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Evans-Gilbert T, Figueroa JP, Bonvehí P, Melgar M, Stecher D, Kfouri R, Munoz G, Bansie R, Valenzuela R, Verne E, Salas D, Jennifer Sanwogou N. Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean. Vaccine 2024; 42:2310-2316. [PMID: 38438288 DOI: 10.1016/j.vaccine.2024.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.
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Affiliation(s)
- Tracy Evans-Gilbert
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica.
| | - J Peter Figueroa
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston, Jamaica.
| | - Pablo Bonvehí
- Center for Medical Education and Clinical Research, Av. Las Heras 2929, 1425 Buenos Aires, Argentina.
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala 01011, Guatemala.
| | - Daniel Stecher
- Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121 ABG Buenos Aires, Argentina.
| | - Renato Kfouri
- Immunization Department, Brasilian Society of Pediatrics, R. Santa Clara, 292 - Copacabana, Rio de Janeiro, RJ 22041-012, Brazil.
| | - Greta Munoz
- Hospital Pediátrico Baca Ortiz, S/N y D.M., Avenida 6 de Diciembre & Av. Cristóbal Colón, Quito, Ecuador.
| | - Rakesh Bansie
- Academic Hospital Paramaribo, RRP8+PQ7, Flustraat, Paramaribo, Suriname.
| | | | - Eduardo Verne
- Hospital Nacional Cayetano Heredia, Av. Honorio Delgado 262, San Martín de Porres 15102, Peru.
| | - Daniel Salas
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
| | - N Jennifer Sanwogou
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
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Etapelong Sume G, Quamrul H, Md S, Kissa J, Hutin Y. National immunization technical advisory groups (NITAGs) in the WHO Eastern Mediterranean Region (EMR): A decade of shaping immunization policies, 2010-2021. Vaccine 2024; 42:629-635. [PMID: 38143199 PMCID: PMC10850980 DOI: 10.1016/j.vaccine.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
In the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO), little is known on National Immunization Technical Advisory Groups' (NITAGs) outputs, including recommendations and their outcomes. We abstracted information from the WHO/UNICEF joint reporting forms and extracted implemented immunization policy decisions from the WHO immunization portal. We describe trends in establishments and functionality of NITAGs and immunization policies implemented in EMR from 2010 to 2021. In 2013, all 22 EMR countries had a NITAG, although only 20 remained active in 2021. The number of countries meeting six NITAG process indicators increased from 7 in 2010, to 14 in 2019, then reduced to 12 in 2021. In 2021, the proportion of countries with a functional NITAG decreased with income level, from 83% in high-income countries, to 55% in middle-income countries and 20% in low-income countries. From 2010 to 2021, there were 103 new vaccine introductions, 31 vaccine switches, and 28 schedule changes implemented across all 22 countries, irrespective of income groups. While NITAGs are established and making recommendations in countries, their functionality decreases with income level. Governments should continue to invest in NITAGs, including on strengthening processes and ensuring that recommendations made are based on evidence to decision frameworks.
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Affiliation(s)
- Gerald Etapelong Sume
- Immunization Vaccine Preventable Disease and Polio Transition Unit, Department of Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt.
| | - Hasan Quamrul
- Immunization Vaccine Preventable Disease and Polio Transition Unit, Department of Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt
| | - Sharifuzzaman Md
- Immunization Vaccine Preventable Disease and Polio Transition Unit, Department of Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt
| | - John Kissa
- Immunization Vaccine Preventable Disease and Polio Transition Unit, Department of Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt
| | - Yvan Hutin
- Department of Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt
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Soleimani N, Ghoshouni H, Mostafavi H, Modiri MH, Attar MHM, Mousavi SM. Addressing conflicts of interest regarding the vaccine in infectious disease outbreaks based on good governance for health approach: a policy brief. BMC Health Serv Res 2023; 23:1028. [PMID: 37749540 PMCID: PMC10521481 DOI: 10.1186/s12913-023-10020-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Infectious disease outbreaks pose a significant threat to public health, and achieving herd immunity highlights the importance of addressing conflicts of interest (COI) in vaccine development and policy-making. This policy brief aims to present policy options that address COI regarding vaccines in infectious disease outbreaks, based on good governance for health approach. METHODS Our study used a scoping review methodology. We conducted a systematic search, which led to identifying 43 eligible articles. A qualitative approach (i.e., content analysis) was employed for data analysis, using "ATLAS.ti 9" software. The primary results underwent a process of cleaning, categorisation, and subsequent discussion in three sessions with the research team. RESULTS Relationships between theindustry and "government/policymakers" as well as "academic institutions/researchers" are prominent origins of COI regarding the vaccine in infectious disease outbreaks. To address this issue, we present nine policy options that target both the root cause of the problem and the adoption of good governance for health approach. CONCLUSIONS The key principles of good governance for health, including, "Transparency", "The Rule of Law", "Effectiveness", "Efficiency", "Participation", "Consensus Orientation", "Equality", "Responsibility", "Responsiveness" and "Accountability" must be taken into account when formulating policy options to address COI regarding the vaccine in infectious disease outbreaks. The effectiveness of the policy options outlined in this policy brief should be assessed in practical contexts, as this evaluation may uncover the need for revisions.
