Flu vaccine after 65: why an enhanced vaccine

General information, not medical advice. Ask your GP or pharmacist which vaccine is right for you.

A flu vaccine after 65 is worth planning this autumn: in Flanders, the Departement Zorg, the Flemish government’s health department, recommends the flu jab between mid-October and the end of November. The Belgian Superior Health Council, which gives scientific advice to Belgian policymakers, recommends an enhanced vaccine for people over 65. Here is what that means, what it costs and how to combine it with the covid jab.

Why the Superior Health Council recommends an enhanced vaccine

In the advice for the 2026-2027 flu season, people aged 65 to 74 have high priority, with a high-dose vaccine or an adjuvanted vaccine. From 75 and for residents of care homes, priority is very high, with the same two vaccines. Healthy people aged 50 to 64 have moderate priority and receive a standard vaccine.

An adjuvanted vaccine contains an added substance, the adjuvant, that strengthens the immune response. A high-dose vaccine contains more of the virus protein your body builds its defence against. According to the Superior Health Council, both enhanced vaccines have proved superior to standard-dose vaccines in clinical studies, although the evidence is stronger for the high-dose vaccine. The Departement Zorg writes that an enhanced vaccine can offer better protection.

Flu vaccine after 65: what a large study of the high-dose vaccine shows

DiazGranados and colleagues published a randomised trial in 2014, in which participants are assigned a vaccine by lot. The study follows 31,989 adults aged 65 or older in the United States and Canada over two flu seasons.

Laboratory-confirmed flu occurs in 1.4 percent with the high-dose vaccine and in 1.9 percent with the standard vaccine. The relative efficacy, the percentage difference in flu cases between the two groups, is 24.2 percent. Serious adverse events, meaning serious health problems during the study, are reported by 8.3 percent of participants with the high-dose vaccine and 9.0 percent with the standard vaccine. The study was funded by Sanofi Pasteur, the maker of the vaccine.

How many people over 65 get vaccinated

According to the 2023-2024 Health Interview Survey by Sciensano, the Belgian institute for public health, 64.8 percent of people over 65 had a flu vaccination in the twelve months before the survey. These figures are self-reported, and Sciensano calls this far below the 75 percent target the World Health Organization sets for older people. According to the World Health Organization, most people recover within a week, but older people are at greater risk of severe illness or complications. If you care about your healthy years of life, the flu jab belongs in your autumn plans.

Where to get the vaccine and what it costs

According to the Departement Zorg, GPs, pharmacists, nurses and midwives can vaccinate. Giving the jab is free, although your GP may charge a consultation fee. The flu vaccine itself is not free, but people over 65 get a refund through their health insurance fund for both the regular and the enhanced vaccine. In a care home recognised by Flanders, the flu vaccine is free.

A GP gives a 76-year-old woman a flu vaccine in her upper arm at the surgery

RIZIV, the Belgian National Institute for Health and Disability Insurance, publishes the amounts. For a standard vaccine you pay 4.08 euros if you belong to a risk group, or 2.45 euros with increased reimbursement. If you are not in a risk group, you pay 17.74 euros. The high-dose vaccine and the adjuvanted vaccine are partly reimbursed for people over 65 if the treating doctor considers an enhanced vaccine necessary, or if the pharmacist records the dispensing in your Shared Pharmaceutical Record. You then pay 7.92 euros, or 4.71 euros with increased reimbursement. If you do not meet the conditions, you pay 30.87 euros. One flu vaccine per person per season is reimbursed.

Flu and covid jab in one visit

The covid vaccine is free, and you can get it between early October and mid-December. If you choose both vaccines, the Departement Zorg says they can be given in the same visit between mid-October and the end of November. The Superior Health Council considers giving them together safe and effective. The Departement Zorg also recommends a vaccine against pneumococci, bacteria that can cause pneumonia among other things, for everyone from 65. Protection against RSV, a virus that infects the airways, is recommended from 75 and from 60 with at least one risk factor.