Table 2.

Challenges noted by partner country points of contact in developing sustained seasonal influenza vaccine programs.

Challenge type	Specific challenge
Lack of documentation of value of vaccination	Limited or uncertain disease burden / value of vaccination Limited data on risk groups Concerns about vaccine effectiveness in potential target groups
Vaccine safety	Concerns about use in pregnant women
Stakeholder/policy makers need education	Need for stakeholder communication materials Negative experience with 2009 pandemic vaccines
Unprepared regulatory landscape for influenza vaccines	Few or no influenza vaccines currently approved NRAs lack experience with influenza vaccines
Lack of national influenza vaccination policy	Inexperienced NITAGs Lack of sufficient local subject matter expertise
Poor program readiness	Lack of existing programs accessing SAGE-recommended target groups Lack of distribution plan Limited cold chain capacity to accommodate seasonal bolus of vaccine doses
Product issues	Concerns regarding short product expiry dates, especially in countries with year-round disease
Costs	Costs of vaccine Cost-effectiveness of vaccination programs