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Affiliation(s)
- Nazanin Soleimani
- Health Management and Economics, School of Public Health, Health Policy and Management Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamed Ghoshouni
- Health policy Research center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hakimeh Mostafavi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Seyed Masood Mousavi
- Health Management and Economics, School of Public Health, Health Policy and Management Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Intusoma U, Thewamit R, Thamcharoenvipas T, Khantee P. Epidemiology and burden of Haemophilus influenzae disease in Thai children before implementation of the routine immunisation programme: A National Health Data Analysis. Trop Med Int Health 2022; 27:546-552. [PMID: 35477947 DOI: 10.1111/tmi.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To conduct the first pre-Haemophilus influenzae (Hi) type b (Hib) immunisation programme-based epidemiological study using national health data. METHODS We analysed National Health Security Office data, which cover 72% of the Thai population. The study population included children aged <18 years admitted for Hi disease from 2015 to 2019. Hi disease diagnosis and death were based on the International Statistical Classification of Diseases and Related Health Problems (10th revision) hospital discharge summary codes. We estimated the hospital cost per admission using diagnosis-related grouping with a global budget. RESULTS A total of 1125 children aged <18 years were admitted for Hi disease. During the 5-year-study, the annual incidence of Hi disease varied from 1.5 to 1.9 per 100,000 children, with an overall case fatality rate (CFR) of 2%. Pneumonia was the most common clinical form, followed by meningitis and sepsis. The incidence, clinical forms and severity of Hi disease were age specific. Infant CFR was higher than that of other age groups. The incidence of Hi disease in children aged <5 years was 4.9 per 100,000 (CFR = 2.0%). Sepsis was the primary cause of infant death, whereas pneumonia was the cause of death in children aged >5 years. The hospital cost ranged from 25,000 to 30,000 THB per admission. CONCLUSIONS This analysis provided epidemiological data of Hi in Thai children before the Hib routine immunisation programme. The incidence of Hi disease was lower than that previously speculated. Our results could facilitate an assessment of the impact of Hib immunisation programme in Thailand.
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Affiliation(s)
- Utcharee Intusoma
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rapeepat Thewamit
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Titaporn Thamcharoenvipas
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Puttichart Khantee
- Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Colson AR, Morton A, Årdal C, Chalkidou K, Davies SC, Garrison LP, Jit M, Laxminarayan R, Megiddo I, Morel C, Nonvignon J, Outterson K, Rex JH, Sarker AR, Sculpher M, Woods B, Xiao Y. Antimicrobial Resistance: Is Health Technology Assessment Part of the Solution or Part of the Problem? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1828-1834. [PMID: 34838281 DOI: 10.1016/j.jval.2021.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Antimicrobial resistance is a serious challenge to the success and sustainability of our healthcare systems. There has been increasing policy attention given to antimicrobial resistance in the last few years, and increased amounts of funding have been channeled into funding for research and development of antimicrobial agents. Nevertheless, manufacturers doubt whether there will be a market for new antimicrobial technologies sufficient to enable them to recoup their investment. Health technology assessment (HTA) has a critical role in creating confidence that if valuable technologies can be developed they will be reimbursed at a level that captures their true value. We identify 3 deficiencies of current HTA processes for appraising antimicrobial agents: a methods-centric approach rather than problem-centric approach for dealing with new challenges, a lack of tools for thinking about changing patterns of infection, and the absence of an approach to epidemiological risks. We argue that, to play their role more effectively, HTA agencies need to broaden their methodological tool kit, design and communicate their analysis to a wider set of users, and incorporate long-term policy goals, such as containing resistance, as part of their evaluation criteria alongside immediate health gains.
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Affiliation(s)
- Abigail R Colson
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK.
| | - Alec Morton
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Christine Årdal
- Antimicrobial Resistance Centre, Norwegian Institute of Public Health, Oslo, Norway
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, England, UK
| | - Sally C Davies
- UK Department of Health and Social Care, London, England, UK
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England, UK
| | | | - Itamar Megiddo
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Chantal Morel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany; Department of Business Studies, Uppsala University, Uppsala, Sweden; Geneva Transformative Governance Lab, Science Faculty, University of Geneva, Geneva, Switzerland
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | | | - John H Rex
- F2G Limited, Eccles, Cheshire, UK and AMR Solutions, Boston, MA, USA
| | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, England, UK
| | - Beth Woods
- Centre for Health Economics, University of York, York, England, UK
| | - Yue Xiao
- China National Health Development Research Centre (National Centre for Medicine and Health Technology Assessment), Beijing, P. R. China
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Stein-Zamir C, Rishpon S. The National Immunization Technical Advisory Group in Israel. Isr J Health Policy Res 2021; 10:7. [PMID: 33499907 PMCID: PMC7835647 DOI: 10.1186/s13584-021-00442-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
National Immunization Technical Advisory Groups (NITAGs) are defined by the World Health Organization as multidisciplinary groups of health experts who are involved in the development of a national immunization policy. The NITAG has the responsibility to provide independent, evidence-informed advice to the policy makers and national programme managers, on policy issues and questions related to immunization and vaccines.This paper aims to describe the NITAG in Israel. The Israeli NITAG was established by the Ministry of Health in1974. The NITAG's full formal name is "the Advisory Committee on Infectious Diseases and Immunizations in Israel". The NITAG is charged with prioritizing choices while granting maximal significance to the national public health considerations. Since 2007, the full minutes of the NITAG's meetings have been publicly available on the committee's website (at the Ministry of Health website, in Hebrew).According to the National Health Insurance Law, all residents of Israel are entitled to receive universal health coverage. The health services basket includes routine childhood immunizations, as well as several adult and post - exposure vaccinations. The main challenge currently facing the NITAG is establishing a process for introducing new vaccines and updating the vaccination schedule through the annual update of the national health basket. In the context of the annual update, vaccines have to "compete" with multiple medications and technologies which are presented to the basket committee for inclusion in the national health basket. Over the years, the Israeli NITAG's recommendations have proved essential for vaccine introduction and scheduling and for communicable diseases control on a national level. The NITAG has established structured and transparent working processes and a decision framework according to WHO standards, which is evidence-based and country-specific to Israel.The recent global COVID-19 pandemic is a major concern for all countries as well as a challenge for NITAGs. Currently, the NITAGs have a key role in advising both on sustainment of the routine immunization programs and on planning of the COVID-19 vaccination campaigns, with ongoing updates and collaboration with the Ministry of Health and health organizations.
