Expert opinion on improving influenza vaccination coverage rate in Qatar: Strategic solutions and role of live attenuated influenza vaccine (LAIV)

ABSTRACT

Seasonal influenza remains a major public health challenge in Qatar, causing significant morbidity and mortality among high-risk groups. Despite annual campaigns and free vaccines, coverage-rate is low, especially among children, the elderly, and pregnant women. This expert opinion review highlights vaccine-related epidemiological trends and barriers to uptake, including hesitancy, limited public awareness, logistical issues, and gaps in healthcare provider education in Qatar region. The panel underscores the urgent need for robust public education, targeted outreach, and empowering healthcare professionals to improve vaccine uptake. Special emphasis is placed on the role of live-attenuated-influenza-vaccine (LAIV), which allows needle-free administration, enhanced immunogenicity, and is suitable for school-based programs. Recommendations include expanding access via mobile clinics and schools, aligning procurement with seasonal peaks, and strengthening surveillance and quality systems. Adopting these strategies and empowering healthcare providers with necessary tools and knowledge can significantly improve influenza vaccination-coverage in Qatar and reinforce long-term public health resilience.

Introduction

Seasonal influenza poses a substantial public health challenge, contributing to considerable morbidity and mortality worldwide.^1,2 The majority of influenza cases present with mild to moderate symptoms such as fever, headache, arthralgia, upper respiratory symptoms, and malaise, and most individuals recover within 1–2 weeks.³ However, some patients experience severe symptoms requiring medical attention.¹ According to the World Health Organization (WHO), there are 3 to 5 million cases of severe illness annually, resulting in an estimated 290,000 to 650,000 respiratory-related deaths globally.⁴

Vaccination is the most effective measure to prevent influenza infection and its complications.⁵ Although vaccination is recommended for all individuals to help control the spread of influenza, the WHO specifically recommends annual vaccination for high-risk-groups, children aged 6–59 months, adults aged ≥65 y, individuals with chronic conditions, neurologic/neurodevelopmental disorders, residents of nursing homes or chronic care facilities, immunosuppressed individuals, pregnant or postpartum women (within 2 weeks of delivery), children or adolescents receiving aspirin (due to risk of Reye syndrome following influenza infection), and individuals with extreme obesity (BMI ≥40 g/m²).^1,5–7

The WHO Global Action Plan (GAP) for influenza vaccines, initiated in 2006, aimed to expand influenza vaccine production to bridge the gap between demand and supply.^8,9 Over the years, GAP has catalyzed progress in scaling up manufacturing capabilities, however, the global production capacity for seasonal and pandemic influenza still falls short of the volume required to immunize 70% of the global population equitably (the WHO-recommended threshold), underscoring the need for continued efforts and additional interventions to overcome regional disparities, particularly in the Middle East and North Africa (MENA) region.¹⁰ In the MENA region, influenza ranks as the second most significant contributor to lower respiratory infections, highlighting the urgent need for preventive measures.⁶ Although the seasonality of influenza and other respiratory viruses is well established across many parts of the world, the epidemiological data from the MENA region remains comparatively sparse.¹¹ Notably, in Qatar, the several seasonal peaks of influenza A tends to occur earlier than in other MENA regions, typically between November and December, followed occasionally by a secondary surge of influenza B in March.^4,12 Seasonal peaks lead to variable surges in influenza activity, contributing to gaps in the timing and availability of vaccines, which are the two key factors highlighted by physicians.¹³

The Joint Committee on Vaccination and Immunization (JCVI) in 2012 recommended using influenza vaccines that target multiple strains in children and older adults, demonstrating a robust immune response, and sustained protection against evolving viral variants.¹⁴ The cold-adapted, live attenuated influenza vaccine (LAIV), licensed by the USFDA in 2003, is approved for individuals aged 2 to 49 y. LAIV is formulated to mimic the immune response elicited by wild-type influenza viruses, offering effective protection while maintaining a favorable safety profile.¹⁵ In accordance with international guidelines, routine influenza vaccination is recommended in Qatar for prevention and control. Despite several national initiatives, vaccination coverage rate (VCR) remains suboptimal (51.3% for MENA region).¹⁶ The challenges associated with a low VCR include limited public awareness, vaccine hesitancy, and gaps in outreach initiatives.^17–19 This necessitates an in-depth understanding of the barriers to enable future endeavors to increase VCR.

