 vaccine have carried over to RSV and the RSV vaccine.

 Based on this survey’s results, consider whether combined messaging about the COVID-19, 

annual flu, and RSV vaccines is appropriate.

 Due to the relatively high proportion of people in the APPC study9 that reported being unsure 

if RSV usually produces cold-like symptoms or serious breathing problems (44%), disseminate 

messages about the risk of these symptoms due to RSV infection.

 Due to the relatively high proportion of people in the APPC study9 unsure if RSV could survive on 

hard surfaces (75%), disseminate messages about the possibility for RSV to live for many hours 

on hard surfaces and direct them to CDC’s RSV transmission page for more information. 

 Due to the high proportion of people in the APPC study9 unsure if a person could get reinfected 

with RSV (60%), create and share messages communicating that people can get infected with 

RSV multiple times throughout their lives.35

 Note: These messages would also support the mitigation of the belief that infection-induced 

immunity is superior to vaccine-induced immunity.

 Due to the high proportion of people in the APPC study9 that were unsure if a person with 

RSV could spread it before symptoms appeared (54%), create and share messages that people 

infected with RSV may be contagious a day or two before they start showing symptoms and as 

long as 4 weeks after they stop showing symptoms. Direct them to CDC’s RSV transmission page

for more information. 

 Due to the significant number of people from the APPC study9 who were unable to correctly 

identify the seasons in which a person is most likely to contract RSV, create messages 

highlighting the importance of vaccination prior to RSV season for those that choose to get 

vaccinated and the importance of mitigation efforts during the fall and winter seasons.
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State of Vaccine Confidence Insights Report | September 1, 2023

 Due to a lack of general knowledge about RSV, consider creating messages that describe RSV’s 

impact on older adults in previous years, especially before the COVID-19 pandemic.

Theme 3: Low consumer trust in FDA, CDC, 

pharmaceutical companies, and vaccines may 

negatively impact RSV vaccine uptake. 

Patterns of eroding public trust in government over the past two decades as well as recent declines 

in trust associated with the COVID-19 pandemic may contribute to people’s perceptions of vaccines, 

including the RSV vaccine.36 Additionally, continual messaging from those opposed to vaccines and 

public health interventions adds to a complex information environment. 

Perceptions, Concerns, and Threats that Might Impact Vaccine Confidence 

and Demand

 Researchers and scientists encountered significant challenges during previous attempts to 

develop an RSV vaccine dating back to the 1960s.37 This may impact vaccine confidence if older 

individuals perceive these earlier unsuccessful clinical trials as a reason to doubt the safety of the 

new RSV vaccine formulations. 

 News outlets are reporting that although a majority of FDA independent advisors recommended 

Pfizer’s RSV vaccine, some are concerned about vaccine safety after 2 recipients, out of 

approximately 20,000, developed Guillain-Barré syndrome.38

 Many adults are sharing posts on social media highlighting minimal trust in pharmaceutical 

companies, which might negatively impact vaccine confidence in and uptake of the RSV 

vaccine.39,40,41,42

 Many consumers are using social media to 

share their belief that older adults should avoid 

the RSV vaccine because the government 

and pharmaceutical companies cannot be 

trusted.43,44,45 

 Some individuals are still concerned about the 

management of the COVID-19 pandemic, dissuading them from receiving the RSV vaccine.46,47,48

 New research from APPC indicates that communicating the FDA’s vaccine approval process 

can increase acceptance of RSV vaccination.49 In a survey experiment, 57% of respondents who 

were presented with a flowchart detailing FDA’s rigorous vaccine approval process were very 

or somewhat likely to recommend the RSV vaccine to a pregnant family member or friend, 

compared with 40% of respondents in a control group who were not exposed to the flowchart. 
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State of Vaccine Confidence Insights Report | September 1, 2023

Commonly Asked Questions 

 What was the approval process for the RSV vaccine?