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Affiliation(s)
- Chen Stein-Zamir
- The Israeli NITAG, Jerusalem, Israel.
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel.
- The Hebrew University of Jerusalem, Faculty of Medicine, Braun School of Public and Community Medicine, Jerusalem, Israel.
| | - Shmuel Rishpon
- The Israeli NITAG, Jerusalem, Israel
- Haifa District Health Office, Ministry of Health, Haifa, Israel
- School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Fourn L. [Modelization of recommendation framework advice for children immunization to Beninese decision makers]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2020; 32:273-278. [PMID: 32985844 DOI: 10.3917/spub.202.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The coverage of immunization against avoidable disease in the Republic of Benin as in other West African countries, is declining nowadays. To sustain the government effort, National Immunization Technical Advisory Groups (NITAG) were created technically and funded by the West African health organization (WAHO) and Preventive Medicine Agency in countries of the Economic Community of West African States (ECOWAS) including the Republic of Benin. The variation in experts’ methods of analyzing evidence sometimes results in risk error and lack of statistical power. This situation does not allow for the comparison of the scientific validity of certain recommendations made to policy makers, due to the lack of a rigorous framework. The aim of this paper is to design an improved framework to be used in the Republic of Benin in order to encourage a more harmonized approach based on evidence used by expert consultative committees. This framework shows four fundamental scientific steps including a Ministerial referral procedure, recommendation framework, evidence-based data collection, model analyses appropriate for expert advice on vaccines and child immunization, as well as three administrative steps including scientific discussion and work meetings without forgetting ethical aspects.
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Panero MS, Khuri-Bulos N, Biscayart C, Bonvehí P, Hayajneh W, Madhi SA. The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries-Argentina, Jordan, and South Africa (2017-2018). Vaccine 2020; 38:7118-7128. [PMID: 32950303 PMCID: PMC10783979 DOI: 10.1016/j.vaccine.2020.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Toward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance. METHODS In 2017-2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC). RESULTS Document review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation. CONCLUSIONS Systematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.
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Affiliation(s)
- Maria S Panero
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Cristián Biscayart
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Argentina
| | - Pablo Bonvehí
- Sociedad Argentina de Infectología, Buenos Aires, Argentina
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Buffardi AL, Njambi-Szlapka S. Questions for future evidence-informed policy initiatives: insights from the evolution and aspirations of National Immunization Technical Advisory Groups. Health Res Policy Syst 2020; 18:40. [PMID: 32321521 PMCID: PMC7178973 DOI: 10.1186/s12961-020-00551-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/19/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Attention to evidence-informed policy has grown; however, efforts to strengthen the quality and use of evidence are not starting from a blank slate. Changes in health architectures and financing pose different considerations for investments in evidence-informed policy than in the past. We identify major trends that have shifted the environment in which health policies are made, and use the evolution and future aspirations of National Immunization Technical Advisory Groups (NITAGs) in low- and middle-income countries to identify questions the sector must confront when determining how best to structure and strengthen evidence-informed health policy. DISCUSSION Trends over the last two decades have resulted in a dense arena with many issue-specific groups, discrete initiatives to strengthen evidence-informed policy and increasing responsibility for subnational institutions. Many countries face a shifting resource base, which for some reduces the amount of resources for health. There is global momentum around universal health coverage, reflecting a broader systems approach, but few examples of how the vast array of stakeholders relate within it are available. NITAG aspirations reflect four interconnected themes related to their scope, their integration in national policy processes, health financing and relationships with ministries of finance, and NITAG positioning relative to other domestic and international entities, raising questions such as, What are the bounds of issue-specific groups and their relationship to allocation decision-making processes across health areas? How do technical advisory groups interface with what are inherently political processes? When are finances considered, by whom and how? What is the future of existing groups whose creation was intended to enhance national ownership but who need continued external support to function? When should new entities be created, in what form and with what mandate? CONCLUSIONS Countries must determine who makes decisions about resources, when, using what criteria, and how to do so in a robust yet efficient way given the existing and future landscape. While answers to these questions are necessarily country specific, they are collective matters that cannot be addressed by specialised groups alone and have implications for new investments in evidence-informed policy.
