AMRO and WPRO have increased the per capita number of doses distributed since 2008 as seen in Fig. 2 and Fig. 4. Surprisingly, Hong Kong was one of the few states in WPRO to have decreased per capita distribution between 2008 and 2011, by 23%. EURO has seen a 29% decrease

in numbers of doses distributed since 2008. In all, 56% of countries in EURO had lower per capita distribution rates in 2011 than in 2008 as seen in Fig. 3. The decline in distribution in EURO requires particular attention in light of the EU Council recommendations and its sharp contrasts with the trends in AMRO and WPRO. However, it should be noted that the IFPMA IVS data may not accurately represent dose distribution in some countries of some WHO regions, as non-IVS members may supply the bulk

of vaccine in some large countries [10]. This is likely the case in India where the IFPMA IVS doses distributed were 1.1 doses per 1000 population Bortezomib in vivo in 2011. On the other hand, the IFPMA IVS data for EURO should represent the totality of doses distributed, as all doses are sourced from IFPMA IVS members [11]. As observed in the previous survey [8], percent rate of change this website in distribution of doses per 1000 population is not correlated with country income. To increase the relevance of this information, IFPMA IVS intends to collect additional data on a range of vaccination uptake factors from a sub-group of countries to identify sharp increases and decreases in distribution rates and improves vaccination coverage Parvulin measures that can improve vaccination uptake. These data may contribute to a better understanding of the enablers of seasonal influenza vaccination by region or by country. Interviews will be conducted to assess whether factors such as recommendations,

reimbursement policies, and communication played a role in driving immunization in a selection of these countries, as suggested in the previous IFPMA IVS survey [8]. In the US, where immunization recommendations originate from consultations with a broad array of stakeholders, including medical/pediatric associations, NGOs, and the vaccine industry, it is believed that community involvement may act as a driver for vaccination coverage. Furthermore, pragmatic recommendations, such as the Advisory Committee on Immunization Practices (ACIP) recommendation for routine use in all age groups, since 2010 [12], and the department of Health and Human Services’ ambitious objectives of 80%–90% coverage rate in various groups [13], are likely to enhance VCR. The previous survey [8] showed little correlation between country wealth and dose distribution. We repeated the same analysis for the current survey results and found that GNI did not correlate with dose distribution. Few countries had important proportional decreases in dose distribution/1000 pop.