When older people stay healthy, they keep volunteering, keep contributing
Each winter, New Zealand's hospitals brace against a familiar trio of respiratory threats — and RSV, the quietest of the three, may be the most preventable. Economic modelling now makes a compelling case that publicly funding an RSV vaccine for adults aged 65 and over could spare thousands of older New Zealanders from hospitalisation, while returning far more to society than it costs. The question this research poses is not merely financial, but moral: when a tool exists to protect the most vulnerable, and the numbers support its use, what does it mean to wait?
- RSV hospitalises older New Zealanders at rates comparable to influenza, yet unlike flu, no publicly funded vaccine exists — leaving a preventable burden falling hardest on Māori, Pacific peoples, and those with chronic illness.
- At Auckland's winter peak last year, severe acute respiratory admissions reached 121 per week, with RSV ranking third among detected viruses — a system already stretched thin absorbing a threat it could partially deflect.
- Independent modelling projects that 60% vaccine uptake among those 65 and over would prevent over 5,000 hospitalisations and nearly 35,000 GP visits across four years, generating $138.5 million in net economic returns.
- Beyond hospital beds, the human dividend is significant: healthy older adults contribute an estimated 2.2 million volunteer hours and 2.7 million carer hours — value that disappears when serious illness strikes.
- Expanded pharmacy access this winter — including co-administration with flu vaccines and walk-in services — lowers practical barriers, but public funding remains the missing step Australia has already taken for adults 75 and older.
Winter in New Zealand hospitals means pressure — influenza, COVID, and a third threat that rarely makes headlines: respiratory syncytial virus. RSV is highly contagious, seasonal, and hits older adults hard, carrying hospitalisation and mortality risks comparable to influenza. For those with chronic lung, heart, or metabolic conditions, the danger is higher still. A single RSV hospitalisation in Auckland costs the health system an average of $4,758, and at last winter's peak, severe acute respiratory admissions in the city reached 121 per week.
New economic modelling offers a striking counterargument to inaction. If the RSV vaccine reached 60% uptake among New Zealanders aged 65 and over, researchers project the health system would avoid 5,395 hospitalisations, 1,113 emergency department visits, and nearly 35,000 GP appointments over four years — a net economic return of $138.5 million. But the case extends beyond healthcare savings. Older adults who stay well keep contributing: the modelling estimates an additional 2.2 million volunteer hours and 2.7 million carer hours would be preserved — real social value that never appears on a hospital balance sheet.
The burden is not evenly shared. Māori and Pacific peoples, along with those in low-income communities, face elevated RSV hospitalisation rates. Multigenerational households are particularly exposed, with the virus moving between young children and older adults in both directions. Infectious disease specialist Dr Hasan Bhally notes that RSV symptoms overlap significantly with COVID and influenza, making self-monitoring for shortness of breath, wheezing, or worsening cough essential for at-risk adults.
Until now, limited access has constrained uptake. This winter, that changes in part: the vaccine Arexvy is now registered for adults aged 50 to 59 with risk factors and all adults 60 and over, and New Zealand pharmacies can administer it alongside the seasonal flu vaccine. Walk-in services and community pharmacy locations remove barriers that have long kept preventive care out of reach for older, rural, and Māori and Pacific communities. Australia has already funded RSV vaccination for adults 75 and older nationally. Whether New Zealand moves from expanded pharmacy access to full public funding — and how soon — remains the open question this winter's data may help answer.
Winter in New Zealand hospitals means pressure. Influenza arrives. COVID circulates. But there's a third respiratory threat that often gets less attention: respiratory syncytial virus, or RSV, a highly contagious seasonal infection that hits older adults particularly hard. Now, economic modelling suggests that publicly funding an RSV vaccine for people aged 65 and older could prevent thousands of winter hospitalisations and generate substantial economic returns—not just in direct healthcare savings, but in the volunteer hours and informal caregiving that older people contribute when they stay healthy.
The numbers are substantial. Independent healthcare economics researchers modelled what would happen if the RSV vaccine reached 60% uptake among New Zealanders aged 65 and over. Over four years, they found, the health system would avoid 5,395 hospitalisations, 1,113 emergency department visits, and nearly 35,000 GP appointments. The net economic return: $138.5 million. To put that in perspective, those prevented hospitalisations alone would free up significant capacity during the winter months when hospitals are already stretched thin. In Auckland alone, severe acute respiratory infection admissions reached 121 per week at last year's winter peak, with RSV ranking as the third most commonly detected virus in the hospital system.
But the economic case extends beyond hospital beds and doctor visits. When older adults avoid serious RSV illness, they remain active longer—volunteering, caring for grandchildren, supporting their families and communities. The modelling estimates this would generate an additional 2.2 million volunteer hours and 2.7 million carer hours over four years. These are real contributions to society that don't show up on a hospital bill but matter enormously to the people who depend on them.