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Affiliation(s)
- Anne L. Buffardi
- Overseas Development Institution (ODI), 203 Blackfriars Rd, London, SE1 8NJ United Kingdom
| | - Susan Njambi-Szlapka
- Overseas Development Institution (ODI), 203 Blackfriars Rd, London, SE1 8NJ United Kingdom
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Strengthening national teams of experts to support HPV vaccine introduction in Eastern Mediterranean countries: Lessons learnt and recommendations from an international workshop. Vaccine 2020; 38:1114-1119. [PMID: 31771862 DOI: 10.1016/j.vaccine.2019.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/20/2022]
Abstract
Several countries have started to introduce the HPV vaccine into their national immunisation programme, with the majority of these countries being high or upper-middle income countries. Currently, 91 countries have introduced the HPV vaccine globally. One of the regions lagging behind in the introduction of the HPV vaccine is the Eastern Mediterranean Region, with currently only Libya and the United Arab Emirates having introduced the HPV vaccine. In order to support countries in the Eastern Mediterranean Region with their decision-making process for HPV vaccine introduction, a regional workshop was organised to explore the current status of HPV vaccine introduction plans in the Eastern Mediterranean countries, gaps in information about HPV disease burden in the region and the need for quality HPV data to make an informed decision to introduce the HPV vaccine, socio-cultural and religious challenges with HPV vaccine introduction, and the role of NITAGs in formulating recommendations for HPV vaccine introduction. Participating countries reflected on their respective status of decision making process about HPV vaccine introduction; they discussed any needs for operational research to support the decision-making process; and highlighed technical and financial support that might be required from partners to assist with HPV vaccine introduction. Recommendations were made on how to advance the decision-making process for HPV vaccine introduction. The workshop increased the awareness of the need of data on burden of disease and the associated benefits of HPV vaccination in Eastern Mediterranean countries. The importance of collaboration between different programmes including: immunisation, adolescent health, school health, sexual and reproductive health and cancer control programmes was clearly emphasized.
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Strengthening vaccination frameworks: Findings of a study on the legal foundations of National Immunization Technical Advisory Groups (NITAGs). Vaccine 2020; 38:840-846. [PMID: 31706811 DOI: 10.1016/j.vaccine.2019.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 11/22/2022]
Abstract
In 2017, the Strategic Advisory Group of Experts on Immunization's Assessment Report of the Global Vaccine Action Plan noted the need to "better document the ways in which legislation and regulations have been used to promote or undermine immunization at the national level". Despite National Immunization Technical Advisory Groups (NITAGs) now existing in over 134 countries worldwide, there has been very little academic consideration of their legal underpinnings. In this paper, we compare the legal foundations and authority of 28 NITAGs from the six WHO Regions. All are members of the Global NITAG Network. We categorize the NITAGs based on their legal foundation and on the authority granted to them by their government, organizing them into a taxonomy of models. We then propose legal considerations for governments contemplating establishing or reforming a NITAG.
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Wiyeh AB, Sambala EZ, Ngcobo N, Wiysonge CS. Existence and functionality of national immunisation technical advisory groups in Africa from 2010 to 2016. Hum Vaccin Immunother 2018; 14:2447-2451. [PMID: 29771634 PMCID: PMC6284504 DOI: 10.1080/21645515.2018.1475815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the existence and functionality of National Immunisation Technical Advisory Groups (NITAGs) in Africa between 2010 and 2016, using data from the WHO-UNICEF Joint Reporting Form. The number of African countries with NITAGs increased from 15 (28%) in 2010 to 26 (48%) in 2016. Countries with a functioning NITAG increased from 5(9%) in 2010 to 16 (30%) in 2016. In 2016, 13 of the 27 (48%) low-income African countries reported having a NITAG; seven (54%) of them functional. Thirteen of the 26 (50%) middle-income countries reported having a NITAG; nine (69%) of them functional. In 2016, six of the seven African countries (86%) in the WHO Eastern Mediterranean Region had a NITAG, with three (50%) functional. In the WHO African Region, 20 of the 47 countries (43%) had NITAGs; 13 (65%) of them functional. Substantial investments should be made to ensure that every African country has a functional NITAG.
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Affiliation(s)
- Alison B Wiyeh
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Evanson Z Sambala
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Ntombenhle Ngcobo
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Charles S Wiysonge
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics , Department of Global Health, Stellenbosch University , Cape Town , South Africa.,c Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
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13
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Kotirum S, Muangchana C, Techathawat S, Dilokthornsakul P, Wu DBC, Chaiyakunapruk N. Economic Evaluation and Budget Impact Analysis of Vaccination against Haemophilus influenzae Type b Infection in Thailand. Front Public Health 2017; 5:289. [PMID: 29209602 PMCID: PMC5701919 DOI: 10.3389/fpubh.2017.00289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/19/2017] [Indexed: 12/04/2022] Open
Abstract
Current study aimed to estimate clinical and economic outcomes of providing the Haemophilus influenzae type b (Hib) vaccination as a national vaccine immunization program in Thailand. A decision tree combined with Markov model was developed to simulate relevant costs and health outcomes covering lifetime horizon in societal and health care payer perspectives. This analysis considered children aged under 5 years old whom preventive vaccine of Hib infection are indicated. Two combined Hib vaccination schedules were considered: three-dose series (3 + 0) and three-dose series plus a booster does (3 + 1) compared with no vaccination. Budget impact analysis was also performed under Thai government perspective. The outcomes were reported as Hib-infected cases averted and incremental cost-effectiveness ratios (ICERs) in 2014 Thai baht (THB) ($) per quality-adjusted life year (QALY) gained. In base-case scenario, the model estimates that 3,960 infected cases, 59 disability cases, and 97 deaths can be prevented by national Hib vaccination program. The ICER for 3 + 0 schedule was THB 1,099 ($34) per QALY gained under societal perspective. The model was sensitive to pneumonia incidence among aged under 5 years old and direct non-medical care cost per episode of Hib pneumonia. Hib vaccination is very cost-effective in the Thai context. The budget impact analysis showed that Thai government needed to invest an additional budget of 110 ($3.4) million to implement Hib vaccination program. Policy makers should consider our findings for adopting this vaccine into national immunization program.
