Civil Society in Decision Making for
Immunization Policies:
the example of National Immunization
Technical Advisory Groups (NITAGs)
Center for Vaccine Ethics and Policy
Global 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:
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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
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Diversity of vaccine providers with lower price
• But…
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Multiple health priorities, limited human resources and logistical
capacities
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Expensive vaccines with limited funds available
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An expressed need for National adaptation of Global and Regional
recommendations to take into consideration local realities
New context for immunization
• But…
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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…
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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
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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 evidencebased 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
TECHNICAL ADVISORY
SAGE
REGIONAL COMMITEE
FINANCIAL AND OPERATIONNAL
GAVI BOARD
REGIONAL ICC
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ICC
MoH
MoH & MINFI
About the NITAGs
• What is the role of a National Immunization Technical
Advisory Group (NITAG)?
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Guide policy makers and program managers to make evidence-based
immunization related policy decisions
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To provide some technical recommendations for all vaccine
preventable diseases to National authorities
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This is NOT serving as an implementing, coordinating or regulatory
body
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Only the National authorities are making the final decision.
About the NITAGs
About the NITAGs
• What are the areas covered?
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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?
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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 (evidencebased, 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
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Where expertise is available
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Where National Authorities are supportive to independent process
for decision making (strong Civil Society, democratic models)
• Strong Technical Partnerships
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Between NITAGs and between NITAGs and the Global
Immunization Community
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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
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Shaped the National Research agenda
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Strengthened the need for Evidence based decision
making in Health Area
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Advocated the need for the increase of National
Spending for Immunization
Websites and Contacts
NITAG Resource Center
http://www.nitag-resource.org/
SIVAC Initiative
http://www.sivacinitiative.org/
AMP
http://www.aamp.org
Contact us:
Dr Kamel Senouci, Director SIVAC Initiative
 ksenouci@aamp.org