To address these challenges, an expert panel was convened to evaluate the epidemiology of influenza, the current vaccination status, and identify key barriers to influenza vaccination in Qatar. The panel also aimed to provide practical strategies to strengthen influenza prevention efforts in Qatar and to improve vaccination uptake by encouraging the use of LAIV, which is easier to administer and offers immunogenic as well as logistical advantages particularly in children, who are key transmitters of influenza within households and communities.²⁰

Methodology

A steering committee, including experts from key medical organizations (N = 12) across Canada, Qatar, Oman, and the United Kingdom (UK), was convened in May 2025 for the Qatar Influenza Workshop organized by the Qatar Infectious Disease Society. The experts shared best practices and implementation approaches for effective vaccine coverage. The steering committee also discussed the characteristics and advantages of LAIV and its potential impact on increasing VCR in Qatar. This expert opinion paper is a result of the literature review, insights from the meeting, and expert recommendations formulating an action plan allowing optimal utilization of resources and cost-effective practices for better care of the Qatari population to reduce the influenza burden.

Burden of influenza in MENA and Qatar

Burden of influenza in MENA

Influenza poses a substantial threat not only to the individual health but also to the healthcare system and the broader economy at both the global and regional levels, underscoring the critical importance of widespread immunization.²¹

Between 1999 and 2015, global respiratory mortality due to influenza demonstrated significant age-related variation. Among children under 5 y of age, the mortality ranged from 2.1 to 23.8 deaths per 100,000, while for adults under 65 y, the mortality rate was lower in the range of 1.0 to 5.1 per 100,000. Mortality risk further increased with age, as individuals aged 65 to 74 y experienced rates from 13.3 to 27.8 per 100,000, whereas those aged ≥75 y had annual mortality ranging from 51.3 to 99.4 per 100,000.²²

Surveillance data from MENA provides further insight into the regional impact of influenza. An analysis of influenza epidemiology conducted between 2010 and 2016 included over 70,500 influenza cases identified across 17 countries. Influenza A and B viruses accounted for a median of 76.5% and 23.5% of seasonal influenza cases, respectively. Notably, influenza A was the predominant type, responsible for 86.8% of seasonal infections. Among influenza A cases, the pandemic A(H1N1) strain was the most prevalent (61.9%), followed by the A(H3N2) subtype (24.0%).¹²

Additional population-based data highlight the significant burden of influenza-associated complications in the region. A study from Oman (2008–2013) reported that the incidence of influenza-associated severe acute respiratory infection (SARI) was highest among children aged 0–4 y, with estimates ranging from 32 to 42 cases per 100,000 population. Individuals aged 65 y and above, also experienced substantial burden, with SARI rates between 12 and 27 cases per 100,000 population. The highest rate of influenza-related mortality occurred in adults aged 65 and older, with 39.5 deaths per 100,000 in 2014 and 11.3 per 100,000 in 2015.²³

Burden of influenza in Qatar

Age distribution data from Qatar suggest that influenza infections are more frequent in older children above 5 y.²⁴ Though the influenza mortality is lower in children compared to adults, pediatric patients are approximately five times more likely than adults to acquire influenza, possibly due to increased exposure within both school and household environments. This increased susceptibility also means that healthy children play a disproportionate role in the household transmission of influenza, accounting for an estimated 80% of secondary infections infection cases.⁷

Although comprehensive epidemiological data on influenza in Qatar remain scarce, more recent studies provide further insight into the disease patterns. A descriptive study (N = 998) conducted at primary health care corporation (PHCC) centers across Qatar, between November 2018 (418 cases) to April 2019 (59 cases), reported a higher frequency (63.8%) of influenza in children and adults aged 15 to 50 y. Further, type A influenza virus was observed to be the predominant (77.1%) circulating strain.²⁵ In a large retrospective study among 44,000 Qatari adults who visited healthcare centers between 2012 and 2017, 22.6% tested positive for the influenza virus, underscoring its significant impact on the adult population. During the same period, surveillance among pediatric patients (under 15 y of age) reported a prevalence of 18.4% for influenza viruses.²⁴ Another retrospective study analyzed 33,404 children <15 y (2012–2017) who were presented with influenza influenza-like illness (ILI) (18.5%). Influenza virus contributed 23% of total ILI cases, representing the second most frequent infection in 2017. Influenza A was more prevalent than influenza B, with seasonal peaks typically occurring during the cooler months. The reason for this surge in cases may be the lack of timely availability of the vaccines.²⁶