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Affiliation(s)
- Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Faculty of Pharmacy, Social and Administrative Pharmacy Department, Rangsit University, Muang Pathum Thani, Thailand
| | - Charung Muangchana
- National Vaccine Institute (Public Organization), Ministry of Public Health, Nonthaburi, Thailand
| | - Sirirat Techathawat
- National Vaccine Institute (Public Organization), Ministry of Public Health, Nonthaburi, Thailand
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Department of Pharmacy Practice, Naresuan University, Phitsanulok, Thailand
| | - David Bin-Chia Wu
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Department of Pharmacy Practice, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, University of Wisconsin, Madison, WI, United States.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Malaysia
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14
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Timmis JK, Black S, Rappuoli R. Improving accountability in vaccine decision-making. Expert Rev Vaccines 2017; 16:1057-1066. [DOI: 10.1080/14760584.2017.1382358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- James Kenneth Timmis
- Student MSc Health Policy, St Mary’s Campus, Imperial College London, London, UK
| | - Steven Black
- UC Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH, USA
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15
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The European Union Joint Procurement Agreement for cross-border health threats: what is the potential for this new mechanism of health system collaboration? HEALTH ECONOMICS POLICY AND LAW 2016; 12:43-59. [DOI: 10.1017/s1744133116000219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe Joint Procurement Agreement (JPA) is an innovative instrument for multi-country procurement of medical countermeasures against cross-border health threats. This paper aims to assess its potential performance. A literature review was conducted to identify key features of successful joint procurement programmes. Documentary analysis and a key informants’ interview were carried out to analyse the European Union (EU) JPA. Ownership, equity, transparency, stable central financing, standardisation, flexibility and gradual development were identified as important prerequisites for successful establishment of multi-country joint procurement programmes in the literature while security of supply, favourable prices, reduction of operational costs and administrative burden and creation of professional expert networks were identified as desirable outcomes. The EU JPA appears to fulfil the criteria of ownership, transparency, equity, flexibility and gradual development. Standardisation is only partly fulfilled and central EU level financing is not provided. Security of supply is an important outcome for all EU Member States (MS). Price savings, reduction in administrative burden and creation of professional networks may be particularly attractive for the smaller MS. The JPA has the potential to increase health system collaboration and efficiency at EU level provided that the incentives for sustained commitment of larger MS are sufficiently attractive.
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16
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Silva ML, Paget WJ, Mosnier A, Buthion V, Cohen JM, Perrier L, Späth HM. Development of Seasonal Influenza Vaccination Recommendations: Relevance and Influence of the Evidence on the Decision-Making Process in France and the Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:670-679. [PMID: 27565285 DOI: 10.1016/j.jval.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Target groups for seasonal influenza vaccination are defined at the country level and are based on several factors. However, little is known about the national decision-making procedures. OBJECTIVE The purpose of this study was to compare the evidence used for the development of recommendations and its impact on the choice of target groups in France and the Netherlands. METHODS A preliminary documentary analysis identified institutions to include in the assessment: governmental authorities, research institutions, associations, and manufacturers. At least one expert from each group was invited to our study. Thirty-three semi-structured interviews were conducted in 2013 (16 France, 17 the Netherlands). We used NVivo10® to perform a thematic content analysis. RESULTS Clinical/epidemiological studies were the evidence most used in both countries. Economic models were increasingly being used; these had greater influence on the decision making in the Netherlands than in France, probably because of the presence of a modeler. Generally, the quality of the evidence used was poor, although no systematic use of standard protocol for its assessment was observed. A general protocol was sometimes used in France; however, the personal judgment of the experts was crucial for the assessment in both countries. CONCLUSIONS There were differences in the target groups, for example, pregnant women, recommended only in France. France and the Netherlands use similar evidence for developing vaccination recommendations, although different decisions are sometimes made regarding target groups. This could be associated with the lack of systematic standard appraisals, increasing the influence of the experts' judgment on decision making. The development of standards for the appraisal of evidence is recommended.
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Affiliation(s)
- Maria Laura Silva
- University of Lyon, Lyon, France; University of Bordeaux, Bordeaux Population Health Research Center U1219 Inserm, Bordeaux, France; University Lumière Lyon 2, CNRS, GATE-LSE UMR 5824, Ecully, France.
