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Article History

Received: 31 July 2025

Accepted: 15 May 2026

First Online: 1 June 2026

Declarations

Ethics approval and consent to participate: This work was conducted as a public health program evaluation and health systems analysis, drawing on publicly available and secondary data sources and structured consultations with professionals engaged in influenza vaccination programs in their institutional or technical roles. In accordance with standard definitions of human subjects research, this activity did not involve the collection of data about identifiable individuals or private information and therefore did not meet the criteria for human subjects research. As such, institutional review board or research ethics committee approval was not required. No personal, sensitive, or identifiable information was collected, recorded, or included in this study. Stakeholder consultations were conducted solely to obtain expert perspectives on programmatic and policy considerations rather than personal experiences. Participation in consultations was voluntary. Verbal informed consent was obtained from all participants prior to each consultation using a standardized script. Participants were informed of the purpose of the activity, how the information would be used, and their rights to decline participation, withdraw at any time, or refrain from answering specific questions. To ensure confidentiality and data protection, no names or direct identifiers were recorded, and all findings are presented in aggregate, non-attributable form. Notes from consultations were securely stored and accessible only to the study team. The project adhered to established ethical principles, including respect for persons, voluntary participation, minimization of risk, and protection of confidentiality.

Consent for publication: Not applicable.

Competing interests: N.B. has been employed by Pfizer since January 2025, after the completion of his contributions to this study. J.T. was employed by Manatt Health, from February 2023 to June 2025, following his work on the study, during which time he provided consulting services to Regeneron, J&J, Gilead, and Denali. The following authors do not have any competing interests to disclose: A.M., A.T., B.M., C.H., D.C., K.H., M.D., M.E., M.Mal., M.Maz., T.S., V.U., S.K.