A descriptive study conducted at Hamad Medical Corporation, Qatar, between 2012 and 2013 identified, tracked, and analyzed communicable diseases in a hospital setting. Among the 1065 cases, 20.3% were Qatari nationals, of whom 120 had an ILI.²⁷

Current vaccination landscape in Qatar

Vaccination coverage serves as a key indicator of public health status in a country or a region, reflecting the reach and effectiveness of its healthcare services. WHO has set a benchmark for influenza immunization, aiming for vaccination coverage rates to exceed 75% of the overall population to ensure robust herd immunity and reduce disease burden.²⁸ Qatar maintains a comprehensive policy for seasonal influenza vaccination, fully aligning with WHO recommendations. The Ministry of Public Health (MOPH) and the national immunization committee recommend annual influenza vaccination for all residents aged 6 months and older, with a strong focus on high-risk groups such as the elderly, individuals with chronic medical conditions, pregnant women, and healthcare workers.^29–31 Seasonal influenza vaccines are free of charge and are readily available at PHCC centers, hospitals, and through annual nationwide vaccination campaigns targeting both the general and high-risk population.

A cross-sectional descriptive study (2018–2019) was conducted in PHCC to understand the vaccine uptake during the influenza season (N = 998 ILI cases, among which 49.7% were influenza-positive). Of the influenza-positive cases, 87% were not vaccinated. Around half (46%) of individuals belonged to the 15 to 50 y age group. Vaccine uptake was comparable among females (50.5%) and males (49.5%). Among those who received the influenza vaccine, 52.3% belonged to high-risk groups, whereas vaccine uptake among pediatric patients under five y of age was only 14.7%. Only 2.6% of pregnant women were vaccinated during the study period. During a similar timeframe, vaccination in individuals with diabetes was reported to be 21.3%. Influenza vaccine uptake among PHCC healthcare staff was only 23%, attributed to personal perceptions of vaccine effectiveness.²⁵

To improve influenza vaccination among health care workers (HCW) in Qatar, a vaccination campaign was conducted in November 2015 (N = 4,700). A total of 77% of the target population received the influenza vaccine in 2015. However, 9% declined vaccination, and 14% were either on leave or had previously been vaccinated. Remarkably, vaccine uptake was highest among aides (98.1%), followed by technicians (95.2%), physicians (84%), and pharmacists (73.2%). Of those who declined vaccination, 34% provided no reason, 18% cited behavioral concerns, and 21% declined due to medical reasons.³² In another study, conducted between 2020 and 2024 (N = 7,463), the vaccination rate reduced further as only 65.2% of HCWs received the influenza vaccine, which could be due to reduced perception of influenza severity post COVID-19.³³

Similarly, several influenza vaccination campaigns were conducted between 2013 and 2015 influenza season seasons in Qatar. The campaign team promoted and educated the HCWs about vaccination and its benefits through access campaigns featuring an outreach at 90+ vaccination centers, mobile vaccination teams, educational events, and reminders for healthcare staff and real-time campaign monitoring. Despite these, the survey reports highlight suboptimal uptake of the influenza vaccine of 37.2% to 64.3% from 2013/14 to 2014/15.²⁹ PHCC staff vaccination coverage improved marginally in 2024 to 65.2%.³³ Currently, the efforts by MOPH in Qatar include the availability of vaccines in 90 healthcare locations, including 31 PHCC health centers, HMC outpatient clinics, and more than 45 semi-governmental and private hospitals and clinics, aiming to improve vaccination coverage.³⁴

Aziz et al conducted a cross-sectional questionnaire-based survey in 2021, which included 450 HCW. A total of 96.3% of participants reported having received an influenza vaccination at least once in the past, while 73.7% were vaccinated during the most recent season. Vaccination rates were higher among physicians aged 45 and older, with a 100% uptake among those aged 65 and above. This age-related difference was statistically significant (p = .004). Also, statistically significant associations were observed with gender and work experience. Male physicians reported a higher vaccine uptake (82.1). Similarly, those with 11 or more years of experience in primary healthcare showed an elevated rate of vaccine uptake (86.8%). These findings suggest that professional longevity and gender may play meaningful roles in vaccine acceptance among medical personnel.³⁰

