How seniors can access 4 key vaccines this fall — for COVID, flu, pneumonia, and RSV

This story is part of CBC Health’s Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven’t subscribed yet, you can do that by clicking here.

With COVID-19 hospitalizations rising again, plus early signals suggesting other respiratory viruses are starting to circulate, Canada has an expanded slate of vaccines for seniors in its arsenal. 

COVID, influenza, pneumococcal, and — for the first time — respiratory syncytial virus (RSV) vaccines will all be available this fall for older adults. 

There’s hope the mix of new and updated shots will help keep more seniors out of hospital as health-care teams brace for the possibility of yet another busy fall and winter.

But while older Canadians may have more options to protect themselves than ever before, physicians warn staggered rollouts, patchwork approaches among the provinces, and high costs for certain shots could hinder uptake.

“The vaccine landscape is becoming more promising for older Canadians,” said Dr. Samir Sinha, the director of geriatrics at Sinai Health System in Toronto. “It’s also becoming a bit more complicated.”

Here’s what seniors need to know about the slate of shots arriving this fall.

Which vaccines will be available?

Updated COVID vaccines are already starting to roll out in various provinces, at different times.

Monovalent, mRNA-based shots from Pfizer and Moderna, which target the XBB.1.5 Omicron subvariant, have already been approved by Health Canada, and a third, non-mRNA option from Novavax is still under review.

“The most current versions have been adjusted to be effective against the newest variants,” said Dr. Roger Wong, clinical professor in geriatric medicine at the University of British Columbia. 

The delivery of flu shots to the provinces and territories is also well underway, a spokesperson for the Public Health Agency of Canada (PHAC) told CBC News.

Vaccines for pneumococcal disease are routinely offered as well — offering protection against potentially-deadly infections caused by the bacteria Streptococcus pneumoniae, which can lead to serious pneumonia. 

And the newest shot rolling out later this respiratory virus season is GSK’s vaccine for RSV, which was approved by Health Canada in August for adults 60 and up.

RSV is highly contagious, and for most people, it manifests like a common cold. But in more vulnerable populations, RSV can cause bronchiolitis — the inflammation of the small airways in the lungs — or pneumonia.

A PHAC spokesperson said a “limited” supply of the RSV shots will be available for the fall and winter season.

When can you get each shot?

When it comes to the flu shot, things are simple: Medical experts say everyone should get an annual vaccine once they become available in the weeks ahead.

As for COVID, Canadian guidance suggests waiting around six months after your last vaccination or infection to get the latest vaccine.

Timing the administration of a pneumococcal vaccine can vary between individuals as well. 

Sinha said all Canadians over 65 should get the newest type of pneumococcal shot, but if you’ve been previously vaccinated against this type of bacterial infection, you might still need another — so it’s worth talking to your primary-care provider to see if you’re eligible. 

Meanwhile RSV shots have been approved in Canada for all those 60 and up, and Sinha said he’s recommending the vaccine to all his older patients. Official recommendations on the vaccine’s use, however, haven’t yet been released by Canada’s national vaccine advisory body, and PHAC doesn’t expect that guidance until 2024.

South of the border, U.S. officials say seniors should talk to their doctors about the benefits and risks, and consider getting the shots before RSV is widely circulating.

Are these vaccines free?

It depends on the shot — and which province you’re in.

“Some vaccines, they aren’t covered necessarily by every province’s public health-care system,” noted nurse practitioner Anne Summach, an assistant teaching professor at the University of Alberta. “Cost is a big barrier.”

Both the COVID and standard influenza vaccines are available for free across Canada. Some provinces also offer free enhanced flu shots for seniors, which offer better protection than standard doses.

But which enhanced flu shots are free for seniors also depends on where you live.

In B.C., for instance, one influenza vaccine with an adjuvant to create a stronger immune response is free for all adults 65 and up — while a higher-dose flu shot that’s also recommended for seniors is only free for people living in long-term care, assisted living facilities, and First Nations communities. 

Ontario, in contrast, offers both options free to all seniors. 

WATCH | Experts say to wait for updated COVID-19 shots: 

Wait for updated COVID-19 booster this fall, experts suggest

Featured VideoDespite an expected fall wave of COVID-19, health experts recommend most people wait for the next, updated vaccine — still a few weeks away — to get a booster for the most protection.

“Our advice always is — if cost is a barrier around the influenza vaccine for one of the enhanced vaccines that might not be covered — even just getting the basic standard influenza vaccination is better than doing nothing at all,” Sinha said.

The situation is a little different for the pneumococcal vaccine, as both older and newer versions exist. Sinha recommended talking to your primary-care provider to see your options — and to find out the cost in your area.

As for the new RSV shots, most provinces will not be covering the cost, though Ontario is providing the vaccine free-of-charge in congregate living settings like long-term care homes.

Many Canadians who want the shot could wind up paying somewhere upwards of $200 out-of-pocket, experts warn.

And Sinha said seniors who want a full slate of all four vaccines, including high-dose flu shots, the latest pneumococcal vaccine, and the new RSV shot, may face costs totaling well over $500, depending on the province.

“When we’re talking about our most vulnerable citizens across our country… an out-of-pocket expense is probably out of the question, as is the likelihood that they’ll actually have private drug coverage,” Sinha said, adding those barriers could impact uptake.

Can you get multiple shots at once?

Canada’s vaccine advisory body says it’s fine to get both COVID and flu vaccines on the same day, and some regional public health officials are also recommending eligible seniors get the pneumococcal shots during the same appointments as well.

But the new RSV shots are a separate issue. 

Frontline providers say they don’t expect that vaccine will be co-administered with other shots, though Canadian guidance still isn’t out just yet to guide those decisions. 

The U.S. Centers for Disease Control and Prevention (CDC) has noted there is “currently limited data available” regarding the RSV vaccines being co-administered with other vaccines.

In clinical trials, there were also rare instances of patients who got both RSV and flu shots suffering severe side effects, the Washington Post recently reported, though experts say it’s not clear whether this is a “statistical fluke” or the result of administering the vaccines together. 

Why should seniors consider so many vaccines?

The bottom line for older adults, medical experts say, is that many diseases hit harder later in life, making vaccination a crucial protective measure.

“We know for older adults, there can be changes in their immune system,” said Wong. “Sometimes it’s from aging itself, and sometimes it’s other health conditions they’re living with, like diabetes or a heart condition.”

Both the youngest and oldest among us typically fare worse when faced with influenza, for instance, while the elderly have overwhelmingly borne the brunt of serious and deadly COVID infections in Canada and beyond throughout the last few years.

New data out this week from the U.S. CDC suggests that trend continued in 2023, with adults aged 65 and up accounting for roughly 63 per cent of all COVID-related hospitalizations. 

As for RSV, Canadian research suggests the virus has a more outsized impact on kids, and particularly infants under six months of age, but can also turn serious in older adults with pre-existing health conditions.

American figures recently released also showed that, from early 2022 to early 2023, hospitalizations for RSV among adults aged 60 and up were less frequent than admissions for COVID or influenza — but were typically associated with more severe disease, including the need for high-flow oxygen or ICU admission.

Meanwhile, Canadian data suggests the case fatality rate of pneumococcal pneumonia is typically up to seven per cent, and even higher among the elderly. 

Even when seniors survive a significant illness, Summach stressed that they don’t always bounce back as easily as younger adults, and can lose muscle strength or other abilities. 

“Vaccination is one mechanism we have at our disposal to prevent those seasonal illnesses that can reduce function over time,” she said. “Whatever you have access to, get it.”