 The FDA’s Center for Biologics Evaluation and Research (CBER) is responsible for regulating 

vaccine use in the United States. Once a vaccine receives FDA approval, it is reviewed by 

the Advisory Committee on Immunization Practices (ACIP), a group of medical and public 

health experts who develop recommendations for use of a vaccine in the United States. If the 

CDC Director approves ACIP’s recommendation, it becomes the official CDC public health 

guidance and can lead to a vaccine becoming a part of the official U.S. adult and childhood 

immunization schedules. Even after vaccines are approved and recommended for public use, 

CDC and FDA use different systems to monitor their safety, which helps ensure a vaccine’s 

continued success in the United States. The general stages of vaccine development are:

1.Research and discovery

2.Proof of concept

3.Testing the vaccine

4.The manufacturing process

5.Approving the vaccine (FDA)

6.Recommending the vaccine for use (ACIP and CDC)

7.Monitoring safety after approval (CDC and FDA)50

 More information about the vaccine approval process can be found on CDC’s website: How 

Vaccines are Developed and Approved for Use. You can also view an infographic of the Vaccine 

Life Cycle provided by CDC as well an infographic highlighting FDA’s role in the vaccine 

approval process created by FactCheck.org. 

 Will the RSV vaccine be covered through Medicare or Medicaid?

 The Inflation Reduction Act of 2022 states that any vaccine recommended by ACIP must 

be covered under Medicare prescription drug plans (Part D) and Medicaid in 2023 without 

consumer cost sharing.51 This means that individuals covered through Medicare Part D or 

Medicaid can receive an RSV vaccine without any co-payment or deductible, provided they are 

eligible for vaccination. The Affordable Care Act requires private insurance plans to cover CDCrecommended vaccines without cost sharing. 

 Medicare Part D plans identify covered vaccines through formularies. Part D plan formularies 

must include all commercially available vaccines (except those covered by Part B). A new 

preventive vaccine may not specifically appear in the formulary, but the plan may still cover 

the vaccine.52 Contact your plan to find out about coverage for vaccines.

 Will the RSV vaccine be free for older adults that do not have insurance?

 Older adults without health insurance coverage may experience financial hardship obtaining 

an RSV vaccine.53 Medicare enrollees without a Part D plan may have to pay for the RSV vaccine 

out of pocket.54 If you do not currently have health insurance, visit www.HealthCare.gov to 

learn more about health coverage options.
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State of Vaccine Confidence Insights Report | September 1, 2023

Inaccurate Health Information Themes

 Many social media posts depict the RSV vaccine as a ploy to help pharmaceutical companies 

make more money.55,56,57

 Some social media users believe there is insufficient clinical trial data to support the FDA 

approval of RSV vaccines.58,59,60

Ways to Take Action

 Consider adapting the process and risk messages about the FDA’s vaccine approval process from 

APPC’s study to older adult populations, using the examples from APPC as a starting point.

 Due to consumers’ concern about the RSV vaccine approval process, consider disseminating 

materials that clearly outline how vaccines are developed and approved, such as this 

representation of the Vaccine Life Cycle provided by CDC or these English and Spanish

infographics highlighting FDA’s role in the approval process created by FactCheck.org.

 Identify trusted messengers and community partners to craft and/or support the dissemination 

of messages about the risks of RSV infection, the availability of an RSV vaccine, and to talk with 

their provider about RSV vaccine.

 Consider working with local personalities and trusted messengers that have been impacted by 

RSV to craft and disseminate messages about the RSV disease and the benefits of vaccination. 

 To leverage search engine and social media algorithms, monitor news media for reports of 

celebrities or prominent figures impacted by RSV and, when identified, disseminate messages 

about the seriousness of RSV for older adults, especially those with high risk conditions, and 

the availability of vaccination without mentioning the person affected.
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State of Vaccine Confidence Insights Report | September 1, 2023

References

Note: omitted numbers are social media citations, which can be found in this online document.