Although the MOPH in Qatar recommends that pregnant women receive a single dose of the influenza vaccine during any trimester, a 2022 study reported that vaccine uptake among pregnant women was only 11%.³⁵ This study reveals a significant lack of educational initiatives, prescription practices, and documentation regarding concerns about influenza vaccination among pregnant women within antenatal clinics, as managed by healthcare professionals.³⁵ Coverage among young, healthy children remains lower than anticipated, despite the flexibility to receive the vaccine year-round, beyond routine appointments.^36,37

Challenges for influenza vaccination in Qatar

Influenza vaccination coverage in Qatar, while supported by annual nationwide campaigns and free vaccine access, continues to face substantial challenges at both the population and health system levels. Understanding and addressing these obstacles is essential for advancing vaccine uptake and mitigating the impact of seasonal influenza, especially among high-risk groups.

Vaccine hesitancy and perceptual barriers

According to the results of a 2021 questionnaire-based survey among HCWs in Qatar, the most commonly reported barrier to influenza vaccination was the belief that one could get the infection even after being vaccinated, which was cited by 92.6% of respondents. Additionally, 29.5% reported experiencing adverse events from previous influenza vaccinations, contributing to hesitancy.³⁰

A study (2020–2024) assessed the vaccination status of HCWs at the PHCC for seasonal influenza in Qatar among Qatari versus non-Qatari population, revealing non-Qataris had higher uptake of 54.31% for influenza than Qatari population (10.89%). For seasonal influenza vaccination among healthcare workers in the PHCC, age ≥50 was significantly associated with higher odds of vaccination (aOR = 1.52, 95% CI: 1.24–1.86, p = .001). Additionally, non-Qatari nationality (aOR = 1.38, p = .001) and fewer years of service (aOR = 1.35, p = .001) were significantly associated with higher vaccine uptake. The difference in the vaccination uptake may be due to institutional mandates and global trends in HCW behavior, such as trust in vaccine efficacy, and diminished concerns about adverse events which contribute to higher acceptance.³³

Knowledge gaps and lack of awareness about the high-risk categories

A cross-sectional study was conducted to understand physician’s knowledge, attitude, and practices concerning influenza vaccination among high-risk patients in the MENA region, which included Qatar. Half of the physicians had knowledge about influenza vaccination; however, only 25.4% of the physicians practiced offering influenza vaccines to their patients. Several identified barriers were unawareness about vaccine availability (32%), and operational challenges like forgetfulness (23.4%), patient reluctance (9.7%), distrust in the efficacy of the vaccine (9.3%), and fear or history of adverse events (19.7% and 9.3%).³⁸

Logistical and sociocultural factors

Experts mentioned that there is a limited reach in schools and other educational institutions with vaccination programs and this precludes from achieving the global VCR target of over 75% for healthy children and breaking transmission chains. There is a lack of Qatarspecific studies; however, regional and international studies have seen similar barriers, a few of which are summarized below.

An infodemic, significantly amplified by the pervasive influence of social media in everyday life, contributed to widespread misinformation and confusion. A quantitative study analyzed 4,511 anti-vaccination tweets posted from the UK, of which 334 tweets were anti-vaccination-based, which were not scientific and factual, but based on personal beliefs and experiences.¹⁹

A survey-based study from Jordan summarized knowledge, attitude, and perceptions in parents (N = 477) concerning childhood influenza vaccination. Vaccine uptake rate was 12.0% and parents expressed hesitancy due to concerns about vaccine safety. However, 21.8% of parents reported increased motivation to vaccinate their children when recommended by the health care provider. The availability of free vaccination through various programs increased the willingness to vaccinate from 5.6% to 27.4%.³⁹ Though not a major issue in Qatar, logistics hindrances like the unavailability of the vaccine in some areas remain a challenge. As vaccination is recommended prior to the start of the influenza season, a delay in availability due to logistical reasons may result in a decrease in vaccination rate.^40,41

Expert recommended strategies to improve vaccination uptake in Qatar

Enhancing influenza vaccination coverage in Qatar requires a multi-pronged, evidence-driven approach, tailored to national epidemiology, healthcare infrastructure, and sociocultural dynamics. Drawing from the latest research and best practices, the experts recommended the following strategies to address persistent barriers and maximize public health benefits.

