Update on RSV vaccination programme 2025 (WHC/2025/016)

Issue date:

6 May 2025.

Status:

Action.

Category:

Public health.

Title:

Update on RSV vaccination programme 2025.

Date of expiry / review:

Not applicable.

For action by:

• Chief Executives, health boards / trusts.
• Vaccination Operational Leads, health boards / trusts.
• Medical Directors, health boards / trusts.
• Directors of Primary Care, health boards / trusts.
• Nurse Executive Directors, health boards / trusts.
• Chief Pharmacists, health boards / trusts.
• Directors of Public Health, health boards / trusts.
• Heads of Midwifery, health boards / trusts.
• Executive Director of Public Health, Public Health Wales.
• Head Vaccine Preventable Disease Programme, Public Health Wales.
• Director of Vaccine Delivery, Vaccination Programme Wales, NHS Executive.
• Community Pharmacy Wales.
• General Practitioner Committee, Wales.
• General practitioners.

Sender:

Dr Keith Reid, Deputy Chief Medical Officer (Public Health).

Health, Social Services and Early Years Group Welsh Government contacts:

Vaccination Division
Welsh Government
Cathays Park
Cardiff
CF10 3NQ.

Email:

wg.vaccinationsprogrammeteam@gov.wales

Dear Colleagues,

In June 2024, I wrote to you regarding 2 new respiratory syncytial virus (RSV) immunisation programmes for older adults and pregnant women, starting from 1 September 2024. I am writing to you today to highlight my concern that vaccination uptake rates for these programmes, and the catch-up campaign for older adults, are much lower than expected. I am therefore asking you to take immediate action to address this.

Current position

We introduced the RSV programmes in Wales to mitigate the significant impact the virus has on our citizens and primary and secondary care services. 90% of children will be infected with RSV by age 2. The risk of severe illness is highest in those under 6 months old. During a normal RSV season infection in children under 2 years old is responsible for approximately 7,000 to 9,500 GP appointments and 2,300 to 2,600 hospital admissions in Wales. It is estimated that RSV infection in over 75 year olds is responsible for 7,000 to 9,000 GP appointments, 700 to 1,000 hospital admissions and 400 to 600 deaths in Wales each year. The total burden of mortality, morbidity and healthcare usage related to RSV is at least equivalent to that of influenza.

The RSV vaccination programmes were recommended by the Joint Committee on Vaccination and Immunisation based on achieving coverage of at least 60% for the maternal component and 70% for the older adult component. Current uptake rates are significantly below these figures.

As of 29 April, uptake rates for those who turned 75 years between September 2024 and January 2025 (who should have been invited to a vaccination appointment by 29 April), is just over 38%. For older adults aged 75 to 79 years, covered by the catch-up campaign, uptake is just under 44%. For pregnant women the overall vaccination rate is between 38% and mid-40% mark.

There is significant variation in uptake between health boards and between the most and least deprived areas of Wales. Amongst pregnant women the uptake in the least deprived quintile of area of residence is around 20% higher than in the most deprived.

Vaccine effectiveness

We have increasing evidence from the UK and other nations of the protection afforded by high uptake of the RSV vaccine and the impact on hospitalisations. In the last RSV season studies completed in Scotland, with a 68% vaccination uptake, showed a 62% reduction in total number of RSV related hospitalisations in those aged 75 to 79. A major 2024 study in Argentina, one of the first countries in the world to introduce a maternal vaccine, shows a 70% reduction in RSV hospital admissions, in infants up to 6 months of age, when mothers were vaccinated during pregnancy.

Achieving high uptake in Wales has the potential to prevent hundreds of hospital admissions each year. If we are going to achieve similar impact in Wales this coming winter we need to achieve significantly higher vaccination coverage.

Targeted action

There is an urgent need to improve vaccine uptake substantially and reduce the equity gap. To ensure these improvements, all health boards must:

• Immediately review their RSV programmes and draw up detailed plans for improving uptake and the completing the catch-up campaign. The plans must set out how health boards will communicate a clear message to their local populations as to how, when and where individuals are able to obtain RSV vaccination in that area.
• Support primary care services by deploying health board immunisation teams to deliver RSV vaccinations where it is evident there is a lower uptake rate.
• Provide copies of their plans for improving uptake and completing the catch-up campaign to vaccination programme Wales by 30 May 2025.

In undertaking the actions outlined above, health boards must be conscious of the need to maximise uptake across all groups, with a particular focus on ensuring vaccination equity, for example, by seeking to ensure uptake rates are similar in the least and most deprived areas of the health board. Furthermore, they must ensure that all older adults are invited to receive a vaccination within 12 weeks of them turning 75, and pregnant women are being offered RSV vaccination at their 28-week antenatal appointment.

I recognise that health boards and GP practices have already worked quickly to implement the new vaccine alongside other winter vaccine programmes. Further accelerating implementation so that the expected RSV vaccination uptake is achieved will be crucial to properly protecting the health of our population this winter and mitigating the enormous strain that RSV places on primary and secondary care services.

Yours sincerely,

Dr Keith Reid.
Deputy Chief Medical Officer (Public Health).