The 65+ age group comprises 15% of Canadians, but 70% of all flu-related hospitalizations, and 90% of flu-related deaths. This population is also significantly more likely to develop secondary infections, such as pneumonia.
Fluzone HD (high dose) is a flu vaccine that is new to the Canadian market, indicated specifically for individuals over the age of 65. It has been used extensively in the US for the past several years. It is one of the options that is not available from the Alberta government, and it costs about $80 a dose.
There is already a flu vaccine targeted to this age group that is covered, called Fluad. However, the National Advisory Committee on Immunization (NACI) which sets the public policy for flu, points out that we do not have proof that it works better:
"A phase III, randomized, observer-blinded study comparing the safety and immunogenicity of a MF59 adjuvanted influenza vaccine with unadjuvanted influenza vaccine in adults ≥65 years of age noted no significant difference in the clinical effectiveness between adjuvanted and unadjuvanted TIV in terms of ILI Footnote 146. However, this study was not designed to estimate vaccine effectiveness against laboratory-confirmed outcomes."
AND it may be more likely to cause a reaction (although not a serious one):
"MF59-adjuvanted TIV produces injection site reactions (pain, erythema and induration) significantly more frequently than unadjuvanted vaccines, but they are classified as mild and transient. Systemic reactions (myalgia, headache, fatigue and malaise) are comparable or more frequent with Fluad® compared to unadjuvanted vaccines and are rated as mild to moderate and transient."
Fluzone HD has some great efficacy data, specifically a study of around 32,000 people published in the New England Journal of Medicine. Specifically, they found a 24.2% reduced risk of contracting the flu compared to the Fluzone non-HD flu vaccine.
At $80 vs a 'free' flu shot (already paid for by your taxes), it is not a straightforward decision. However, we have found that those with private coverage sometimes get a portion of the Fluzone HD covered. There are also those who have had a hospitalization from the flu and would pay $80 in hopes of reducing the chances of having to go through that again. It may be difficult to find, but Sanofi has created a 'flu shot finder' for their product.