Strenghtening NITAGs through the Partnership for Influenza Vaccine Introduction
The Partnership for Influenza Vaccine Introduction (PIVI), based at The Task Force for Global Health (TFGH), is an innovative public/private program that partners with the Centers for Disease Control and Prevention (CDC), Ministries of Health, corporate partners and others to create sustainable, routine, seasonal influenza vaccination programs in low- and middle-income countries. PIVI’s goal is to create routine, seasonal influenza vaccination programs to protect communities from the impacts of both seasonal and pandemic influenza. Working with countries’ Ministries of Health, as well as with other technical collaborators, PIVI supports capacity building for NITAGs to make evidence-based vaccine policy decision making. These activities are coordinated with NITAG strengthening work carried out through other projects and cooperative funding agreements between countries and CDC’s Influenza and Global Immunization Divisions. The work is also closely coordinated with NITAG focal points in WHO regional and country offices.
Workshops adapted as needed
Through these combined efforts, in the second half of 2017, PIVI organized five NITAG workshops that were attended by participants from seven countries. PIVI support to NITAGs strengthening focuses in 2 areas:
- Support to newly established NITAG or NITAGs with renewed membership : the objective is to provide technical assistance to orient NITAG members on WHO guidance for NITAG optimum functioning including on the methodology for developing evidence-based recommendations; and
- Strengthen NITAG working groups: the objective is to provide technical assistance to working groups to review the evidence-based methodology and apply the principles for preparing a technical dossier using the example of seasonal influenza
Two workshops on general NITAG support were held in Lao People’s Democratic Republic and Mongolia. The main outcome of these workshops were to develop and refine their working documents, including their Internal Procedures Manual that layout NITAGs mode of operations and annual work plan. Rotavirus vaccines and seasonal influenza were examples used for practicing on the development of evidence-based recommendations in Lao PDR and Mongolia respectively.
With regards to the 2nd area of support, three workshops were organized for NITAG “working groups” around the topic of seasonal influenza vaccination - in Vietnam, Armenia (two participants each from Republic of Georgia and from Moldova also attended) and Côte D’Ivoire. The role of NITAG working groups is to conduct evidence-based reviews on the disease and vaccine under consideration for consideration and discussion by the entire country NITAG.
A pool of expert trainers
CDC and PIVI facilitated access to technical expertise through hiring of experienced NITAG trainers who previously worked for the SIVAC Initiative of Health Policy and Institutional Development (from the Agence de Medicine Preventive or AMP). Drs Antoinette Ba-Nguz, Adeel Shah and Ginette Hounkanrin conducted the trainings. CDC and PIVI also provided co-facilitators and influenza subject matter experts, as needed, for the workshops. For the training in Armenia, WHO EURO arranged translation of training materials into Russian and supported the attendance of staff from Moldova.
A targeted response to the lack of data
Due to the complexity of influenza disease and vaccine, it is challenging to conduct an exhaustive literature review. Indeed, certain factors need to be taken into account on an annual basis, including vaccination requirements, changing circulating influenza strains and ongoing monitoring and evaluation of vaccine effectiveness and safety. Country NITAGs also frequently report challenges with access to global literature. To assist with these challenges, PIVI provided additional technical resources for NITAG seasonal influenza working groups in the form of literature reviews carried out using suggested NITAG methodology, quality reviews with the CASP tool and synthesis of the evidence These reviews covered the 2012-2017 time-period and included key elements in the NITAG Recommendation Framework including disease burden (global and regional data), influenza vaccine safety and efficacy/effectiveness, cost effectiveness, vaccine acceptability etc. In order to complete these reviews before the 2017 workshops, PIVI and CDC conducted this work under significant time constraints and there are plans to review and evaluate the materials following the 2017 workshops. We hope that these resources, that include details on risk groups that may be helpful for countries considering which high risk groups to include in their seasonal influenza vaccination program, can eventually be shared more widely for use by other NITAGs.