While some provinces are covering the cost of a high-dose influenza vaccine for seniors this flu season, the formulation won't be covered by Newfoundland and Labrador's Medical Care Plan.
Ontario is offering Fluzone High Dose to people over 65. Saskatchewan, Manitoba, Prince Edward Island and Nova Scotia are covering the cost for seniors in long-term care homes to get the shot, but N.L. is opting instead to offer another senior-specific formulation for people 65 or older in long-term care homes.
It's called Fluad, and according to its website it contains "an immune-enhancing ingredient that can help provide a strong immune response to the flu."
Fluad and Fluzone High Dose are formulated for senior citizens because older people are particularly vulnerable to influenza.
As to which is more effective, an N.L. health department spokesperson cited the federal government's National Advisory Council on Immunization, which said there is not enough evidence yet to recommend one over the other.
'It wasn't offered to me'
Ann O'Reilly, a senior who lives in Torbay, told CBC News she would have liked to receive a vaccine suited to her age, but one wasn't made available to her.
She described a conversation she had with a fellow customer while waiting for a flu shot at a drug store in Torbay. O'Reilly said the customer told her he'd received a higher-dose vaccine, so she inquired with staff but was told she only needed a standard flu shot.
"It wasn't offered to me, she just told me that this one was adequate," O'Reilly recalled.
Over-the-counter, but not free
Both Fluzone High Dose and Fluad are available without a prescription. Customers in Newfoundland and Labrador have to pay out of pocket, or else have their insurance provider cover the cost. O'Reilly said she would have been happy to pay the $80 it approximately costs for Fluzone High Dose.
Stacey Biset Rodriguez is a registered nurse at the JEMA International Travel Clinic in downtown St. John's, which sells Fluzone High Dose.
"The reason that there is a specialized vaccine for that age is group is that often adults in that age group don't process vaccines as well," she said.
"Basically, it works better."
More evidence needed
A study cited by the immunization advisory council found the high-dose vaccine was 22 per cent more effective at preventing influenza-related illness and hospital admissions than the standard formulation.
The same committee said Fluad "may be effective at reducing the risk of hospitalization for influenza and influenza complications in the elderly," but more research is needed.
In its Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2018–2019, the committee made two different recommendations for vaccines administered as part of free immunization programs versus those administered at an individual level.
The committee said "cost-effectiveness assessments" were outside the scope of its review and therefore "there is insufficient evidence to make a comparative recommendation on the use of these vaccines."
In other words, the committee couldn't make a recommendation on the cost-versus-benefit to health authorities.
However, the chapter went on to say that while there is insufficient evidence to compare Fluzone High Dose and Fluad, there is good evidence regarding high dose compared to normal formulations of the flu shot.
High dose costs more, but there's good evidence that it works better than the standard shot in people over 65.
That's why, on an individual level — like when a person or private insurer is paying — "NACI concludes that, given the burden of disease associated with influenza A," high dose should be offered to people to people over 65 ahead of the standard dose.