Abstract
The individual and community health benefits of vaccination have received significant attention and are now well understood. However, much less is known about immunization as a regulated space, its principles and standards and its institutions and instruments. In 2011, the World Health Organization (WHO) recommended that National Immunization Technical Advisory Groups (NITAGs) be established in each member country. NITAGSs are envisioned as independent, multidisciplinary expert groups within the national immunization framework, tasked with providing evidence-based evaluations and recommendations to governmental decision-makers about specific vaccines, vaccine-dosing, vaccine program development and immunization policy and practice more generally. As of 2020, 171 WHO countries have formed NITAGs. The widespread formation of NITAGs has highlighted an absence of sustained scholarship around immunization as a policy area subject to law, and it has given rise to many governance and operational questions. In 2017, for example, representatives of the Global NITAG Network (GNN) agreed that there is insufficient understanding of the impact of law on the functioning of NITAGs. Similarly, the Strategic Advisory Group of Experts on Immunization called for research into the variety of ways in which legislation and regulation have been used to promote immunization at a national level and to achieve different ends in relation to immunization and NITAG functioning. In answer to this call, the NITAG Environmental Scan (Project) was initiated. Drawing on scholarship around good governance, this article offers a comprehensive common assessment schema for critically and systematically approaching questions about NITAG governance and operation, applying that schema to the foundation instrument of the Côte d’Ivoire’s NITAG. It also reports on how well the schema is engaged by the NITAG foundation instruments in other GNN countries.
Highlights
The individual and community health benefits of vaccination are well understood[1] and have been acknowledged in formal legal processes in multiple countries,[2] vaccine uptake rates are not where they need to be for adequate control of vaccine preventable diseases.[3]
We report on how well the schema is engaged by the National Immunization Technical Advisory Groups (NITAGs) foundation instruments in other countries that were studied in the NITAG Environmental Scan, all of them Global NITAG Network (GNN) members
Given the importance of immunization to country and global public health objectives, and given the challenges of achieving sufficient vaccination rates in the face of countervailing preventive pressures, healthcare demands and anti-vaccination machinations, it is important to commit attention to, and exercise care in, the development of the policy and operational architecture relating to immunization
Summary
The individual and community health benefits of vaccination are well understood[1] and have been acknowledged in formal legal processes in multiple countries,[2] vaccine uptake rates are not where they need to be for adequate control of vaccine preventable diseases.[3]. As each of the seven elements of the assessment is explored, it is applied to the foundation instrument of the Cote d’Ivoire’s NITAG, being Decree 226 Regarding the Creation, Organization, Properties and Functioning of the National Committee of Independent Experts for Vaccination of Cote d’Ivoire. This application is valuable for uncovering the approach (and the sufficiency of the approach) adopted in a typically understudied low-income African country. MacDonald, et al, ‘Strengthening Vaccination Frameworks: Findings of a Study on the Legal Foundations of National Immunization Technical Advisory Groups (NITAGs)’, Vaccine 38 (2020), pp. Our findings and recommendations can help further inform and strengthen existing NITAG evaluation tools
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