Dr. Samir Sinha is the director of health policy research at the National Institute on Ageing and the director of geriatrics at Sinai Health and the University Health Network.
Every year in Canada, the flu causes an estimated 175,000 emergency department visits, more than 12,000 hospitalizations and 3,500 deaths, making it one of Canada’s leading causes of death. Older people and those with certain chronic health conditions are especially at risk of severe illness and influenza-related complications.
If Australia’s experience this year is any indication, their record number of flu cases suggests we are only at the beginning of one of our worst influenza seasons. Together with the continuing number of COVID-19 infections and an unprecedented surge in respiratory syncytial virus (RSV), a bad flu season risks further overwhelming our already strained health care systems.
So why aren’t we taking the flu more seriously?
It is also particularly worrying that, in many parts of Canada, people are at higher risk of severe and possibly fatal consequences of the flu because they live in a province or territory that isn’t doing two simple things to help reduce its spread: actively vaccinating for more than one illness at the same time, and offering free access to enhanced flu vaccines for older Canadians.
The good news is that influenza is one of the most vaccine-preventable causes of death in Canada. The National Advisory Committee on Immunization (NACI) recommends everyone aged six months and older get a seasonal influenza vaccine every year. Yet despite the significant and chronic burden of the flu, Canada’s influenza vaccination rates remain stubbornly low.
It’s not that Canadians are broadly opposed to being vaccinated. Indeed, survey data from the National Institute on Ageing (NIA) demonstrated the COVID-19 pandemic actually improved Canadians’ overall attitudes about vaccines and their willingness to get a flu shot.
We need to quickly build on this change in sentiment with additional strategies to boost influenza vaccine uptake, and our data identify two important ways to do this.
The first way is to make it more convenient for people to get their flu shot, including by offering it at the same time they get a COVID-19 booster or another vaccine for older Canadians, such as the pneumococcal or shingles vaccine. NACI has already determined that the co-administration of these particular vaccines is safe. In addition, our survey showed nearly 60 per cent of Canadians and 73 per cent of older Canadians said they would get a flu shot and COVID-19 vaccine at the same time if they had the option.
The second way is to provide those with weaker immune systems an enhanced influenza vaccine, rather than a standard vaccine. Enhanced vaccines encourage the body to create a stronger immune response than would occur with a standard vaccine and, as such, are the preferred choice for older adults. A systematic review released this year by the U.S. Advisory Committee on Immunization Practices showed enhanced vaccines are consistently more effective for older adults than standard-dose vaccines, especially when it comes to flu-associated hospitalizations.
Despite the clear evidence of the benefits of enhanced influenza vaccines, getting publicly funded access to them in Canada depends on where you live. In certain provinces and territories – such as Quebec, Newfoundland, Nova Scotia, the Northwest Territories and Nunavut – enhanced influenza vaccines are only free this year to some older members of their populations, such as people living in long-term care settings.
If the goal of public health programs is public health, denying universal access to publicly funded enhanced influenza vaccines makes no sense. The survey data shows that most Canadians agree. More than three-quarters say it is important that older Canadians have access to enhanced vaccines, and 82 per cent say those vaccines should be available to older Canadians free of charge. This would also increase vaccine uptake, as almost one-third of older Canadians say they would be more likely to get a flu shot if they were offered free access to enhanced vaccines.
Several other countries – such as the United States, United Kingdom, Australia and Germany – already provide publicly funded enhanced flu vaccines for their older populations. All of Canada’s provinces and territories should do the same, and quickly, as the influenza season is already upon us and people are already getting sick. To that end, NACI should follow the example of its U.S. counterpart and give clear guidance to provinces and territories about the benefits of getting enhanced influenza vaccines into the arms of all older Canadians and others with higher risks of complications from the flu.
In the meantime, everyone can do their part by taking the flu more seriously – and getting their shots as soon as possible.