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: 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 Numerous successful existing national independent committees Thailand, China, Sri Lanka, USA, Canada, Australia, South Africa, UK, France, Brazil… WHA (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 & MINFI MoH

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

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 Center SIVAC Initiative AMP Contact us: Dr Kamel Senouci, Director SIVAC Initiative 