Building resilient and response-ready influenza vaccination programs for pandemic preparedness: a comparative analysis from five middle-income countries.

UNLABELLED: Influenza vaccination programs are critical in reducing the morbidity and mortality from seasonal influenza and bolstering pandemic preparedness. However, there is a notable lack of information about the factors contributing to resilient and response-ready influenza vaccination programs in middle-income countries (MICs). This study set out to identify determinants of resilient and response-ready seasonal influenza vaccination programs in MICs.

METHODS: This study used a collective case study design to analyze structural and programmatic elements of resiliency and response-readiness within MIC influenza vaccination programs. A multi-step process was used to select suitable countries for the case study analysis, including an initial literature landscaping of MICs, stakeholder mapping, and an online scoping survey. A conceptual framework was developed to guide analysis across six determinants of resilient and response-ready programs: political, economic, structural, communication & education, socio-behavioral, and COVID-19 response. Data for the selected case studies were gathered via a narrative literature review (initial search conducted January-September 2022) and stakeholder consultations with 27 stakeholders (held between June and September 2022). Findings from the literature review and stakeholder consultations were analyzed using the framework to identify key themes related to influenza vaccination program resiliency and response-readiness.

RESULTS: Five countries - Albania, Bolivia, Brazil, South Africa, and Thailand - met the study selection criteria and were selected as geographically diverse case studies. Five key themes emerged as consistent indicators of resilient and response-ready influenza vaccination programs: 1) building research capacity and a clear pathway from evidence to policy creates resilient and responsive influenza programs; 2) diversified procurement mechanisms help ensure a reliable supply of influenza vaccines; 3) healthcare workers are essential partners for implementing resilient and response-ready influenza vaccination programs; 4) demand generation is key to driving and maintaining influenza vaccine uptake; and 5) building and maintaining seasonal influenza vaccine infrastructure contributes to pandemic preparedness.

CONCLUSIONS: The findings offer valuable insights and actionable guidance to improve influenza vaccination program resiliency and response-readiness in MICs and more broadly. Strengthening areas highlighted in this evaluation can help countries improve influenza vaccination coverage while building greater program resilience and readiness to respond to future public health threats, including influenza pandemics.