1. U.S. Census Bureau. (2021). American Community Survey S0101: Age and Sex. U.S. Department 

of Commerce. Retrieved August 23, 2023 from https://data.census.gov/table?q=PEPAGE&t=Age+and+Sex&tid=ACSST1Y2021.S0101

2. Hamid, S., Winn, A., Parikh, R., Jones, J. M., McMorrow, M., Prill, M. M., Silk, B. J., Scobie, H. M., & 

Hall, A. J. (2023). Seasonality of Respiratory Syncytial Virus — United States, 2017–2023. 

Morbidity and Mortality Weekly Report, 72(14), 355–361. https://doi.org/10.15585/mmwr.

mm7214a1

3. Centers for Disease Control and Prevention. (2023, June 29). CDC Recommends RSV Vaccine For 

Older Adults [Media statement]. U.S. Department of Health and Human Services. https://

www.cdc.gov/media/releases/2023/s0629-rsv.html

4. Melgar, M., Britton, A., Roper, L. E., Talbot, H. K., Long, S. S., Kotton, C. N., & Havers, F. (2023). Use 

of respiratory syncytial virus vaccines in older adults: Recommendations of the Advisory 

Committee on Immunization Practices — United States, 2023. Morbidity and Mortality 

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Appendix: Inputs and Sources

Social Media Listening & Media Monitoring Data Sources

Input Cadence Sources Tactics for Utilization

Communication 

Surveillance Report

Daily on 

weekdays

Google news

Meltwater

CrowdTangle

Native platform 

searches

Share of voice topic analysis to 

identify themes

Emerging topics 

Meltwater Daily Facebook, Twitter, 

Instagram

Blogs

News media

Online forums

Share of voice topic analysis

Emerging theme topics

Identify high reach/velocity topics

OADC (Office of the 

Associate Director 

of Communication) 

Channel COVID-19 

Post metrics

Weekly Sprout Social

Native OADC (Office of 

the Associate Director 

of Communication) 

account analytics

Analyze # of posts, topics 

Success of messages, # of 

impressions, reach, # engagements

OADC Channel 

Comment Analysis

Daily on 

weekdays

Native platform 

searches

Sentiment analysis

Identify message gaps/voids

Direct Report Data Sources

Input Cadence Sources Tactics for Utilization

CDC-INFO Metrics Weekly CDC-INFO inquiry line 

list

Prepared response 

(PR) usage report

Cross-compare PR usage with 

inquiry theme analysis

Sentiment analysis

Identify information gaps/voids

VTF Media 

Requests

Weekly Media request line list Leading indicator for news 

coverage

Identify information gaps/voids

Web Metrics Weekly Top pages

Google search queries

Top FAQs

Referring domains

Identify information gaps/voids,

Identify keywords/search terms, 

changes in web traffic
Page: 20

State of Vaccine Confidence Insights Report | September 1, 2023

Research and Literature Data Sources

Input Cadence Sources Tactics for Utilization

Poll Review Weekly Harris Poll, PEW 

research, Gallup Poll, 

KFF, Annenberg Public 

Policy Center 

New data related to 

vaccine hesitancy

Identify socio-behavior indicators 

related to motivation and intention 

to vaccinate 

Literature Review Weekly PubMed, LitCovid, 

ProQuest Central, 

Altmetric 

New data related to 

vaccine hesitancy

Identify current vaccination 

intention

Identify barriers to vaccination

Third Party Report Data Sources

Input Cadence Sources Tactics for Utilization

Tanaq Social 

Listening +Media 

Monitoring Report

Weekly Meltwater

Sprout Social

First Draft

Native platform 

searches

Trending topics

Demographic and geographic 

conversation monitoring

Washington St. 

Louis iHeard

Weekly Proprietary methods Survey results

Emerging threats and data deficits

Vaccine narratives

Project VCTR Weekly Proprietary methods National and regional trends 

in negative attitudes toward 

vaccination

Conversations around Legislation