In 1980, the Public Health Service established an objective of immunizing 60% of high-risk persons with influenza vaccine annually by the year 1990. As no more than 32% of high-risk persons currently receive influenza vaccine each year, the Health Care Financing Administration (HCFA) has undertaken an influenza vaccination demonstration project for Medicare enrollees. Federally purchased vaccine is being distributed to physicians, health departments, hospitals, nursing homes and health maintenance organizations (HMOs). If the project is cost-effective, Congress has authorized HCFA reimbursement for influenza vaccination. Changing reimbursement policy alone, however, is unlikely to substantially improve influenza vaccine delivery; HCFA reimbursement for pneumococcal immunization since 1981 has not increased the use of pneumococcal vaccine. In contrast, federal purchase and distribution of vaccines to state and local health departments has helped maintain the remarkable success of childhood immunization programs. In addition, in Canada, provincial health departments purchase more than 80% of all influenza vaccine distributed, and from 1980 through 1988, per capita vaccine distribution increased 140%. These experiences suggest the need for an expanded policy goal for the influenza vaccination demonstration project that includes federal purchase and distribution of influenza vaccine. This approach, together with a change in reimbursement policy, offers greater promise for achieving our nation's objective for influenza vaccination.