Since the past decade influenza vaccination is becoming an increasingly important aspect of public health programs. In the early 1990s independent investigators began to gather information on the comparative use of influenza vaccine in developed countries. The annual level of influenza vaccine distributed in each country was calculated as the number of doses distributed per 1000 total resident population. During the first period of research in 18 developed countries influenza vaccine was widely underused. From 1980 to 1992 the annual vaccination rates increased in most of the 18 countries. But Austria (Switzerland and Finland) showed little change (20 doses/1000 in 1982 and 23 doses in 1992). When in 1992-1995 four new countries were included, doses increased slightly in Austria, too, to about 52 doses/1000 in 1995, but the country still belonged to the low-use countries compared to Spain 160 doses/1000, although vaccination was recommended for all elderly people <65 years and persons with high-risk medical conditions. Self-payment was usual, and there was no reimbursement within the national or social health insurance schemes. From 1996 (77 doses/1000), to 2000 (118 doses/1000) and 2003 (127 doses/1000), vaccination increased slightly, but Austria remained one of the lowest three Western European countries reported, together with Sweden (127) and Norway (102). Possible reasons for the low usage in Austria may be the following: people mistake influenza for an influenza-like illness, a lack of effective social marketing, costs are not taken over by social or private insurance and discordance in the Austrian medical fraternity about the importance of vaccination. Especially in view of a possible new influenza pandemic, public awareness of the importance of vaccination must increase.