High-Dose Flu Vaccine Dries Up for Portugal’s Oldest Residents

Vaccination units across Portugal are finding themselves in the awkward position of having to turn away some of the country’s oldest citizens just as the seasonal flu picks up speed. Reports of a sudden shortage of the high-dose influenza vaccine—the one reserved for everyone aged 85 and above—have spread from Trás-os-Montes to the Algarve, provoking anxiety among families and putting local health managers on the defensive.

Shortage surfaces nationwide

Clinicians first noticed the stock-out in late October, but it was only after All Saints’ Day that the Direção-Executiva do Serviço Nacional de Saúde admitted the problem was now “generalised.” The confession followed a record-breaking start to the campaign that began on 23 September: more than 300 000 high-dose shots had been delivered in just seven weeks, a figure officials say already exceeds the total for the entire 2024-2025 season. With demand running ahead of forecasts, health centres emptied fridges that were meant to last until Christmas. By 12 November roughly 74 % of people over 85 had received the jab, leaving an estimated 100 000 elders still unprotected while the virus continues its march.

Why the 85-plus cohort needs the stronger dose

For seniors of such advanced age, resistance to infection is dramatically reduced. The high-dose formulation contains four times more antigen than standard vaccines, triggering a stronger immune response that can slash the risk of hospitalisation and pneumonia. Portugal learned that lesson the hard way last winter when the Instituto Nacional de Saúde Doutor Ricardo Jorge documented an excess mortality of more than 1 600 deaths between late December and late January, most of them women well past their 85th birthday. Researchers stopped short of proving that a supply crunch caused the spike, yet public-health leaders regard broad coverage in this age group as a non-negotiable safety net.

How did supplies run dry?

Internal emails reviewed by this newspaper show that forecast models used by the Direção-Geral da Saúde relied heavily on uptake rates from 2024, a season when concerns about respiratory viruses were receding. This time, however, family doctors actively phoned every eligible patient and community groups organised transport to vaccination hubs, pushing uptake “far beyond scenario A,” according to one planning officer. At the same time, manufacturers in Europe diverted a portion of production to the United States after an early surge there, leaving Portugal fewer doses to reorder once fridges began to empty. Health-care economists warn that just-in-time procurement looks nimble on spreadsheets but collapses when public enthusiasm suddenly spikes.

What local clinics are telling patients

In Setúbal, reception desks now advise anyone born before 1941 to leave a mobile number and wait for an SMS. In Guarda, nurses have started explaining that even if fresh stock arrives, deliveries are expected in small weekly batches, not the large pallets that launched the campaign. Patients are being reminded that the ordinary-dose vaccine remains available but that it was not designed with 85-year-old immune systems in mind. Some carers have begun charting road trips to neighbouring Spain, yet Spanish authorities also restrict the high-dose variant to residents.

Government and health authorities scramble for replacements

After an unsuccessful attempt to redistribute remaining vials among Unidades Locais de Saúde, Lisbon instructed each ULS to purchase directly from suppliers. That is easier said than done: wholesalers are charging a premium for last-minute orders, and a complex European regulatory web means Infarmed must clear every batch before use. The Health Ministry insists the financial ceiling is no obstacle, though no timeline has been given for restoring full stock. Officials have floated the possibility of importing from Australia, where winter has ended, provided the lots match European specifications.

Broader implications for winter care

Emergency physicians fear a repeat of last January’s crunch, when flu and cold snaps collided to push São João Hospital close to capacity. Pulmonologists note that a partially protected senior population could translate into more admissions at precisely the moment when wards must also cope with COVID-19 boosters and routine surgeries postponed during the pandemic. A single avoidable admission, they point out, costs the system more than ninety high-dose vials.

What seniors and families should do now

Health authorities continue to urge those still waiting not to give up. They recommend confirming contact details with local centres, staying alert to missed calls and updating personal records on the SNS 24 portal so that appointments are not lost in the shuffle. Geriatricians add that hand hygiene, mask use in enclosed busy spaces and prompt medical attention for early symptoms remain crucial layers of protection—especially while the stronger vaccine is out of reach.

Looking ahead to future campaigns

Policy analysts say the shortage has laid bare the need for larger pre-season orders, overlapping suppliers and a reserve stockpile, much like Portugal maintains for strategic medications. The Health Ministry has promised a full audit once the last dose is administered. Stakeholders across the spectrum—family doctors, pharmacists and patient advocates—argue that planning for the 2026 campaign must start now if Portugal is to maintain its hard-won reputation as one of Europe’s vaccination success stories.