Characterization of influenza vaccination recommendation across spatial scales in the United States

The US public health system is organized in 3 levels: national, state-level, and county-level. Public health messaging both within and across these scales may not always be consistent, and for transmissible public health threats where cases in one spatial location may impact other areas, this lack of consistency could create problems. Here, we collected and analyzed data on influenza vaccination recommendations across public health administration levels. We assess spatial heterogeneity at the county level, and analyze consistency in recommendations across spatial scales. We also compare information accessibility with influenza vaccine affordability and availability to identify factors that may be most related to vaccine uptake. We find that influenza vaccine recommendations are highly variable in both their priority group specificity and in their ease of access, and there is poor agreement across spatial scales. This lack of consistency results in a lack of clear relationship between vaccination information and vaccine uptake. This work highlights the need for greater consistency in specific, easily accessed public health information from trusted sources.