Civil Society in Decision Making for Immunization Policies: the example of National

Immunization Technical Advisory Groups (NITAGs)

Center for Vaccine Ethics and PolicyGlobal Vaccines 202X: Access, Equity,

Ethics Philadelphia, USA, 3rd May 2011

About the SIVAC Initiative

• The SIVAC Initiative assists in the establishment or strengthening of functional, sustainable National Immunization Technical Advisory Groups (NITAGs) in GAVI-eligible and middle-income countries.  

• The aim is to enhance the use of evidence-based decision making in the development of immunization programs and policies.  

• SIVAC provides support in the form of technical assistance, briefings, tools development, and information sharing.

• SIVAC is a program of the Agence de Médecine Préventive (AMP), an intrenational non-profit organization that links and mobilizes resources to address the needs of developing countries in the area of infectious diseases.

• SIVAC is funded by a generous grant form the Bill & Melinda Gates Foundation

About the SIVAC Initiative

• SIVAC Initiative's major activities are:

• To establish partnerships within the immunization community to support NITAGs’ activities

• To assist in the creation of new NITAGs• To strengthen existing NITAGs• To support a regional approach to generalize the

establishment of NITAGs in West Africa• Knowledge sharing (including the NITAG Resource

Center)

New context for immunization

• New and complex context for Immunization• New vaccines, new compositions, new presentations, and new

indications and …Future vaccines

• Diversity of vaccine providers with lower price

• But…

• Multiple health priorities, limited human resources and logistical capacities

• Expensive vaccines with limited funds available

• An expressed need for National adaptation of Global and Regional recommendations to take into consideration local realities

New context for immunization

• But…

• Immunization and Vaccines outside from EPI: Absence of recommendations for some groups such as persons consulting the private health sector, military personnel, workers, tourists, school children, adolescents…

• Limited mandate of Inter-agency Coordinating Committees (ICCs) - Focus on EPI- Mostly In GAVI eligible countries only- Primarily operational coordination mainly on resources (proposals,

annual progress reports, annual work plans…)- Some ICCs have technical sub-committees

A global recommendation to establish NITAGs

• WHO-UNICEF Global Immunization Vision & Strategy GIVS 2006-2015

• Numerous successful existing national independent committees

• Thailand, China, Sri Lanka, USA, Canada, Australia, South Africa, UK, France, Brazil…

• WHA 61.15 (2008), “WHA requests the DG to…strengthen national capacity for making evidence-based policy decisions to adopt new vaccines”

• WHO SAGE Recommendations,

• Specific WHO Regional Offices recommendations (16th WHO AFRO TFI, WHO SEARO, WPRO, EMRO, EURO)

About the NITAGs

SAGE

TECHNICAL ADVISORY FINANCIAL AND OPERATIONNAL

REGIONAL COMMITEE

?

GAVI BOARD

REGIONAL ICC

ICC

MoH & MINFIMoH

About the NITAGs

• What is the role of a National Immunization Technical Advisory Group (NITAG)?

• Guide policy makers and program managers to make evidence-based immunization related policy decisions

• To provide some technical recommendations for all vaccine preventable diseases to National authorities

• This is NOT serving as an implementing, coordinating or regulatory body

• Only the National authorities are making the final decision.

About the NITAGs

About the NITAGs

• What are the areas covered?

• Vaccine quality and safety,• Immunization policy and strategies (EPI and outside EPI)• Introduction of new vaccines and immunization technologies• Maintaining a high routine immunization coverage• Promoting national vaccine security in procurement• Guiding national authorities on the public health needs for new

and emerging vaccine-preventable diseases.

= all the topics in the Immunization and Vaccines areas for which MoH needs technical and scientific advices.

About the NITAGs

• Why having national experts from the Civil Society?

• Ensuring a proper dissemination• Ensuring sustainability• Empower national authorities• Ensure a comprehensive and integrated approach• Create a neutral forum• Ensure the credibility of decision making process• Help resist pressure form interest groups

• Representing a broad range of disciplines• Senior pediatricians, epidemiologists, public health experts, health

economists, vaccinology experts, social scientists etc.

• Ex-officio (not voting) : MoH different division• Liaison members (not voting) : WHO, UNICEF, NGOs…

Challenges for a NITAG

• “Independent expertise"• Transparency of the process• Quality of the recommendations (evidence-

based, experts)• Human resources (experts and the executive

secretariat)

• Recognition from the MoH (endorsement of the recommendations…)

• Recognition from the global Immunization community of the NITAG (WHO, Unicef, NGOs, Funders…)

What is expected to be in place in 202X?

• Countries are able to make their own decisions regarding Immunization policies through Efficient and Sustainable NITAGs

• Where expertise is available

• Where National Authorities are supportive to independent process for decision making (strong Civil Society, democratic models)

• Strong Technical Partnerships

• Between NITAGs and between NITAGs and the Global Immunization Community

• To ensure that recommendations are evidence-based

What is expected to be in place in 202X?

• Strong collaboration between SAGE, RTAGs and NITAGs

• NITAGs activities have

• Shaped the National Research agenda

• Strengthened the need for Evidence based decision making in Health Area

• Advocated the need for the increase of National Spending for Immunization

Websites and Contacts

NITAG Resource Centerhttp://www.nitag-resource.org/

SIVAC Initiativehttp://www.sivacinitiative.org/

AMPhttp://www.aamp.org

Contact us:

Dr Kamel Senouci, Director SIVAC Initiative ksenouci@aamp.org