1. 2004 Pan American Health Organization Immunizations-PAHO Strengthening National Immunization Technical Advisory Groups in the Americas Jon K. Andrus Barbara Jauregui Cara Janusz

2. Pan American Health Organization Background: PAHO ProVac Initiative –PAHO project financed by the Bill & Melinda Gates Foundation –ProVac aims to strengthen technical capacity at the country-level for evidence-based decisions on new vaccine introduction –To date, ProVac has focused on the following new vaccines: Rotavirus Pneumococcal conjugate HPV Influenza (pandemic and seasonal) (near future: dengue, malaria and others)

3. 2004 Pan American Health Organization Opportunities to improve decision-making processes 1 Burns JE, Mitrovich RC, Jauregui B, Ruiz Matus C, Andrus JK. Descriptive analysis of immunization policy decision making in the Americas. Rev Panam Salud Publica. 2009;26(5):398–404.

4. *Includes financing data from all countries in the region; same data will be disaggregated and analyzed for only the countries included in the study. EPI Financing and Vaccine Legislation in the Americas 79% 92% 99% 94% 90% Number of Laws EPI Expenditures (millions)

5. Pan American Health Organization Situation Analysis: NITAGs in the Americas –Many existing NITAGs –Chartered by ministerial decree or law –Members represent different fields of expertise –Few NITAGs independent from Ministry of Health –Not all NITAGs declare conflict of interest

6. 2004 Pan American Health Organization 1.Strengthen infrastructure and processes for decision-making related to new vaccines in the LAC Region 2.Develop tools and training workshops to assist multidisciplinary country teams in conducting economic and epidemiological impact studies 3.Support country-led cost-effectiveness analyses and other economic evaluations to support the new vaccine decision making process in LAC 4.Advocate for evidence-based decision-making 5.Assist countries in the LAC Region in planning for vaccine introduction when evidence supports a decision to introduce ProVac Initiative: Objectives

7. 2004 Pan American Health Organization –Provide support for NITAG members in the PAHO region to assist and observe ACIP and NACI meeting –Invite Members of National Committees to Regional and Sub-regional Immunization meetings (i.e. TAG) –Develop Operational Guidelines for NITAGs –Provide platform for virtual exchanges between NITAGs in the Region to discuss relevant and timely vaccine- related policy issues Activities with National Committees on Immunization

8. Countries have requested technical support from PAHO; to help integrate economic studies into the national decision-making process - 2006 Directing Council resolution (CD47.R10) National Committee ProVac Central Team (PAHO HQ) ProVac Centers of Excellence Ministry of Health National level Regional level ProVac Country Team EPI Manager Surv. Officers Clinician Health Economist PAHO Country Focal Point Nat’l Consultant Strengthening NITAGs

9. 2004 Pan American Health Organization Functions Formal structure Procedures Standardizing criteria for decision making regarding immunization PAHO Operational Guidelines for NITAGs

10. 2004 Pan American Health Organization Frameworks of Evidence for Decision-makers Technical Criteria: Burden of disease Vaccine characteristics (efficacy, safety, etc) Adverse events and post- marketing surveillance Economic considerations (CEA) Programmatic and Operational Criteria: Supply chain Other logistical and operational issues Financing strategies and budget impact studies Stakeholder support Social Criteria: Risk perception Political will Equity

11. 2004 Pan American Health Organization Harmonize ProVac tools – Build upon newly acquired skill sets Generate models to compare multiple health interventions (against vaccination strategies) Improve macro-evidence frameworks Catalyze transition from regional priority-based decision-making to national evidence-based decision-making in the Region Long-term Goals of ProVac

12. 2004 Pan American Health Organization www.paho.org/provac ( ProVac e-Support Center ) Contact Jon K. Andrus, Barbara Jauregui or Cara Janusz at: provac@paho.org Further Information

13. Thank You