Recommendations for seasonal influenza vaccination are standard in most developed countries. Many rapidly developing countries have recently begun to adopt recommendations for high-risk target groups, such as the elderly. Population-based surveys to determine use, rather than purchases, of seasonal influenza vaccine are rare outside North America and Western Europe. Such surveys can provide important information on the progress of national immunization programs and on the awareness of influenza among the general public. We report the results of a survey conducted in 10 countries in Africa, Asia Pacific, Eastern Europe, Latin America and the Middle East that aimed to determine influenza vaccination coverage among adults, the elderly, and children and to find out how influenza is perceived in these regions. Seasonal influenza vaccine coverage varied markedly across countries, and no single factor guaranteed high coverage. Our results indicate that strong recommendations appear insufficient, and that fully funded immunization programs together with high awareness in the population are key to encouraging high influenza vaccination coverage.