In the wake of the rapid deployment and acceptance of COVID-19 vaccines, other, more specialized vaccines are now available. Among them are treatments for respiratory syncytial virus, or RSV, an illness that can affect the very young and the very old.

Unlike COVID vaccines, these new treatments are expensive, so it makes sense to first get them into the arms of those who need them most. As Dr. Elisabeth Rosenthal, the former editor-in-chief for KFF Health, writes in TIME, that’s what's happening in Europe, where policymakers can guide national health systems into making decisions that are good for both public health and public finances. As a result, they are prioritizing the health of infants, who are both more vulnerable to RSV and have many more years to live.

But, as Rosenthal points out, the U.S. lacks such government planning, and so the market takes the lead. Here, drug makers Pfizer and GlaxoSmithKline are marketing RSV vaccines to seniors, who are bombarded with ads for the shot on TV. The math for the companies is simple: There are 75 million older Americans who are eligible for the drug, and they don't need a prescription to get the shot, regardless of whether they're vulnerable to RSV or not. On the other hand, there are only 3.7 million infants born each year—and none of them are paying attention to ads on TV.

It doesn’t have to be this way, Rosenthal writes. As the pandemic effort shows, it’s possible to have a cohesive national vaccination strategy. But it requires leadership from policy makers.

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