Empowering health care professionals

Healthcare professionals (HCPs), due to their direct exposure to pathogens and contact with at-risk populations, play a pivotal role in vaccination delivery and public trust. Empowering HCPs from Qatar by addressing barriers such as getting infected even if vaccinated and fear of adverse events is key to tackling hesitancy.³⁰ Nearly 95% of primary HCPs from Qatar strongly agreed that vaccination reduced disease burden;³⁰ however, influenza vaccination uptake among PHCC staff was at 65.2% for the year 2020–2024 indicating a gap between perceived benefits and practice.³³ An increase in the rate of vaccine uptake among HCPs will enable them to convey evidence-based message on vaccination and positively empower HCPs to recommend, prescribe, and administer vaccines to their patients. Targeted, evidence-based strategies, including educational programs, automated reminder systems into in electronic health care systems, enhanced vaccine accessibility, incentive-based initiatives, real-time feedback loops, and supportive health policies, are essential for improving vaccine acceptance and strengthening overall immunization coverage.⁴² Key interventions help bridge gaps between knowledge and practice while enhancing workforce resilience to influenza. An early implementation through a tailored toolbox enhancing clinical training for physicians, nurses, midwives, and pharmacists can support sustained program performance, improve vaccine advocacy, and public health protection.⁴³ A study surveyed 88 nurses’ knowledge, attitudes, and practices regarding influenza vaccination for pregnant women in 2023–2024 in Iraq. Most nurses showed adequate knowledge and positive attitudes toward vaccination, though many lacked awareness of influenza’s impact on newborns. While 51.1% recognized the vaccine’s role in protecting pregnant women, the findings highlight the need for targeted educational interventions to strengthen nurses’ understanding and improve maternal vaccination rate.⁴⁴ Additionally, empowering nurses to vaccinate in both schools and primary care settings minimizes appointment durations and enhances accessibility. While community pharmacies may play a role in the future, experts noted that logistical constraints make their immediate use challenging in Qatar.

Though influenza vaccination is not mandatory for HCWs in Qatar, the PHCC in Qatar provides complimentary influenza vaccines to all PHCC staff members and high-risk patient groups.³⁰ A mandatory immunization program against influenza may help to raise the vaccination rate among HCWs in Qatar. This will help achieve herd immunity and reduce the risk of transmission of influenza to patient population from unvaccinated HCWs.⁴⁵ The vaccine mandates may require assessing the cultural, ethical, and legal obligations in the regional context.⁴⁵

Harnessing data from primary healthcare centers

Due to its warm climate, Qatar experiences influenza activity throughout the year, necessitating continuous surveillance to characterize virus circulation and guide vaccination strategies.²³ Harnessing data from primary healthcare centers and implementing yearly flu testing will help enhance influenza surveillance in Qatar.^32,46 In particular the opening of schools after the summer vacation is a time when new strains of influenza enter the country and increase in circulation.

Research from Qatar has reported widespread viral influenza circulation.²⁶ Maintaining real-time vaccination coverage monitoring systems to detect gaps, inform targeted outreach, and evaluate the effectiveness of immunization campaigns is critical. Leveraging AI for timely identification and management of infectious disease outbreaks could help strengthening influenza disease surveillance to enable swift, proactive interventions that protect public health.^47–49

Quality improvement methodologies need to be adopted to reduce missed opportunities for vaccination to improve health outcomes. Implementing quality improvement measures at clinical and institutional levels based on the findings of regular audit of missed opportunities will also benefit in increasing vaccination coverage.⁵⁰

A robust influenza strategy must align financial investments with meaningful health outcomes. Experts opined that with thoughtful planning and prioritization, Qatar can reduce morbidity and mortality rates while maintaining cost-effectiveness and that return on investment will be evident not just in reduced disease burden, but in long-term gains to public health resilience.

Robust public education and communication

Effective public communication and awareness, particularly about newer subtypes (A(H1N1)pdm09 and A(H3N2))⁵¹ of influenza virus that could differ from season to season, can encourage vaccine uptake by individuals, specifically, high-risk groups such as the elderly, individuals with chronic medical conditions, pregnant women, and healthcare workers for protection from current health risks.⁵² To ensure wide-reaching impact across Qatar’s diverse communities, educational campaigns should be made multi-faceted, culturally sensitive, and linguistically inclusive. Numerous strategies to achieve these include the creation of accurate content that helps distinguish facts from myths and cultural misconceptions. Leveraging timely multichannel communication to counter misinformation, provision of clear, evidencebased information in appropriate languages to include the diverse ethnicities residing in Qatar.⁵³ Similarly, roadshows, campaigns, and educational kiosks featuring interactive exhibits and community engagement, such as interactive question-and-answer sessions, can help clarify doubts about vaccination, including its efficacy, impact, and protective benefits for healthy individuals, thereby improving herd immunity.^54,55

