Investments in seasonal influenza vaccination programs pack a punch for pandemic preparedness.

Low- and middle-income countries with seasonal influenza immunization programs, prior to the COVID-19 pandemic were able to deliver vaccines faster and achieve, higher coverage compared to countries without such capabilities. Middle Income, (lower- and upper-) countries participating in the Partnership for International Vaccine, Initiatives (PIVI) described influenza processes and systems that contributed to more, efficient and effective COVID-19 mass vaccination campaigns because of existing, capacities. Some routine systems were easy to pivot while others required, modifications to address the need for speed and volume when responding to the, COVID-19 pandemic. While annual influenza programs are a natural "warm base" (i.e., keeping operations such as staffing and supply chains operating at a minimum sustainable level during non-crisis periods) for honing emergency response readiness in vaccination, investments in areas more specific to pandemic preparedness remain a need. Regional variations in readiness and opportunities for cooperation should also be explored.