by Kamel Senouci and Lara Gautier, AMP Many national immunization programs rely on the professional advice of national immunization technical advisory groups (NITAGs) to help them make critical decisions on introducing new vaccines. Implemented in April 2008 by Agence de Médecine Préventive (AMP) in partnership with the International Vaccine Institute, the SIVAC Initiative supports the development of these NITAGs in low- and middle-income countries. In this article, we take a look at how SIVAC has supported the establishment and achievements of NITAGs around the world. NITAGs work to enhance the use of evidence-based decision-making processes in the development of immunization programs and policies at the national level. SIVAC supports this valuable work by providing technical assistance in the creation of NITAGs and offering support once they have been created. This can include training, tools development, and knowledge-sharing through the NITAG Resource Center, a multilingual website that offers information, tools, and short learning modules. The first country to receive SIVAC’s support was Côte d’Ivoire, whose NITAG—the Comité National d’Experts Indépendants pour la Vaccination et les Vaccins de la Côte d’Ivoire (CNEIV-CI)—was officially created in January 2010. As part of the development of a draft recommendation by CNEIV-CI on the management of adverse events following immunization (AEFI), SIVAC provided technical support in developing terms of reference documents for the evaluation and management of AEFI in Côte d’Ivoire. These were validated in June 2012 at the second regular meeting of CNEIV-CI. In January 2011, the inaugural meeting of Mozambique’s NITAG—the Comité de Peritos para a Imunização (CoPI)—was held in Maputo. Supported by SIVAC, the CoPI rapidly began to issue recommendations on vaccine policies. During its first year, two meetings were held and nine recommendations were issued on topics such as the reliability of data from the Expanded Programme on Immunization (EPI), cold chain logistics requirements, and the introduction of new and underused vaccines. These recommendations were then adopted and implemented by the country’s Ministry of Health. At the CoPI’s last meeting in April 2012, three further recommendations were issued on vaccine safety issues, EPI staff training, and new mechanisms for vaccine registration. His Excellency Dr. Alexandre Lourenço Jaime Manguele, the Minister of Health, confirmed the key role of the CoPI in strengthening the country’s immunization program through an evidence-based approach. In June 2012, the minister signed an agreement extending SIVAC support through mid-2013. During 2011 and 2012, SIVAC helped Kazakhstan, Kyrgyzstan, and Mongolia to establish their own NITAGs. Benin, Senegal, and Vietnam plan to establish NITAGs in the coming months, with SIVAC support. While the main thrust of SIVAC activities to date has focused on establishing new NITAGs in low- and middle-income countries, SIVAC also works to strengthen existing NITAGs. This involves providing assistance to NITAGs on how to ensure greater compliance with international NITAG standards and how to help NITAGs to make evidence-based recommendations that are relevant to the national context. In this way, since 2010, SIVAC has been supporting NITAGs in Indonesia, Lebanon, Nepal, and Tunisia. For example, the Indonesian Technical Advisory Group for Immunization (ITAGI) recently issued a recommendation regarding a pilot study on inactivated polio vaccine in the country. The ITAGI is also working on recommendations related to the pneumococcal and rotavirus vaccines. The Comité Technique des Vaccinations (CTV) of Tunisia is also very active: since the 2011 rubella epidemic, the CTV has been coordinating the adoption of the strategy for the elimination of rubella and increasing monitoring of congenital rubella syndrome. The CTV is also modifying its vaccination strategy for rubella vaccine in the EPI to reach new age targets. SIVAC is also helping NITAGs and national immunization programs to conduct cost-effectiveness analyses of new vaccine introductions. This is being performed as part of the ProVac International Working Group established by the ProVac Initiative of the Pan American Health Organization Immunization Project, which was created to share ProVac tools and methodologies with other regions. In collaboration with World Health Organization Regional Offices, SIVAC will provide direct technical assistance for cost-effectiveness evaluations of potential new vaccine introductions in four middle-income countries: Albania, Azerbaijan, Egypt, and Iran. This work began in May 2012 in Albania with a cost-effectiveness analysis on the potential introduction of rotavirus vaccine. NITAGs in low- and middle-income countries have demonstrated their value by issuing important recommendations on new immunization policies and vaccine introductions. However, NITAGs can further improve the decision-making processes, and SIVAC is working hard to provide tailor-made support to countries by promoting evidence-based processes that can improve their immunization policies and programs. For more information, please visit the SIVAC Initiative website. We encourage your questions or comments. Please click reply at the bottom of the page.
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