Expand access to vaccination through outreach programs, education institutions, healthcare workers

To maximize public health impact in Qatar, access to influenza vaccination can be expanded by leveraging coordinated outreach programs, active involvement of various education institutions, and mobilizing healthcare workers. Over the years, Qatar has witnessed an expansion of seasonal influenza vaccination program. During the year 2021, free seasonal influenza vaccines had been offered at all PHCC centers, HMC outpatient clinics, and over 45 private and semi-private clinics and hospitals throughout Qatar.⁵⁶ In the year 2025, free influenza vaccines were provided at over 103 healthcare facilities, including 31 PHCC centers, 57 private sector facilities encompassing major hospitals, and 15 semi-governmental facilities such as Qatar Energy and Qatar Red Crescent.⁵⁷

The experts emphasized prioritizing high-risk populations, and school-aged children through targeted outreach activities and public awareness campaigns. Educational institutions play a vital role in organizing vaccination drives and educating students, staff, and families about the importance of immunization. Annual school-based immunization programs using the LAIV, which allows needle-free administration, are an effective way to reach children who are major drivers of household and community transmission. Initiating a phased rollout that starts with younger children, supported by trained nursing staff, increases efficiency and long-term vaccine adoption. The engagement of healthcare workers, who serve as a trusted source of information, in educational activities addresses vaccine hesitancy and supports long-term vaccine uptake. Community vaccination drives are a strategic way forward to engage, motivate, and build trust by tailoring messages as per the needs of the target audience.⁵⁸ The recent initiation of two targeted school-based campaigns (Human Papillomavirus (HPV) and Tetanus, Diphtheria, and Pertussis (TDP) vaccinations) represents a strategic move toward integrating immunization within educational settings.

Mobile clinics act as an effective tool for advancing Universal Health Coverage by ensuring equitable access to essential health services.^42,59 Expanding mobile vaccination clinics in underserved areas and remote communities in Qatar will help to overcome geographic and logistical barriers.

Vaccine procurement and distribution with Qatar’s seasonal vaccination period

Strategically aligning vaccine procurement and distribution with Qatar’s seasonal vaccination period (September to March) will ensure timely access.²⁵ However, experts noted that with year-round case detection, policymakers should consider extending the vaccination timeline or initiating it earlier. This flexible approach will allow for more adaptive protection in response to fluctuating case patterns.

Live attenuated influenza vaccine: distinctions and potential for expanding coverage

LAIV is a nasal spray, containing live attenuated influenza viruses that replicate in the nasal cavity and induce a mucosal, cellular, and systemic immune response resembling natural immunity. Importantly, this increased the immune response in both the upper and lower airways, reducing person-to-person spread of the virus. This feature sets LAIV apart from conventional inactivated influenza vaccines (IIV), which contain inactivated components, induce little mucosal immunity, and are delivered by intramuscular injection.⁶⁰ The LAIV viruses are designed to replicate only at the cooler temperatures of the upper respiratory tract (approximately 33°C) and are unable to replicate in the warmer environment of the lower respiratory tract (>33°C), thereby enhancing safety.¹⁵ Studies have demonstrated that school-based programs utilizing LAIV substantially increased influenza vaccination coverage in children and conferred herd protection benefits, reducing influenza-associated illness rates not only in vaccinees but also in unvaccinated peers and older adults.^61,62

Belshe et al presented findings from a randomized controlled trial (N = 8352), a 54.4% reduction in culture-confirmed influenza cases was observed among children who received LAIV compared to those who received the inactivated vaccine (IIV), with 153 cases versus 338 cases, respectively (p < .001). Notably, the LAIV demonstrated superior efficacy against both well-matched and antigenically drifted viral strains.⁶³

Recent studies indicate that LAIV’s effectiveness in children is comparable to IIV. A 2022/23 multi-country analysis found LAIV4 (quadrivalent) vaccine effectiveness at 75.7% (95% CI: 52.0–87.7), slightly higher than IIV4 at 58.5% (95% CI: 38.2–72.1), with both providing substantial protection in children.⁶⁴ A 2024 Italian cohort analysis also reported moderate and similar effectiveness in preventing laboratory-confirmed influenza in children: 43% for LAIV-4 and 54% for IIV, relative to unvaccinated controls, supporting the ongoing inclusion of LAIV as an important option for pediatric vaccination.^65,66

