MONTREAL -- A significantly higher number of people than those officially targeted by Quebec’s free influenza vaccine program will also be able to receive the free vaccine come November - but upon request only.

But many Quebecers -- even physicians -- aren’t aware they can ask for it, according to an MUHC specialist, who is adamant the government should communicate the public health message more clearly -- especially in the middle of a pandemic.

Dr. Earl Rubin, division director of infectious diseases at the Montreal Children’s Hospital, says his personal opinion is that the province’s public flu vaccine program should be universal, as it is in Ontario. But since the vaccine isn’t covered for all in Quebec, those who could benefit “need to be informed.”

“If they are saying that those 60 and above, those six-months to 23-months can get it for free, they need to do proper messaging. Get it out there, so that doctors know, patients know. If patients need to ask, they’ll know to ask. There really is a lack of transparency of the process.”

Quebec’s flu campaign starts in November and targets the following high-risk groups:

  • Children six months to 17 years who have certain chronic diseases
  • Adults who have certain chronic diseases (including pregnant women regardless of the stage of pregnancy)
  • Pregnant women, in the second and third trimesters of their pregnancy
  • Family members who live in the same household as a child under six months, or a person at higher risk of being hospitalized, and their caregivers
  • Health-care workers

Two years ago, the Comite sur l’immunisation du Quebec recommended the health ministry withdraw the following groups from its vaccination program:

  • Healthy children six to 23 months old
  • People aged 60 and over

Why? The immunization committee determined “the risk of flu-related hospitalization and death is low” among those groups. Also, less than half of the population was getting free flu shots. So the recommendation was to target high-risk groups but not to try and decrease “illness, medically attended visits and absenteeism from school and work,” says Rubin.

But the subsequent messaging by the government was half-hearted.

That began in 2018 when then health minister Danielle McCann reversed the previous government's decision. The announcement included the two groups on the list right up there with all the other high-risk groups, indicating they were still among the main targeted groups.

In 2019, the two groups were demoted to a paragraph below the main list of officially covered groups.

Neither announcement specifies the people in those age and health categories would have to request the flu shot if they wanted one, nor was that information part of any publicity campaign. 

In 2020, with COVID-19 cases surging, the health ministry has taken the same tack. A spokesperson told CTV News their “communication actions are not aimed at these clienteles because they are not among the clientele for which vaccination is recommended. However if they request it they will be able to benefit from the free vaccination.” 

The suggestion, that “these people can get vaccinated against the flu free of charge this year if they want to,” is the very last line at the bottom of the page.

Rubin argues again, the government needs to communicate the message more prominently because as many people as possible should be getting a flu shot this season.

Another infectious diseases specialist, Dr. Karl Weiss, had a similar view back in late June, telling CTV News the flu vaccine campaign “shouldn’t focus only on the immune-compromised and the patients who are at high risk.”

Weiss, a physician at the Jewish General Hospital, said even though the flu vaccine isn’t always very effective it “is probably better for people who don’t really need the vaccine on a regular basis -- the healthy general population. If you have everybody with the flu vaccine then you will lower the impact of the flu, and you probably have a better handle of COVID-19.”

It’s not yet known if this season’s flu vaccine will be protective against whichever strains end up circulating in Quebec. In the southern hemisphere, physical distancing and mask-wearing led to a decrease in the number of flu cases, which could very well happen here. 

Some experts say it's not worth taking that chance. Any reduction in the number of flu cases will only help, Dr. Rubin says, "as we go through this second and maybe third wave,” and health-care resources become over taxed. The more people who get the flu vaccine, the greater the potential benefit. He says the Quebec government should be making that clear, so perhaps thousands more people will request it.

To make sure people can all get the flu shot safely amidst the second wave of COVID-19, everyone who lives in the Montreal region and Laval will be able to get their flu shot by appointment only this year, CTV News has learned.

Crowded recreation centres and drop-in clinics are now relics of the not-so-distant past because they don’t allow for distancing measures and place vulnerable populations at risk.

Pediatricians and family doctors who have a vaccination permit are permitted to order the flu vaccine and administer it at their offices to at-risk and very young, healthy patients, says West Island pediatrician Dr. Mitchell Schiller.

Shiller doesn’t know if other doctors’ groups will go the same route, but even though they are not allowed to charge a fee for the service to help cover costs, the pediatricians at his clinic decided “they just have to help out.”

Each regional health board (CIUSSS) is responsible for setting up a flu vaccine program that meets the territory's needs. A couple of months ago, the province’s health ministry offered up several suggestions to help them COVID-proof their plans.

“It’s such a simple thing to do to get vaccination against the flu and it can help to protect so many people," said Julie Provencher, the director of public health activities at the CIUSSS-East Montreal. “It’s essential."

We contacted each of the five CIUSSS in the Montreal region as well as the Laval CIUSSS, and here’s the information they each provided about how their public flu vaccine programs will operate:

CIUSSS –West-Central Montreal

  • Flu vaccine available by appointment only in November at its five CLSCs to ensure proper distancing
  • Appointments can be made online using the Clic Sante platform starting in mid-October, or by telephone (telephone number TBD) for people without Internet access
  • Appointments will be available until 8 p.m. at some sites
  • They will conduct outreach for more at-risk clientele, for example, seniors who receive home care, people with mental health problems
  • The vaccination page will be updated by the end of September

CIUSSS – North-Central Montreal

  • By-appointment only to respect distancing and hygiene measures
  • Three fixed vaccination sites across the territory
  • Communication campaign to come

CIUSSS – East Montreal

  • By-appointment only, online through Clic Sante, or by telephone
  • Outreach to vulnerable populations, including people who are homeless, live in social housing and seniors residence
  • They are working on a communication plan and are assembling the staff required to meet the demand

CIUSSS – South-Central Montreal

  • By-appointment only, through Clic Sante and by telephone
  • Will also vaccinate any at-risk people when they go for regular medical appointments and follow-ups at hospitals and clinics
  • Will conduct outreach: people receiving home care, the homeless, those living in seniors' residences and social housing

CIUSSS – West-Island Montreal

  • By-appointment only through the online Clic Sante portal or by telephone to limit waiting times and allow them to respect distancing measures

CISSS – Laval

  • By-appointment only
  • Clinics will be adapted to public health measures to ensure distancing can be respected at all times from arrival through the post-vaccine waiting period and to prevent crowding
  • Appointment scheduling will take into account the time needed for disinfection
  • There will be outreach to vulnerable populations, for example, in seniors residences, external cancer clinics, and admitted patients at Cite-de-la-Sante Hospital and the Jewish Rehabilitation Hospital

At Friday's COVID-19 press briefing, Quebec's director of public health said this year the province ordered 35 per cent more doses of influenza vaccine than last year to meet any increased demand.

People will also be able to pay and receive a flu shot at many Quebec pharmacies offering the service if they don't meet the province's public program criteria.