Unequal access: Respiratory syncytial virus vaccine uptake by socioeconomic status among older adults in Australia

Respiratory Syncytial Virus (RSV) vaccination was first approved by the Therapeutic Goods Administration of Australia for older adults in January 2024. We aimed to evaluate uptake among people aged ≥75 years across different socioeconomic thresholds. Male and female FluTracking participants were included in this cross-sectional study if they had an Australian residential postcode documented, returned at least one weekly survey between 30 March 2025 and 2 December 2025 while aged ≥75 years, and had a recently documented RSV, influenza, and COVID-19 vaccination status. Socioeconomic status (SES) was allocated by matching participant residential postcode to the Index of Relative Socio-economic Disadvantage for that postcode. Relative difference in vaccine uptake across SES categories was evaluated using logistic regression. A total of 10, 376 participants were included (61. 4% aged 75–79 years, 54. 2% female). High, medium, and low SES categories were represented by 5347 (51. 5%), 3658 (35. 3%), and 1371 (13. 2%) participants, respectively. Recent RSV vaccination was reported by 19. 6% of participants, recent influenza vaccination by 92. 5%, and recent COVID-19 vaccination by 67. 1%. In age, sex, and state/territory adjusted analyses, the odds of vaccination in the medium compared with the high SES group for RSV, influenza, and COVID-19 were 42. 3%, 19. 8%, and 24. 0% lower, respectively. The adjusted odds of vaccination in the low SES group compared with the high SES group for RSV, influenza, and COVID-19 were 47. 1%, 35. 1%, and 30. 2% lower, respectively. We found lower uptake of RSV vaccination among adults aged ≥75 years compared with recent vaccination for influenza and COVID-19. Lower SES groups had lower uptake of all three vaccines compared with the high SES group and the relative difference in uptake across socioeconomic levels were more pronounced for RSV vaccination. Broad public funding for RSV vaccination among older adults in Australia could help to reduce inequity in uptake. • RSV vaccination is recommended for all adults aged ≥75 years in Australia. • Currently, most need to pay ∼AU300 out-of-pocket to receive the vaccine. • Influenza and COVID-19 vaccinations are free. • Respiratory virus vaccine uptake is reduced in lower socioeconomic postcodes. • Relative differences in uptake by socioeconomic level are large for RSV vaccine.