Six steps for successfully proposing a recommendation

4 April 2017

In Senegal, the NITAG (CCVS) Chair tasks six experts to work on cerebrospinal meningitis. The objective is simple: to define whether or not it is appropriate to introduce the MenAfriVac in the routine EPI, starting from 2017. Indeed, Senegal is inside a meningitis belt and is regularly exposed to epidemic flares of cerebrospinal meningitis (CSM).
The vaccine was introduced in the country as part of a campaign in 2012. WHO recommends that the vaccine be introduced into the routine EPI within five years of a campaign. Then, in 2015, Senegal's Minister for Health sent a request to the CCVS experts.



1) Prepare a reference document on CSM 
The Secretariat collects some raw data from grey literature and the information from the Prevention directorate. They reformulate the original question to better advise the authorities in their decision-making. The wording becomes: Is it appropriate to introduce the MenAfriVac in Senegal's routine EPI, starting from 2017? If not, what does the CCVS propose as an alternative?
2) Prepare the recommendation framework on the question 
The Working Group begins the process of defining the recommendation framework. It researches and agrees the various elements to be taken into consideration for issuing an Opinion on the question asked. For each element under consideration, the specific data to be researched must be specified then categorized. The recommendation framework is then submitted to all CCVS experts for Opinion.
3) Literature review
Once the CCVS has validated the framework, the Working Group begins the literature review. All research steps, from the data generated by the systematic database search, to the grey literature data, or the documents from the Prevention directorate, must be documented to guarantee the transparency of the process and the credibility of the generated results.
4) Evaluate the evidence 
Approximately sixty articles are selected to undergo the evaluation test. The Working Group evaluates the articles available in their full version, assessing their relevance in providing elements of response to the specific questions asked by the recommendation framework.
5) Use evidence
Using the articles selected during the evaluation process, the Working Group extracts the evidence it needs to answer the questions asked by the recommendation framework. It is essential at this stage that the Group does not cast any value judgment on the evidence collected. 
6) Discuss 
The Working Group does not issue any recommendations. It discusses and proposes. It is only during the CCVS ordinary meeting that these proposals can become recommendations if the committee members accept them. 

The Secretariat, the cornerstone of  Working Groups
The secretariat plans and organizes the technical group's meetings. But that is not all that it does. It also spends time preparing the reference documents and, before each meeting, submits this documentation to the experts. The president of the cerebrospinal meningitis Working Group, Prof. Bernard Diop, highlights that: "The vitality of a NITAG is measured by that of its Secretariat." 

Five group meeting and two residential workshops were necessary to develop and finalize the recommendation note proposal on MenAfriVac. Throughout the process, SIVAC provided support to the Working Group. In April 2017, the recommendation note proposal will be submitted to all of the experts during the ordinary session for validation and adoption if applicable.


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