Sustainable demand for seasonal influenza vaccines is a component of national security strategies for pandemic preparedness. However, the ongoing COVID-19 pandemic has revealed many weaknesses in the capacity of countries to design and execute sustainable vaccination programs. An influenza pandemic remains a global threat and yet there is no global monitoring system for assessing progress towards influenza vaccination coverage targets. The International Federation of Pharmaceutical Manufacturers and Associations’ (IFPMA) Influenza Vaccine Supply International Task Force (IVS) developed a survey method in 2008 to estimate seasonal influenza vaccination coverage rates, which in turn serves as a crude estimate of pandemic preparedness. It provides evidence to guide expanded efforts for pandemic preparedness, specifically for increasing COVID-19 vaccine immunization levels. Furthermore, the results presented herein serve as a proxy for assessing the state of pandemic preparedness at a global and regional level. This paper adds data from 2018 and 2019 to the previous analyses. The current data show an upward or stable global trend in seasonal influenza vaccine dose distributed per 1,000 population with a 7% increase between 2017 and 2018 and 6% increase between 2018 and 2019. However, considerable regional inequities in access to vaccine persist. Three regions, Africa, the Middle-east, and Southeast Asia together account for 50% of the global population but only 6% of distributed seasonal influenza vaccine doses. This is an important finding in the context of the ongoing COVID-19 pandemic, as distribution of influenza vaccine doses in many ways reflects access to COVID-19 vaccines. Moreover, improving seasonal vaccine uptake rates is critical for optimizing the annual benefits by reducing the huge annual influenza-associated societal burdens and by providing protection to vulnerable individuals against serious complications from seasonal influenza infections.

The World Health Organization noted that COVID-19 vaccination programmes could be leveraged to deliver influenza vaccination. In 2008, the International Federation of Pharmaceutical Manufacturers and Associations' (IFPMA) Influenza Vaccine Supply International Task Force (IVS) developed a survey method using the number of influenza vaccine doses distributed globally to estimate vaccination coverage rates. Seven hundred and ninety-seven million doses were distributed in 2021, representing a 205% increase over the 262 million doses distributed in 2004, exceeding the number of doses distributed during and after the 2009-2010 influenza pandemic. The most obvious explanation for the global increase is the enabling of critical elements of the vaccine ecosystem by decision-makers during the COVID-19 pandemic to reinforce implementation of influenza vaccination programs. Most of the improvements in performance of influenza programs during the COVID-19 pandemic can be classified in four categories: 1) promoting vaccination using tailored approaches for specific populations; 2) improving convenient access to influenza vaccines in COVID-safe settings; 3) improving reimbursement of seasonal influenza vaccination for priority groups; 4) maintaining the timing of vaccination to the autumn. In spite of the increase in rates of seasonal influenza vaccines distributed during the COVID-19 pandemic, globally, the rate of influenza dose distribution is sub-optimal, and a considerable proportion of the influenza infections remains preventable. To sustain the benefits from increased uptake of influenza vaccines, governments need to sustain the efforts made during the COVID-19 pandemic, and a number of global policy endeavours should be undertaken, including developing a clear global roadmap for achieving influenza control objectives, adopted by a WHA resolution, in line with the strategic objective 3 of the Global Influenza Strategy 2030, embedded in the Immunization Agenda 2030 (IA2030).

Seasonal influenza vaccines have the potential to prevent significant morbidity and mortality and the World Health Organization recommends that all countries consider implementing seasonal influenza immunization programmes. These provide invaluable supports to pandemic response, whether through the utilization of influenza epidemiological surveillance systems such as the WHO Global Influenza Surveillance and Response System (GISRS) or RespiMart, by imparting countries with ability to scale up vaccination in response to pandemics, and by contributing to the global production capacity for vaccines. During the COVID-19 pandemic, countries with higher influenza vaccination coverage also achieved higher COVID-19 vaccination coverage. But vaccine hesitancy and complacency are preventing optimal benefits from seasonal influenza vaccination. In 2008, the International Federation of Pharmaceutical Manufacturers and Associations' (IFPMA) Influenza Vaccine Supply International Task Force (IVS) developed a survey method to estimate vaccination coverage rates. The present survey, for 2022 and 2023, highlights that the vast improvements in seasonal influenza vaccination coverage rates achieved during 2020 and 2021 are regrettably not being sustained. Twenty-seven fewer countries in 2022 and 29 fewer countries in 2023 distributed any doses of seasonal influenza than in the peak year for number of countries, 2011. In 2023 there were 17 % fewer vaccine doses distributed globally than in the peak year, 2020. Only 33 of 195 countries achieved the hurdle rate in 2023, defined as number of doses distributed to ≥15.9 % of the population. Governments can strengthen performance of their seasonal influenza vaccination programs with a few key actions. Because immunization returns up to 19 times the cost in societal value, it is critical for governments to identify and implement appropriate countermeasures to vaccine hesitancy and complacency including vaccine advocacy, communications, and communication training for Healthcare Workers. Governments' challenge is to sustain resolve beyond the public health emergency of COVID-19.