Canadians who avoid the flu shot because they fear needles have an alternative that won’t make them hold their breath until it’s over. FluMist, a nasal spray vaccine, offers a painless way for Canadians to get immunized.
But there are major problems: FluMist is not covered under most provincial health plans, and it is not readily available.
Influenza is among the top 10 leading causes of death in Canada, with approximately 3,500 deaths and 15,000 hospitalizations each year. Yet, the Public Health Agency of Canada’s 2023 survey shows that only 42 per cent of adults got the flu shot that year.
According to the Canadian Psychological Association, approximately 25 per cent of adults and 67 per cent of children in Canada are afraid of needles. And while there are various strategies to help people with needle phobias, FluMist offers an alternative that doesn’t require distraction techniques and calming breathing exercises. Created by AstraZeneca, it’s a needle-free influenza vaccine administered through a “gentle nasal spray” by a health-care professional.
FluMist is a live, attenuated vaccine, which means it contains a weakened form of this year’s influenza strain. This “means that it’s still alive, but can’t infect,” says Paul Roumeliotis, a pediatrician who is the medical officer of health and chief executive officer of the Eastern Ontario Health Unit. “It can’t cause infection, but it can stimulate the immune system … When you put something directly into the nose, you will get local antibodies forming, which will protect a person.”
As with the annual flu shot, FluMist is updated annually for each year’s strains of flu to ensure immunity. Unlike the traditional shot, FluMist is cost effective because there is no needle and syringe to buy and dispose of and it’s easier to administer without dealing with needlestick injuries or needle phobia, says Ian Gemmill, a public health physician and consultant in public health medicine.
Although it’s hard to find now, Roumeliotis says he’s “optimistic it will be available for next year’s season. There are people who have insurance, who may take it (this year), but it’s still an inequity. I’d like it to be more equitable. If it’s covered and it’s offered to everybody, that’s the way to go.”
FluMist has been around for the last two decades. It was first approved for the U.S. market in 2003 but didn’t receive Health Canada approval until 2010. Before being authorized in Canada, FluMist had been administered to more than 30,000 people in “controlled clinical studies over multiple years, in various regions, using different vaccine strains.”
Based on these studies, Health Canada recommended FluMist for people aged 2 to 59; in the U.S. it’s recommended for people 2 to 49. “You’ll find all kinds of inconsistencies in countries on their recommendations for use. It all depends on what people think, what they believe, and what their experience is,” says Gemmill. “So, (Health Canada) says 59, so that’s fine.”
In one of the studies, FluMist prevented 85 per cent of flu cases, compared with 71 per cent for traditional injectable influenza vaccine. Another promising finding was that FluMist protected children aged 2 to 17 more effectively than the standard flu shot, making it more suitable for pediatric immunization.
While those were the statistics used to authorize FluMist’s market access, the traditional flu shot and FluMist are equally effective, says Roumeliotis. There’s a misconception that people think neither the flu shot nor FluMist work – or that they give them the flu – and that’s not true, he adds.
It’s important to note that “(the flu shot) effectiveness is somewhere between 40 and 60 per cent at the best of times,” says Gemmill. “Which means that half the time the person who otherwise would have gotten the infection won’t get the infection.”
While Health Canada has approved FluMist’s use across the country, AstraZeneca’s online tool “Where Can I Find FluMist?” reveals that few pharmacies have it in stock.
A pharmacist in Vancouver, who asked to remain anonymous, says she has no supply of FluMist this year because of a previous lack of demand, perhaps caused by a lack of awareness. She says she knows that some parents have taken their children to local public health units to have FluMist administered under the provincial health plan.
According to Immunize Canada’s Publicly Funded Seasonal Influenza Vaccines in Canada fact sheet for 2025-26, Nunavut and the Northwest Territories are the only jurisdictions that cover FluMist for everyone aged 2 to 59. Some provinces, including Quebec, Prince Edward Island and New Brunswick, provide it only to children. British Columbia and Yukon provide FluMist to pediatric patients and to adults aged 18 to 59 with a “strong fear of needles and unwilling to receive an injectable influenza vaccine.”
For the rest of B.C. residents and those living in Alberta, they will have to find a pharmacy that carries FluMist and pay approximately $44 out of pocket or through private health insurance.
Ontario’s health plan used to cover it but there “was little uptake and a lot of wastage, so they didn’t renew it,” says Roumeliotis.
FluMist requires refrigeration; almost a decade ago, flawed studies in the United States claimed it wasn’t effective although it was being tested at the wrong temperature, says Roumeliotis. Because of these studies, there was a lot of skepticism about intranasal vaccines.
He says he hopes that once FluMist becomes available across Canada under provincial plans, public health authorities will promote it through community partners, physicians, pharmacists and multimedia channels.
“FluMist would fit in as an alternative that can potentially convince needle-phobic or anxious patients to take the flu vaccine. That’s across all ages, but particularly younger children,” says Roumeliotis.
“It’s going to be fascinating to see it play out because it feels different from a traditional needle,” says Timothy Caulfield, a health law professor at the University of Alberta and health misinformation expert. “We shouldn’t underplay the role of needle phobia in this context, but I’m curious how the anti-vaxxers are going to frame this.”
It’s still too early to tell whether FluMist will encourage more people to get a flu vaccine, says Roumeliotis.
In August, the U.S. Food and Drug Administration approved FluMist Home, which allows people to order FluMist online, have it delivered to their homes and administer it to themselves and their children without involving a health-care practitioner. It seems that would increase vaccine uptake, but it’s too soon to tell, says Roumeliotis.
“Influenza vaccine is the most expensive vaccine, not per dose, but certainly in terms of the fact you have to (try to vaccinate) the whole population every single year,” says Gemmill. “And given the issues around FluMist, I guess I would say it’s all about options, and I think that each government would say we’re providing options for parents.”
If AstraZeneca wants to make FluMist available for self-administration in Canada, more clinical trials will be required and a new presentation will have to be made for Health Canada approval, says Maryse Durette, a spokesperson for Health Canada, by email.
Although time will tell how FluMist – and public health plans – encourage flu vaccination, the first step is to continue advocating for Canadians to seek it, says Roumeliotis. “You have to explain (immunizations) in a very compassionate way, (with) consistent messaging, making sure that you offset pre-emptively some of the misinformation.”
In Canada, FluMist may not be accessible for everyone, but the flu shot is available and free for all, so everyone should take advantage of it, says Gemmill. “Influenza is immunosuppressive, and we know that other nasty infections can follow it … So, as members of society, we owe it to each other to reduce the risk of these infections because there are some people who are very vulnerable and will get a lot sicker … Don’t second guess, just get it. It’s a safe and effective vaccine, and it can make things better.
Ed note: This article has been updated to correct the spelling of Dr. Gemmill’s last name.
