Vaccination is recognised as one of the most effective ways to combat seasonal influenza—a disease that exerts significant social and economic costs, yet is often neglected by policy-makers and the vaccine target population in developing countries. The situation in China is no exception with seasonal influenza vaccine remaining as a class II vaccine and being financed by citizens’ out-of-pocket payments. The different cultural backgrounds, climate patterns and living standards across China further complicate the policymaking process of developing national level policy guidelines. Nevertheless, China’s recent health care reform that focuses on preventive care, elderly care and equitable health care access has motivated policy-makers at the local level to formulate policies facilitating seasonal influenza vaccination provision. This article seeks to understand this process at the city level under China’s current economic transition background, and aims to identify policy experiences that may be applicable for the larger Asia-Pacific region.