RSV itself is a familiar virus to most people. It causes repeated infections throughout life, typically mild in healthy adults but potentially severe in infants and older people. In older adults, RSV carries a hospitalisation and mortality risk similar to influenza. For those with underlying conditions—chronic lung disease, heart disease, diabetes, kidney or liver disease—the risk is higher still. A single RSV hospitalisation in Auckland costs the health system an average of $4,758. The virus spreads by respiratory droplets, much like flu and COVID, and can survive on surfaces for up to six hours. It peaks in winter but increasingly circulates year-round as international travel brings it across borders.
Certain populations face elevated risk. Māori and Pacific peoples, along with those living in low-income areas, experience higher hospitalisation rates from RSV. Households with both young children and older adults are particularly vulnerable—the virus moves both directions, sometimes carried home by unvaccinated grandparents, sometimes brought in by infected grandchildren. Dr Hasan Bhally, an infectious disease specialist, emphasises the difficulty of distinguishing RSV from COVID and influenza without testing, since symptoms overlap significantly. He urges at-risk older adults to monitor for shortness of breath, wheezing, fever, or worsening cough, and to seek immediate help if these develop.
Until now, the RSV vaccine has not been publicly funded in New Zealand, limiting access. But ahead of this winter, expanded availability is coming. The vaccine, called Arexvy, is now registered for use in adults aged 50 to 59 with risk factors, and for all adults 60 and over. Critically, New Zealand pharmacies can now administer it alongside the seasonal flu vaccine, removing a practical barrier that has long limited uptake of preventive care. Walk-in services, extended hours, and locations integrated into daily routines make vaccination more accessible than waiting for a GP appointment—particularly for older people, those in rural areas, and Māori and Pacific communities who may face greater obstacles reaching general practice.
Pharmacist Din Redzepagic notes that community-based access to vaccines and medicines removes practical barriers of time and cost. Pharmacists, often trusted members of their communities, can make a real difference for people who struggle with traditional healthcare access. Australia has already moved ahead, funding RSV vaccination for all adults aged 75 and older through its National Immunisation Program. New Zealand now has the chance to do something similar—to prevent thousands of winter hospitalisations, free up stretched health services, and keep older people active and contributing to their families and communities. The question is whether the economic case and the human case will be enough to move from expanded pharmacy access to public funding.
Citações Notáveis
RSV spreads by respiratory droplets—coughing, sneezing, or environmental contamination—and can survive on surfaces for up to six hours— Dr Hasan Bhally, infectious disease specialist
Pharmacists are often trusted members of the community, and being able to receive vaccinations in a pharmacy setting can make a real difference for older people, those who are immunocompromised, Māori and Pacific, and people in rural areas— Din Redzepagic, pharmacist
A Conversa do Hearth Outra perspectiva sobre a história
Why does RSV matter now, when we've managed winter respiratory viruses for years?
Because we finally have a vaccine that works, and the modelling shows what prevention actually looks like at scale. We're not talking about marginal improvements—we're talking about preventing over 5,000 hospitalisations in four years. That's real capacity freed up when hospitals need it most.
The economic return seems almost too clean. $138.5 million over four years—how does that actually work?
It's not just hospital beds saved. When older people stay healthy, they keep volunteering, caring for grandchildren, supporting their families. The modelling counts those hours. A grandmother who doesn't get hospitalised is still babysitting, still contributing. That has real economic value, even if it doesn't appear on a hospital invoice.
But the vaccine isn't publicly funded yet. Why the gap between what the modelling shows and what's actually happening?
That's the question everyone's asking. The vaccine is available through pharmacies now, which is progress—but only if people can afford it. Public funding would remove that barrier entirely, especially for people in low-income areas and Māori and Pacific communities, who already face higher hospitalisation rates from RSV.
You mentioned households with young children and older adults are particularly vulnerable. How does that transmission actually work?
Both directions. Sometimes an unvaccinated grandparent brings RSV home and infects the grandchild. Other times the child is the carrier—maybe picked it up at school or daycare—and brings it home to vulnerable older family members. In a multigenerational household, that's a real risk.
What would actually change if New Zealand funded this vaccine like Australia did?
Uptake would likely jump significantly. Right now it's available but requires people to seek it out and pay for it. Public funding removes friction. You'd see older people getting it at the same time as their flu shot, the way they already do with other preventive care. That's when you actually reach the 60% uptake the modelling assumes.
Is there anything the modelling might be missing?
The human side is harder to quantify. What does it mean for someone's quality of life to avoid a serious respiratory infection? To not spend weeks recovering? The numbers capture volunteer hours and carer hours, but they don't fully capture the dignity of staying independent, of not becoming a burden to your family. That matters too.