| | - W John Paget
- Netherlands Institute For Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Valérie Buthion
- University of Lyon, Lyon, France; University Lumière Lyon 2 COACTIS, EA 4161, Lyon, France
| | | | - Lionel Perrier
- University of Lyon, Lyon, France; University Lumière Lyon 2, CNRS, GATE-LSE UMR 5824, Ecully, France; Direction of Clinical Research and Innovation DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Hans Martin Späth
- University of Lyon, Lyon, France; University Claude Bernard Lyon 1, EAM 4128, Lyon, France
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17
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Jit M, Hutubessy R. Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:245-52. [PMID: 26832145 PMCID: PMC4871927 DOI: 10.1007/s40258-016-0224-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker's stated aims for that spending to achieve.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 6BT, UK.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
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18
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Romore I, Njau RJA, Semali I, Mwisongo A, Ba Nguz A, Mshinda H, Tanner M, Abdulla S. Policy analysis for deciding on a malaria vaccine RTS,S in Tanzania. Malar J 2016; 15:143. [PMID: 26956944 PMCID: PMC4782348 DOI: 10.1186/s12936-016-1197-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 03/01/2016] [Indexed: 11/18/2022] Open
Abstract
Background Traditionally, it has taken decades to introduce new interventions in low-income countries. Several factors account for these delays, one of which is the absence of a framework to facilitate comprehensive understanding of policy process to inform policy makers and stimulate the decision-making process. In the case of the proposed introduction of malaria vaccines in Tanzania, a specific framework for decision-making will speed up the administrative process and shorten the time until the vaccine is made available to the target population. Methods Qualitative research was used as a basis for developing the Policy Framework. Interviews were conducted with government officials, bilateral and multilateral partners and other stakeholders in Tanzania to assess malaria treatment policy changes and to draw lessons for malaria vaccine adoption. Results The decision-making process for adopting malaria interventions and new vaccines in general takes years, involving several processes: meetings and presentations of scientific data from different studies with consistent results, packaging and disseminating evidence and getting approval for use by the Ministry of Health and Social Welfare (MOHSW). It is influenced by contextual factors; Promoting factors include; epidemiological and intervention characteristics, country experiences of malaria treatment policy change, presentation and dissemination of evidence, coordination and harmonization of the process, use of international scientific evidence. Barriers factors includes; financial sustainability, competing health and other priorities, political will and bureaucratic procedures, costs related to the adoption and implementations of interventions, supply and distribution and professional compliance with anti-malarial drugs. Conclusion The framework facilitates the synthesis of information in a coherent way, enabling a clearer understanding of the policy process, thereby speeding up the policy decision-making process and shortening the time for a malaria vaccine to become available.
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Affiliation(s)
- Idda Romore
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Postfach, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Ifakara Health Institute (IHI), P.O. Box 78373, Dar Es Salaam, Tanzania.
| | - Ritha J A Njau
- World Health Organization Country Office, P.O Box 9292, Dar Es Salaam, Tanzania.
| | - Innocent Semali
- Muhimbili University of Health and Allied Science (MUHAS), P.O. Box 65015, Dar Es Salaam, Tanzania.
| | - Aziza Mwisongo
- Centres for Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | | | - Hassan Mshinda
- Commission for Science and Technology (COSTECH), P.O. Box 4302, Dar Es Salaam, Tanzania.
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Postfach, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Salim Abdulla
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar Es Salaam, Tanzania.
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Perronne C, Adjagba A, Duclos P, Floret D, Houweling H, Le Goaster C, Lévy-Brühl D, Meyer F, Senouci K, Wichmann O. Implementing efficient and sustainable collaboration between National Immunization Technical Advisory Groups: Report on the 3rd International Technical Meeting, Paris, France, 8-9 December 2014. Vaccine 2016; 34:1325-30. [PMID: 26859237 DOI: 10.1016/j.vaccine.2016.01.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/30/2022]
Abstract
Many experts on vaccination are convinced that efforts should be made to encourage increased collaboration between National Immunization Technical Advisory Groups on immunization (NITAGs) worldwide. International meetings were held in Berlin, Germany, in 2010 and 2011, to discuss improvement of the methodologies for the development of evidence-based vaccination recommendations, recognizing the need for collaboration and/or sharing of resources in this effort. A third meeting was held in Paris, France, in December 2014, to consider the design of specific practical activities and an organizational structure to enable effective and sustained collaboration. The following conclusions were reached: (i) The proposed collaboration needs a core functional structure and the establishment or strengthening of an international network of NITAGs. (ii) Priority subjects for collaborative work are background information for recommendations, systematic reviews, mathematical models, health economic evaluations and establishment of common frameworks and methodologies for reviewing and grading the evidence. (iii) The programme of collaborative work should begin with participation of a limited number of NITAGs which already have a high level of expertise. The amount of joint work could be increased progressively through practical activities and pragmatic examples. Due to similar priorities and already existing structures, this should be organized at regional or subregional level. For example, in the European Union a project is funded by the European Centre for Disease Prevention and Control (ECDC) with the aim to set up a network for improving data, methodology and resource sharing and thereby supporting NITAGs. Such regional networking activities should be carried out in collaboration with the World Health Organization (WHO). (iv) A global steering committee should be set up to promote international exchange between regional networks and to increase the involvement of less experienced NITAGs. NITAGs already collaborate at the global level via the NITAG Resource Centre, a web-based platform developed by the Health Policy and Institutional Development Unit (WHO Collaborating Centre) of the Agence de Médecine Préventive (AMP-HPID). It would be appropriate to continue facilitating the coordination of this global network through the AMP-HPID NITAG Resource Centre. (v) While sharing work products and experiences, each NITAG would retain responsibility for its own decision-making and country-specific recommendations.
