Less than 15% of high-risk Australians are up to date with covid boosters, despite a record flu season and growing concern over RSV in older and immunocompromised patients, the ARA's ASM has been told.
One of Australia’s leading infectious diseases experts has warned that Australia is “really under vaccinating” people most at risk of severe respiratory infections, as influenza, covid and RSV converge ahead of winter.
Speaking at the Australian Rheumatology Association annual scientific meeting earlier this month, Professor Paul Griffin, director of Infectious Diseases at Mater Health Services in Brisbane and Associate Professor of Medicine at the University of Queensland, said older adults and immunocompromised patients were facing a “very significant” risk from vaccine-preventable disease, yet uptake rates for key vaccines remained alarmingly low.
“We had a record-breaking year last year,” he said, referring to the 2025 influenza season, which saw more than 500,000 recorded cases and unusually persistent transmission through summer.
“Ninety people died in January alone from the flu. What’s typically considered a winter virus, 90 people succumbed to the flu in January.”
Professor Griffin, who has led numerous clinical trials in infectious diseases and vaccines, said respiratory viruses remained a major threat for people with autoimmune disease, malignancy, advanced age and those receiving immunosuppressive therapies.
He described immunocompromised Australians as accounting for roughly 4% of the population but representing “around a quarter of severe covid cases” and a disproportionate number of deaths and ICU admissions.
He pointed to the expanding use of biologic therapies in rheumatology and other specialties as a growing challenge.
“The rate of accrual of new biologics has increased exponentially,” he said, noting that B-cell depleting agents and T-cell targeted therapies in particular carried substantial infection risk.
Even low-dose corticosteroids, he added, increased the risk of serious infection “by at least one and a half times”.
While Australia has largely moved on from the acute pandemic phase of covid-19, Professor Griffin cautioned conference delegates against complacency.
“It certainly hasn’t gone away,” he said.
“We still are seeing a lot of more severe cases.”
He said residential aged care outbreaks continue to occur nationwide and that significant numbers of patients were still being admitted to intensive care with covid-related complications.
Current Australian guidelines recommend six-monthly covid boosters for people at highest risk, including older adults and the severely immunocompromised.
Yet Professor Griffin said fewer than 15% of those who should have received a vaccine within the previous six months had actually done so.
“Our covid vaccination rate in the last year overall is about 10%,” he said.
“If you look at people who are high risk, we’re really under vaccinating them at the moment.”
Influenza vaccine uptake has also remained poor despite last year’s severe season.
Professor Griffin said fewer than two-thirds of Australians in the highest-risk age groups received a flu shot in 2025, while uptake in younger adults remained below 10% in many categories.
He argued that low vaccination coverage and the record flu season were unlikely to be unrelated.
“A lot of the press last year said record year, record low vaccination rates,” he said.
“Seems like that’s too big a coincidence for it not to be relevant.”
One of the most striking comparisons presented was between influenza deaths and the national road toll.
“Four hundred more people lost their lives in our country directly to the flu last year,” Griffin said.
“Yet we still can’t get people to take up a single simple intervention to address that.”
Professor Griffin also focused heavily on RSV, describing it as an under-recognised cause of severe disease and long-term functional decline in older adults and immunocompromised patients.
He recalled treating a 90-year-old patient with rheumatoid arthritis who never regained her independence after severe RSV infection.
“A year later, [she] still hadn’t returned to living independently, driving, doing all sorts of other activities,” he said.
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Australia’s RSV vaccine rollout has accelerated rapidly, with new federal funding announced for adults aged over 75 years and Aboriginal and Torres Strait Islander adults over 60 years.
However, Professor Griffin said the complexity of funding arrangements and eligibility criteria was creating confusion and contributing to poor uptake.
“The guidelines are really complicated, evolving rapidly,” he said.
“We’ve got a hybrid program, some state-based, some NIP.”
Beyond respiratory viruses, Griffin highlighted the importance of shingles vaccination for immunocompromised patients, whose risk of herpes zoster may be “two to 10 times” higher than the general population.
He noted that disseminated disease and post-herpetic neuralgia were also substantially more common in these groups.
Throughout his presentation to a packed gallery, Professor Griffin repeatedly stressed that vaccination could not be viewed in isolation.
He urged clinicians to adopt a broader prevention strategy that included patient education, rapid access to PCR testing, prompt antiviral treatment and infection-control measures such as ventilation and masking during periods of high transmission.
“We can’t assume that GPs are going to do this or that people are going to know this stuff themselves,” he said.
“Everyone that’s looking after these high-risk people needs to remind them about being prepared and being vigilant.”
Professor Griffin also warned that misinformation and declining trust in vaccines were undermining public health efforts.
“People turn to social media and AI to get their information,” he said.
“Even if people are legitimately trying to become more informed, they will often get misinformation.”
He said the increasing complexity of adult immunisation schedules meant clinicians needed to approach vaccination more like childhood immunisation programs, with structured reminders and clearer systems.
“Vaccinating older adults is as complicated as the childhood space now,” he said.
Despite the challenges, Griffin said the expanding availability of vaccines against RSV, shingles and evolving COVID variants represented a major opportunity to reduce preventable morbidity and mortality in vulnerable Australians.
“Vaccination remains the highest priority,” he said.
“But it can’t be the only strategy. We’ve got to be prepared in other ways as well.”
The Australian Rheumatology Association’s 2026 Annual Scientific Meeting was held on the Gold Coast from 16-19 May.
