Pharmacy U

WTF: What The Flu?! Top 5 things to know about flu shots during COVID-19


By Tiana Tilli, PharmD, RPh, ACPR at Wholehealth Pharmacy Partners


Interest in influenza immunization is at an all-time high, with a third of Canadians indicating that they’re more likely to get their flu shot this year due to COVID-19.1 This is consistent with what pharmacists in the Southern Hemisphere experienced, with community pharmacists in Argentina reporting providing as many pneumonia and influenza vaccines in two months during COVID-19 as in all of 2019.2 On top of this, pharmacies continue to be the healthcare settings where patients are most likely to get their flu shot.1 While this provides an opportunity for pharmacists on the frontline to take on a public health role as immunizers, it also brings challenges to address. Here are five key things to consider, as you provide injection services this flu season and beyond, in order to provide optimal protection to your patients, address patient questions and concerns, and ultimately keep you and your pharmacy teams safe:


  1. Personal Protective Equipment (PPE)

Immunization services will look different this year! Big differences include personal protective equipment (PPE) and distancing measures.3 Immunizers and pharmacy team members within six feet of each other should wear medical masks and eye protection.3 Gloves are not required unless administering intranasal or oral vaccines.3 Patients should wear non-medical masks.3 Have extra on hand in the event that a patient has forgotten theirs. Full PPE (i.e., gloves, gown, eye protection, medical mask) should be worn if providing first aid (e.g., to patients experiencing adverse events following immunization).4 As such, at least a few sets of full PPE should be available at the pharmacy, and staff should be trained and comfortable donning and doffing equipment. These resources can help (video donning & doffing, infographic donning & doffing)!


  1. Appointment-Based Model (ABM)

Now’s the time for the appointment-based model to shine! Offering immunization services on an appointment, rather than walk-in, basis can help promote distancing within the pharmacy.3,5 It also allows pharmacies to offer immunizations to high-risk patients at off-peak times (e.g., seniors’ hours) to minimize risk of potential exposure from other pharmacy patrons.3,5 Ask patients to arrive on time  and wear accessible clothing (e.g. short sleeves) to prevent taking anything off over one’s head, which can touch or displace one’s mask. Having screening and consent forms available online in advance for patients to complete and bring into the pharmacy can help reduce the time spent in pharmacy. The ABM enables advanced screening for additional immunizations. Pharmacists can proactively fax prescribers with recommendations for vaccine prescription(s). With this approach, the patient’s outstanding vaccines can be ready for administration when they come in for their flu appointment.


  1. Physical Distancing

With respect to distancing during and after immunizations, all communication with patients should occur as the immunizer stands six feet away. Once the procedure has begun, talking should be avoided when possible. Pharmacists can mark the 6 ft. mark with tape and say: “Once I cross this line there is no talking unless you’re feeling unwell, so please let me know if you have any other questions before we begin.” Ask the patient to look away from you to prevent them from coughing/sneezing or breathing on you during the interaction. Setting up the post-immunization monitoring area with distanced squares taped on the ground and chairs within the squares can prevent patients from roaming around. Ensure accessible options for mobility aids and support people are available.3


  1. High-Dose Influenza Vaccine

Pharmacists in Ontario and PEI can provide Fluzone®, the high-dose trivalent influenza vaccine, as part of the publicly funded influenza program for community dwelling adults ≥ 65 years old.6,7 High-dose trivalent vaccines provides protection against two influenza A strains and one influenza B strain while standard-dose quadrivalent vaccines provide protection against an additional influenza B strain.8 The high-dose trivalent vaccines has four times the antigen content compared to the standard-dose vaccine for the influenza strains it provides protection against.9 Because immune systems wane with age, making it more difficult to mount an immune response, this can help older adults mount a greater immune response to the influenza A strains that tend to cause more severe outcomes in older adults.10,11


  1. Providing Multiple Immunizations Per Visit

We want to screen all adults who receive their flu shot for other adult immunizations (e.g., pneumonia, herpes zoster, meningitis B, HPV, Tdap) and provide any outstanding vaccinations at their flu shot appointment if it’s within our scope. NACI recommends offering multiple immunizations at each interaction to reduce the number of different visits patients have with the healthcare system.4 Benefits of this approach include: (1) reducing potential for exposure to COVID-19, (2) conserving infection prevention and control supplies (e.g., cleaning tools), and (3) reducing workload as screening, obtaining consent, preparing immunizations, billing, and primary care provider notification can be done once for multiple vaccines. This approach helps pharmacy teams build on the patient’s openness to receiving a flu shot to discuss additional coverage and provides the most protection for patients who may fall behind on immunizations during the pandemic.4


You’re doing an immense service to your communities by offering injections amid the pandemic. Remember to keep yourself and your pharmacy teams safe – make sure to receive the influenza vaccine early in the season and download the COVID Alert app. The app was developed by the government of Canada and alerts users if they’ve been in contact with anyone who has tested positive for COVID-19. If you want to learn more about changes to the 2020-2021 influenza program and how to operationalize flu shot services, watch Whole Health Pharmacy Partners’ “Flu + More” webinar HERE.


  1. Canadian Pharmacists Association. (2020, August). Is Canada Ready? Flu Season & COVID-19.
  2. Bettina Caponi (International Pharmaceutical Federation). (2020, July 2). Winter is coming: Influenza Vaccination in Times of COVID-19 – Best Practices from the Southern Hemisphere.
  3. Public Health of Canada: NACI Statement and Publications. (2020, August 5). Guidance for Influenza Vaccine Delivery in the Presence of COVID-19.
  4. National Advisory Committee on Immunizations (2020, May). Interim Guidance on Continuity of Immunization Programs During the COVID-19 Pandemic.
  5. Canadian Pharmacists Association. (2020, September 18). Influenza Seasons 2020/2021: Suggested Best Practice for Community Pharmacy.
  6. Ministry of Health and Long-Term Care. (2020, September 23). 2020/2021 Universal Influenza Immunization Program (UIIP).
  7. Government of Prince Edward Island. (2020, September 30). Flu Vaccination Clinics.
  8. World Health Organization. (2020, February 28). Recommended composition of influenza virus vaccines for use in the 2020-2021 northern hemisphere influenza season.
  9. Sanofi Pasteur Limited. (2019). FLUZONE High-Dose Vaccine [Canadian Product Monograph].
  10. Centers for Disease Control and Prevention. (2020, September 22). Flu & People 65 Years and Older.
  11. Public Health Ontario. (2019). Influenza Vaccines for the 2019–20 Influenza Season – Focus on Adults 65 Years of Age and Over.