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Affiliation(s)
- Christian Perronne
- Communicable Diseases Commission, Haut Conseil de la Santé Publique, University of Versailles Saint Quentin, Paris, France.
| | - Alex Adjagba
- Health Policy and Institutional Development Unit, WHO Collaborative Centre, at Agence de Médecine Préventive (AMP), Paris, France
| | - Philippe Duclos
- Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Daniel Floret
- Comité Technique des Vaccinations (CTV), Haut Conseil de la Santé Publique, University of Lyon 1, Paris, France
| | - Hans Houweling
- The Dutch NITAG, Health Council of the Netherlands, The Hague, The Netherlands
| | - Corinne Le Goaster
- Comité Technique des Vaccinations (CTV), Haut Conseil de la Santé Publique, Paris, France
| | - Daniel Lévy-Brühl
- Department of Infectious Diseases, Institut de Veille Sanitaire, Saint Maurice, France
| | - François Meyer
- International Relations, Haute Autorité de Santé, Saint Denis, France
| | | | - Ole Wichmann
- The German NITAG, Immunization Unit, Robert Koch Institute, Berlin, Germany
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20
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Silva ML, Perrier L, Paget JW, Mosnier A, Buthion V, Cohen JM, Späth HM. Influenza vaccination policy-making processes in France and The Netherlands: Framework and determinants. Health Policy 2016; 120:293-305. [PMID: 26806677 DOI: 10.1016/j.healthpol.2016.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/17/2015] [Accepted: 01/05/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Target groups for seasonal influenza vaccination are nationally defined based on several factors. However, few studies have explored the policy-making processes at the country-level. We investigated key differences in the policy-making process for the development of vaccination recommendations between France (FR) and The Netherlands (NL). This paper presents preliminary results on the evidence used in the decision-making process and focuses on the interactions between the experts and stakeholders. METHODS A documentary analysis identified the stakeholders of this process as governmental authorities, research institutions, associations, and manufacturers. This qualitative study included at least one expert from each stakeholder group. Thirty-three semi-structured interviews were performed in 2013 (16 FR, 17 NL). We used NVivo10® to perform a thematic content analysis on the data. RESULTS National Immunization Technical Advisory Groups (NITAGs) were the key stakeholders in the development of recommendations. There was no systematic standard evaluation of evidence during the decision-making process in both countries. Likewise, voting was not systematic, although it did occur more often in FR. A declaration of interests was obligatory in both countries. Experts with no conflicts of interest were rare because many depend on private funding for their research on influenza vaccination. CONCLUSIONS The transparency of the NITAGs' procedures for the development of recommendations should be improved. We believe improvements might be achieved by the systematic standard evaluation of evidence, consistent voting, clear declarations of interest, and increased public funding for vaccination research.
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Affiliation(s)
- Maria Laura Silva
- University of Lyon, Lyon, France; University of Bordeaux; Research Center Bordeaux Population HealthU1219 Inserm, Bordeaux, France; University Lumière Lyon 2; CNRS, GATELSEUMR 5824, Ecully, France.
| | - Lionel Perrier
- University of Lyon, Lyon, France; University Lumière Lyon 2; CNRS, GATELSEUMR 5824, Ecully, France; Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - John W Paget
- Netherlands Institute For Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Valérie Buthion
- University of Lyon, Lyon, France; University Lumière Lyon 2 COACTIS, EA 4161, Lyon, France
| | | | - Hans Martin Späth
- University of Lyon, Lyon, France; University Claude Bernard Lyon 1, EAM 4128, Lyon, France
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Desai S, lsmail SJ, Lerch R, Warshawsky BF, Gemmill I. Canada's National Advisory Committee on Immunization: Celebrating 50 years. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2015; 26:126-8. [PMID: 26236351 PMCID: PMC4507835 DOI: 10.1155/2015/431428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vaccines have saved more lives than any other innovation in modern medicine. National immunization committees play a vital role in the development of evidence-based recommendations for the use of vaccines. The present article describes the evolution and work of the National Advisory Committee on Immunization in Canada as the group marks its 50th anniversary. The article also provides insight into the future challenges that the committee is likely to face.
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22
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Akazawa M, Yongue J, Ikeda S, Satoh T. Considering economic analyses in the revision of the preventive vaccination law: A new direction for health policy-making in Japan? Health Policy 2014; 118:127-34. [DOI: 10.1016/j.healthpol.2014.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 01/17/2014] [Accepted: 07/24/2014] [Indexed: 11/25/2022]
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23
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Advisory Committee on Immunization Practices: Notes from guest lecture at the 14th annual meeting of the Japanese Society for Vaccinology. Vaccine 2013; 31:5621-2. [DOI: 10.1016/j.vaccine.2013.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 05/15/2013] [Indexed: 11/23/2022]
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Nelson EAS, de Quadros CA, Santosham M, Parashar UD, Steele D. Overcoming perceptions of financial barriers to rotavirus vaccine introduction in Asia. Hum Vaccin Immunother 2013; 9:2418-26. [PMID: 23955246 DOI: 10.4161/hv.26107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Despite a WHO recommendation in 2009, reaffirmed in 2013, that all countries should consider introducing rotavirus vaccines into their National Immunization Programs, as of June 2013 only 45 have done so. One major consideration appears to have been the costs of the vaccine to countries. Of concern, is that Asian countries have been slow to introduce rotavirus vaccines despite having robust data that could inform the decision-making process. Although decisions on new vaccine introduction are very complex and vary by country and region, economic evaluations are often pivotal once vaccine efficacy and safety has been established, and disease burden documented and communicated. Unfortunately, with private sector list prices of vaccines often used in economic evaluations, rather than a potential public health sector pricing structure, policy-makers may defer decisions on rotavirus vaccine introduction based on the belief that "the vaccine price is too high," even though this might be based on erroneous data. The Pan American Health Organization's Revolving Fund provides one example of how vaccine price can be made more competitive and transparent through a regional tendering process. Other mechanisms, such as tiered pricing and UNICEF procurement, also exist that could help Asian and other countries move forward more quickly with rotavirus vaccine introduction.
