The role of NITAGs in government decisions on vaccine use: insights from the Fifth Global NITAG Network meeting
Authors: Louise Henaff, Dace Zavadska, Mario Melgar, Johanna Fihman, Christoph Steffen, Joachim Hombach
Journal: The Lancet Infectious Diseases (2024)

In many countries national immunisation programmes are the backbone of primary health care and represent a substantial share in health-care expenditures. Therefore, the introduction and use of a vaccine in a public health programme require a strategic decision resulting in a long-term commitment. Governments rely on the expertise of independent technical expert panels such as National Immunization Technical Advisory Groups (NITAGs) to inform their decisions. Evidence-based, independent, transparent, and timely recommendations made by NITAGs are instrumental to the success of both current and future immunisation programmes. Moreover, during health crises, they are pivotal in contributing to guiding outbreak responses and participating in pandemic recovery efforts. Launched in 2016,1Adjagba A MacDonald NE Ortega-Pérez I Duclos P Strengthening and sustainability of national immunization technical advisory groups (NITAGs) globally: lessons and recommendations from the founding meeting of the global NITAG network.Vaccine. 2017; 35: 3007-3011Crossref PubMed Scopus (19) Google Scholar the Global NITAG Network2Global NITAG NetworkNetwork.https://www.nitag-resource.org/network/vision-missionDate: 2022Date accessed: February 13, 2024Google Scholar is a forum to facilitate the exchange of knowledge, good practices, and information among NITAGs, promoting global and cross-regional collaboration in the field of immunisation policies. In June 2023, the network convened its fifth meeting in Amman, Jordan; 62 NITAG representatives attended in person and 54 online. During the meeting, NITAGs reflected on their learnings from the COVID-19 pandemic. In most countries, NITAGs served as the main advisory body guiding the introduction and use of COVID-19 vaccines;3Kahn AL Steffen CA Henaff L et al.COVID-19 vaccine policy development in a sample of 44 countries—key findings from a December 2021 survey of National Immunization Technical Advisory Groups (NITAGs).Vaccine. 2023; 41: 676-683Crossref PubMed Scopus (6) Google Scholar some countries also established dedicated COVID-19 taskforces. All NITAGs had major political and time pressures and had to navigate unusual complexities in their work. Due to the rapidly expanding and evolving evidence and substantial data gaps, frequent adjustments to recommendations had to be made, ethical considerations addressed, and off-label recommendations were required. This increased workload was often handled with no substantial increase in staffing or resources. The COVID-19 pandemic also underscored the importance of mobilising established global, regional, and subregional networks: promoting the exchange of experiences, comparing policies among neighbouring countries, and maintaining effective communication were crucial.4Tunis M Deeks S Harrison R et al.Canada's National Advisory Committee on immunization: adaptations and challenges during the COVID-19 pandemic.Vaccine. 2023; 41: 6538-6547Crossref PubMed Scopus (1) Google Scholar In addition, the pandemic showed the value of increased interactions with WHO's Strategic Advisory Group of Experts on Immunization including regular updates of global-level recommendations. During the Global NITAG Network meeting participants further discussed approaches and experiences in issuing off-label vaccination recommendations—that is, recommending the use of vaccines beyond the indication on the product label. Off-label recommendations require a clear assessment of the benefits and risks of vaccination and should be directed at populations with the greatest medical need or aimed at improving programmatic use through simplified immunisation schedules. The ability of NITAGs to issue such recommendations varies substantially between countries, often due to legal constraints, concerns about liability, and vaccine hesitancy. Ensuring a timely exchange of information with regulatory authorities and manufacturers is crucial in informing such decisions and could reduce the necessity for off-label recommendations in the longer term. Much welcomed progress in vaccine development and the increasing availability of new or improved vaccines pose a challenge for countries and NITAGs in terms of how to prioritise vaccine interventions and target populations while accounting for the limited financial and programmatic capacities. A survey conducted among Global NITAG Network representatives revealed the varying degrees of NITAG involvement in such decisions and emphasised the need to incorporate additional dimensions to the decision-making process. These included considerations relating to supply, political will, sustainability, demand, and opportunity cost, as part of an overarching approach to national strategic planning. Using tools such as multicriteria decision analysis could help to address these complexities. The Global NITAG Network meeting highlighted the pivotal role of NITAGs in guiding governments in their immunisation programmes and strategies. Many NITAGs are still enhancing their processes and functionality to advise on increasingly complex questions and to be prepared to respond promptly to emergencies. While NITAG members work pro bono and are dedicated to enhancing their competencies to provide the best scientific advice; they rely on a technical secretariat for support. Investing in these functional technical resources, training and peer learning presents opportunities to strengthen NITAGs, thus contributing to more sustainable and country-owned immunisation programmes. We declare no competing interests.