Experts say seniors should get the high-dose flu vaccine, but Nova Scotia doesn’t cover the cost for all seniors

Free flu shots have been available to Nova Scotians for two weeks. The standard flu shot is effective at preventing illness and keeping people out of hospital which is a good thing. 

But if you want a flu shot that contains four times the protection, you will pay over $80 to get the high-dose Fluzone vaccine, plus another $10 for the pharmacy fee. Both the National Advisory Committee on Immunization in Canada and the Centers for Disease Control in the U.S. recommend senior citizens over the age of 65 get the high-dose vaccination, provided they have the choice.

Here’s what the NACI website says:

For individual-level decision making, high-dose vaccine should be used over standard-dose inactivated influenza vaccine, given the burden of influenza A(H3N2) disease and the good evidence of better protection compared to standard-dose in adults 65 years of age and older.

The high-dose flu vaccine contains four times more antigen than the regular vaccine so it provides superior protection against illness and hospitalization. A randomized efficacy study published in the New England Journal of Medicine shows the trivalent high-dose vaccine was 24% more effective in preventing flu in adults 65 years and older compared to a standard-dose vaccine.

Not surprisingly, the high-dose vaccine is also more expensive for provinces to buy, although the Halifax Examiner is still working to obtain a precise price comparison. 

In Nova Scotia, the province covers the cost of the high-dose vaccine for seniors living in long-term care or group settings. In every province and territory except Nova Scotia, Quebec, and British Columbia, provincial governments have chosen to expand coverage to all seniors over the age of 65, regardless of where they live. Presumably the reason is to cut down on the number of people requiring hospitalization once flu season descends in late December.

On Friday, the Examiner asked Health Minister Michelle Thompson why Nova Scotia isn’t covering the cost of the high-dose vaccine for all seniors.

“The regular flu vaccination is effective. We know that it is effective; we have had it longstanding,” replied Thompson. “We appreciate that there are calls to cover the high-dose vaccine and we continue to look at that. There are a number of demands on our publicly funded system, not only on public health but on our Pharmacare program as well. We continue to evaluate that. And we make decisions on an annual basis about what we are able to offer.”

This year, the province didn’t even mention the availability of the high-dose Fluzone vaccine in its October 17 news release announcing shots would be available through doctors’ offices and pharmacies. For 2022, it looks like a done deal although Thompson has left the door open for next year. 

The high-dose flu shot is not covered by Pharmacare so people living on fixed incomes are unlikely to pay close to $100 for the high-dose vaccine, even if they are immuno-compromised and at higher risk. Seniors who do pay for it may be able to deduct the cost on their income tax return as a medical expense so long as they have a doctor’s prescription. 

Susan Leblanc, the NDP member for Dartmouth North, has introduced a bill calling on the government to cover the cost of the high-dose flu shot for all seniors. Leblanc quoted Canadian statistics that pegged the average cost of hospitalizing someone with influenza at about $10,000. 

Apart from wondering if Nova Scotia’s public health policy is sound, the NDP is also voicing concerns about whether access to the high-dose flu shot may be another example of creeping two-tier medicine in Nova Scotia. 

This is the fifth year the high-dose flu vaccine has been available to Canadians. There is scientific evidence the standard flu vaccine we get for free is effective and there is scientific evidence showing the high-dose vaccine is more effective at preventing hospitalizations. 

What we don’t have yet, according to the National Advisory Committee on Immunization, are cost-benefit analyses done in Canada that would guide governments in deciding if the extra public expenditure is worth it. 

“There is insufficient evidence on the incremental value of different influenza vaccines (i.e. cost-effectiveness assessments have not been performed by NACI) to make comparative public health program-level recommendations on the use of the available vaccines,” states NACI.

So NACI does not make a recommendation and leaves it up to each province to make their own policy. There may also be different interpretations of that policy. 

At Shannex campuses in Nova Scotia, seniors who are receiving long-term care get the high-dose flu shot covered by the government. A spokesperson for the company, Shannon Peterson, confirmed that seniors who live in assisted living apartments or independent living settings will get the standard dose for free but if they want extra protection afforded by the high-dose shot, they will have to pay. 

Who knew flu shots could be so complicated? The bottom line is with emergency departments already stretched to the limit, everybody should make time to get some type of flu shot (on the government or on Mastercard) to avoid increasing the burden on the healthcare system.