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Affiliation(s)
- E Anthony S Nelson
- Department of Paediatrics; The Chinese University of Hong Kong; Hong Kong, P.R. China
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25
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Koon AD, Rao KD, Tran NT, Ghaffar A. Embedding health policy and systems research into decision-making processes in low- and middle-income countries. Health Res Policy Syst 2013; 11:30. [PMID: 23924162 PMCID: PMC3750690 DOI: 10.1186/1478-4505-11-30] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/30/2013] [Indexed: 11/21/2022] Open
Abstract
Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization’s Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems.
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Affiliation(s)
- Adam D Koon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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26
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The decision making process on new vaccines introduction in South Africa. Vaccine 2012; 30 Suppl 3:C9-13. [DOI: 10.1016/j.vaccine.2012.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 03/16/2012] [Accepted: 04/04/2012] [Indexed: 11/18/2022]
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Brooks A, Ba-Nguz A. Country planning for health interventions under development: lessons from the malaria vaccine decision-making framework and implications for other new interventions. Health Policy Plan 2012; 27 Suppl 2:ii50-61. [PMID: 22513733 PMCID: PMC3328760 DOI: 10.1093/heapol/czs039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Traditionally it has taken years or decades for new public health interventions targeting diseases found in developing countries to be accessible to those most in need. One reason for the delay has been insufficient anticipation of the eventual processes and evidence required for decision making by countries. This paper describes research into the anticipated processes and data needed to inform decision making on malaria vaccines, the most advanced of which is still in phase 3 trials. From 2006 to 2008, a series of country consultations in Africa led to the development of a guide to assist countries in preparing their malaria vaccine decision-making frameworks. The guide builds upon the World Health Organization's Vaccine Introduction Guidelines. It identifies the processes and data for decisions, when they would be needed relative to the development timelines of the intervention, and where they will come from. Policy development will be supported by data (e.g. malaria disease burden; roles of other malaria interventions; malaria vaccine impact; economic and financial issues; malaria vaccine efficacy, quality and safety) as will implementation decisions (e.g. programmatic issues and socio-cultural environment). This generic guide can now be applied to any future malaria vaccine. The paper discusses the opportunities and challenges to early planning for country decision-making-from the potential for timely, evidence-informed decisions to the risks of over-promising around an intervention still under development. Careful and well-structured planning by countries is an important way to ensure that new interventions do not remain unused for years or decades after they become available.
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Affiliation(s)
- Alan Brooks
- PATH Malaria Vaccine Initiative, Ferney-Voltaire, France
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28
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Hyde TB, Dentz H, Wang SA, Burchett HE, Mounier-Jack S, Mantel CF. The impact of new vaccine introduction on immunization and health systems: a review of the published literature. Vaccine 2012; 30:6347-58. [PMID: 22940378 DOI: 10.1016/j.vaccine.2012.08.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/31/2012] [Accepted: 08/15/2012] [Indexed: 02/05/2023]
Abstract
We conducted a systematic review of the published literature to examine the impact of new vaccine introduction on countries' immunization and broader health systems. Six publication databases were searched using 104 vaccine and health system-related search terms. The search yielded 15,795 unique articles dating from December 31, 1911 to September 29, 2010. Based on review of the title and abstract, 654 (4%) of these articles were found to be potentially relevant and were referred for full review. After full review, 130 articles were found to be relevant and included in the analysis. These articles represented vaccines introduced to protect against 10 different diseases (hepatitis A, hepatitis B, Haemophilus influenzae type b disease, human papilloma virus infection, influenza, Japanese encephalitis, meningococcal meningitis, Streptococcus pneumoniae disease, rotavirus diarrhea and typhoid), in various formulations and combinations. Most reviewed articles (97 [75%]) reported experiences in high-income countries. New vaccine introduction was most efficient when the vaccine was introduced into an existing delivery platform and when introduced in combination with a vaccine already in the routine childhood immunization schedule (i.e., as a combination vaccine). New vaccine introduction did not impact coverage of vaccines already included in the routine childhood immunization schedule. The need for increased cold chain capacity was frequently reported. New vaccines facilitated the introduction and widespread use of auto-disable syringes into the immunization and the broader health systems. The importance of training and education for health care workers and social mobilization was frequently noted. There was evidence in high-income countries that new vaccine introduction was associated with reduced health-care costs. Future evaluations of new vaccine introductions should include the systematic and objective assessment of the impacts on a country's immunization system and broader health system, especially in lower-income countries.
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Affiliation(s)
- Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Report on the 1st international workshop on procedures for the development of evidence-based vaccination recommendations, Berlin, Germany, 22–23 November 2010. Vaccine 2012; 30:2399-404. [DOI: 10.1016/j.vaccine.2011.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 11/20/2022]
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Leask J, Braunack-Mayer A, Kerridge I. Consent and public engagement in an era of expanded childhood immunisation. J Paediatr Child Health 2011; 47:603-7. [PMID: 21951441 DOI: 10.1111/j.1440-1754.2011.02160.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Childhood immunisation programmes have seen well-heralded successes in disease control. An increasing number of scheduled vaccines, narrowing risk-benefit ratios and public attention to vaccine safety raise new questions about consent. We first explore the challenges that this highly dynamic environment poses for valid consent. Then, we broaden this discussion to wider public engagement by suggesting how the public - the bearers of vaccine risk and benefit - can be better involved in immunisation policy.
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Affiliation(s)
- Julie Leask
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney, Sydney, New South Wales, Australia.
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