From burden to benefit: overcoming barriers to immunization in adults, with a focus on respiratory syncytial virus

INTRODUCTION: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection, with substantial morbidity and mortality in older adults, yet its impact in this population remains underrecognized compared with childhood RSV. Despite the availability of effective vaccines, RSV immunization in adults is underutilized, as observed for other vaccines. AREAS COVERED: We summarize the RSV burden in adult populations and present clinical and real-world evidence supporting efficacy/effectiveness and safety of three approved RSV vaccines. We explore barriers to adult vaccine uptake - including limited awareness, lack of reimbursement, mistrust, misinformation, and inconsistent guidance - and highlight broader benefits of adult immunization, including reducing antimicrobial resistance and promoting healthy aging. We conclude that to improve uptake, communication strategies should include messages that emphasize how vaccination prevents severe illness, preserves independence, and supports everyday well-being. We highlight that a life-course immunization strategy, built on trust, is essential to achieve equitable protection across populations. EXPERT OPINION: Adult vaccines remain undervalued despite their proven safety and benefits, which extend beyond infection prevention to support healthy aging and reduce antimicrobial resistance. To maximize their impact, strategies such as harmonizing recommendations, improving reimbursement, leveraging digital tools, and addressing vaccine hesitancy through better communication and research are essential.