High-dose trivalent inactivated influenza vaccine (HD-TIV) contains 60 μg of hemagglutinin per strain, whereas standard-dose vaccines (SD-TIV) contain 15 μg. Given the burden of influenza A subtype H3N2 in older adults and evidence of better efficacy of HD-TIV relative to SD-TIV (Box 1),1–4 Canada’s National Advisory Committee on Immunization recommends HD-TIV over SD-TIV for adults aged 65 years and older; however, the comparative effectiveness of HD-TIV over other options (MF59-adjuvanted TIV or standard-dose quadrivalent influenza vaccine) is uncertain.5 The HD-TIV is publicly funded for adults aged 65 and older in Ontario and for long-term care residents aged 65 and older in Saskatchewan, Manitoba and Prince Edward Island.