Dr. Brian Conway is president and medical director of the Vancouver Infectious Diseases Centre.
Mention the word “pandemic” and most people think of COVID-19. But that hasn’t been the only deadly virus to stop the world in its tracks. More than 100 years since the Spanish Flu pandemic, influenza continues to be a threat.
The flu is one of the 10 leading causes of death in Canada, responsible for an average of 12,200 hospitalizations and about 3,500 deaths every year. Fortunately, we now have accessible and effective vaccines that can help prevent infection and save lives.
At a time of overburdened health care budgets, and after our last respiratory virus season overwhelmed the health system, we need to make sure our vaccination policies and programs target the most vulnerable Canadians: seniors.
People older than 65 have weakened immune systems, making them more susceptible to getting the flu and, if they do, suffering more serious health effects. Seniors who get the flu are, by some estimates, six times more likely than the general population to have a heart attack in the next week.
Among those who are hospitalized with the infection, looking ahead six months, one-quarter of them will not have returned to the level of health they had before they got the flu, and more than one in eight will no longer be able to live on their own.
Unfortunately, seniors also have a lower immune response to vaccination. As a result, they need to receive a vaccine capable of giving them a broader immune response, especially to influenza A, which has been responsible for virtually all infections in that age group over the past two flu seasons and is associated with the most severe disease in seniors.
Many Canadian experts share the view of the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practice (ACIP) that over-65s should receive an enhanced influenza vaccine (EIV). In Canada, we have two safe and effective EIVs available – adjuvanted and high-dose – both of which provide additional protection for older patients compared with standard flu vaccines. ACIP says there’s no evidence that one type of EIV is superior to the other.
Canada’s National Advisory Committee on Immunization (NACI), which has previously recommended to provinces that their flu vaccine programs may use any of the inactivated flu vaccines available for patients aged 65 or older, is nearing completion of a systematic review of flu-related data for that age group. This will give additional clinical guidance to health care providers on the standard of care to help protect at-risk populations.
As a physician who has worked in the field of infectious diseases for more than 30 years, I am confident that the review will, as is the case in the United States, recommend the use of any available EIV for the prevention of seasonal flu in Canadians over the age of 65. With no EIV being considered superior to another, provinces will then be able to decide which vaccine to choose based on other factors, such as health care budgets and vaccine affordability.
This can be a very important consideration, with some EIVs costing as much as four times more than others, without providing significantly higher protection. The cost savings from choosing a less expensive EIV can result in reallocating budget funds to other high-need immunization programs, or to enhancing vaccine uptake, particularly among those aged 65 or older.
It is critical that health authorities also make it as simple as possible for people to get their flu shot. This includes offering the co-administration of the flu vaccine and a COVID booster, something NACI says is both safe and effective.
This makes good public health and economic sense. By getting our vaccine policies and programs right, we can help save lives and prevent the strain imposed by respiratory virus season on our health care budgets as much as possible.
The good news is that there are enough vaccines available for everyone in Canada who wants to be vaccinated. So, if you’re 65 years of age or older, or if you’re likely to come into contact with someone 65 or older – like your parents or grandparents – don’t waste any time getting your flu shot.
By rolling up our sleeves, we can all do our part to protect our health, and the health of the people around us.