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Vaccine. 2015 Oct 13;33(42):5598-5605. doi: 10.1016/j.vaccine.2015.08.082. Epub 2015 Sep 11.

Seasonal influenza vaccine dose distribution in 195 countries (2004-2013): Little progress in estimated global vaccination coverage.

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consultant at Abbott, C.J. van Houtenlaan 36, 1381 CP Weesp, The Netherlands. Electronic address:
Janssen-Crucell Holland B.V., Newtonweg 1-2333 CP, P.O. Box 2048, 2301 CA Leiden, The Netherlands. Electronic address:
Protein Sciences Corporation, 1000 Research Drive, Meriden, CT 06450, USA. Electronic address:
International Federation of Pharmaceutical Manufacturers and Associations, Ch. des Mines 9, P.O. Box 195, 1211 Geneva 20, Switzerland. Electronic address:


Seasonal influenza is an important disease which results in 250,000-500,000 annual deaths worldwide. Global targets for vaccination coverage rates (VCRs) in high-risk groups are at least 75% in adults ≥65 years and increased coverage in other risk groups. The International Federation of Pharmaceutical Manufacturers and Associations Influenza Vaccine Supply (IFPMA IVS) International Task Force developed a survey methodology in 2008, to assess the global distribution of influenza vaccine doses as a proxy for VCRs. This paper updates the previous survey results on absolute numbers of influenza vaccine doses distributed between 2004 and 2013 inclusive, and dose distribution rates per 1000 population, and provides a qualitative assessment of the principal enablers and barriers to seasonal influenza vaccination. The two main findings from the quantitative portion of the survey are the continued negative trend for dose distribution in the EURO region and the perpetuation of appreciable differences in scale of dose distribution between WHO regions, with no observed convergence in the rates of doses distributed per 1000 population over time. The main findings from the qualitative portion of the survey were that actively managing the vaccination program in real-time and ensuring political commitment to vaccination are important enablers of vaccination, whereas insufficient access to vaccination and lack of political commitment to seasonal influenza vaccination programs are likely contributing to vaccination target failures. In all regions of the world, seasonal influenza vaccination is underutilized as a public health tool. The survey provides evidence of lost opportunity to protect populations against potentially serious influenza-associated disease. We call on the national and international public health communities to re-evaluate their political commitment to the prevention of the annual influenza disease burden and to develop a systematic approach to improve vaccine distribution equitably.


Monitoring and evaluation; Seasonal influenza; Vaccination coverage rates; Vaccination policy; Vaccine recommendations; Vaccine reimbursement

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