Though LAIV is not recommended as the first-line vaccine for adults aged > 65 y and in immunocompromised patients, or pregnant women, due to its live viral content (Figure 1), it offers multiple advantages over conventional inactivated vaccines, particularly in the pediatric population, who are the primary vectors for transmitting the virus within the household and the broader community. Its immunogenic profile, ease of delivery, and demonstrated efficacy support its ongoing inclusion as a strategic tool to enhance influenza prevention efforts, especially in school-aged children in Qatar. By facilitating large-scale, needle-free administration in schools, LAIV has the potential to improve coverage rates and interrupt transmission chains, providing enhanced community protection, and supporting national public health goals. In the context of given population structure of Qatar, where the majority of population is young, and <2% are aged > 65 y,⁵⁶ the use of LAIV is favorable. Thus, the advantages cited for LAIV make it an attractive option to prevent seasonal influenza.

Figure 1.

Pros and cons of nasal influenza vaccines.⁶⁶

To strengthen the LAIV vaccination strategies in Qatar, the experts recommend the use of a comprehensive LAIV eligibility checklist (Figure 2). This checklist can help guide the HCPs in systematically assessing suitability for LAIV administration by clearly outlining the indications and contraindications relevant to this vaccine type. This strategy ensures patient safety and has the potential to optimize vaccine uptake by addressing exclusions for populations with a history of severe allergic reactions, immunocompromised status, close contact with severely immunosuppressed individuals, and severe asthma during pregnancy. Displaying this checklist at all vaccination centers across Qatar will empower HCPs to adhere to best practices and promote consistent, safe administration of LAIV as part of the national immunization influenza program.

Figure 2.

LAIV eligibility checklist for use by HCPs.

Conclusion

Despite annual national campaigns and improved vaccine access, influenza vaccination uptake in Qatar remains suboptimal. Key barriers include limited data collection, delays in vaccine procurement and distribution, low public awareness, insufficient training, and education of HCPs, lack of targeted outreach, and concerns around cost-effectiveness. These gaps contribute to low coverage rates, particularly among healthy children and adult groups that play a critical role in community transmission. Experts emphasize the need for clear and consistent public communication, HCP empowerment, and expanded access to both LAIV and IIV, with timely availability being crucial. LAIV, in particular, offers several advantages as it is needle-free, which may reduce vaccine hesitancy; it mimics natural infection more closely, stimulating a robust mucosal and systemic immune response; and it is administered intranasally, which can simplify logistics and improve compliance. However, the use of LAIV is not recommended in adults aged 65 y and above. Strengthening surveillance systems and investing in local research are essential to guide policy decisions. Effective implementation of these strategies, informed by ongoing surveillance and local research, is essential to not only to reduce the burden of seasonal influenza but to also to enhance the year-round coverage in Qatar.

Biography

Muna Al-Maslamani is a distinguished leader in the field of healthcare, renowned for her profound expertise in Transplant Infectious Diseases. She currently serves as Assistant Head of the Infectious Diseases Division and Senior Consultant at Hamad Medical Corporation (HMC). With a career marked by excellence in clinical practice, public health policy, and medical education, Dr. Al Maslamani has played a pivotal role in elevating healthcare standards both nationally and across the region. Her commitment to advancing medical knowledge is further demonstrated by her prolific research contributions, with 238 publications and numerous collaborations with international researchers. Dr. Al Maslamani’s leadership continues to shape the future of infectious disease care and healthcare innovation in Qatar and beyond.

Funding Statement

The Influenza Annual Body Meeting and the medical writing assistance for this manuscript were funded by AstraZeneca FZ LLC.

Disclosure statement

Muna Al-Maslamani, Khalid El Awad, Eman Al Maslamani, Mohammed Alkuwari, Salah Al Awaidy, Peter V Coyle, Manasik Hassan, Hayat S Khogali, Samina Hasnain, Hadi M Yassine, Ahmed Abushahin have no conflict of interest to declare. George Kassianos has received honoraria for participating in meetings, research activities, and for chairing or lecturing at events organized by Sanofi, CSL Seqirus, Pfizer, GSK, AstraZeneca, Valneva, Takeda, Novavax, BioNTech, Moderna, and Viatris.

Data availability statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.