National Immunization Technical Advisory Groups (NITAGs) are multidisciplinary bodies of national experts that provide evidence-based recommendations to policy-makers and immunization programme managers.

NITAGs develop recommendations by systematically gathering, reviewing and evaluating available evidence and incorporating this into the local epidemiological and social context. With this information, NITAGs collaborate with and empower decision-makers to develop highly credible policy decisions, accepted by health-care professionals and the public. Robust decision-making processes are also essential for putting a credible case to decision-makers when it comes to financing new vaccines.

NITAGs in the WHO European Region

Almost all Member States of the European Region have NITAGs in place. Some have been functioning for more than 20 years and have accumulated significant expertise and experience. Others, mainly from middle-income countries, were established only in the last 10 years.

The resources available for NITAGs and their performance vary throughout the Region. Many of the recently established NITAGs face challenges in aligning their functioning with WHO recommendations.

WHO/Europe provides support in building the capacity of NITAGs to make evidence-based recommendations by conducting regional trainings and webinars, providing technical support in introducing a systematic approach to routine NITAG practices, and facilitating peer-to-peer learning and collaboration between NITAGs and the European Technical Advisory Group of Experts on Immunization (ETAGE) and the Strategic Advisory Technical Group of Experts on Immunization (SAGE).

Strengthening NITAGs in Middle-income Countries of the WHO European Region – a joint project of WHO/Europe and RKI

In January 2020, WHO/Europe and the Robert Koch Institute (RKI) of Germany initiated a project to strengthen the functioning of NITAGs in middle-income countries of the Region by providing targeted support in the areas of NITAGs’ needs. The project is part of the German Global Health Protection Programme, funded by the German Ministry of Health, and carried out jointly by WHO/Europe and RKI.

Together with the project team, NITAGs use a project-specific tool to evaluate their functioning and performance and identify areas for improvement. The results of the evaluations are used to develop NITAGs’ improvement plans and guide targeted support from WHO/Europe, RKI and other partners. The project includes regional meetings for NITAGs that provide a platform for sharing experiences and best practices.

Evaluation of NITAGs

Within the project Strengthening NITAGs in Middle-income Countries of the WHO European Region, NITAGs use a standardized questionnaire to evaluate their performance, including their mode of functioning, work processes and integration into the policy process. The tool is used to conduct external evaluations (semi-structured interviews with representatives of NITAGs and their secretariats) or self-evaluations using an instruction guide. Based on the results of evaluations, NITAGs develop improvement plans that will be implemented with targeted technical support from WHO/Europe, RKI and other partners.

Capacity-building

To improve NITAGs’ functioning and capacity to make evidence-based recommendations, WHO/Europe conducts regular trainings for chairs, members and secretariats of NITAGs from middle-income countries.

In 2019, a training workshop on strengthening evidence-based decision-making in immunization was conducted jointly with WHO headquarters and the United States Centers for Disease Control and Prevention (CDC) in Budva, Montenegro. NITAG representatives from 9 middle-income countries attended this training, which focused on aligning NITAGs’ composition and functioning with WHO recommendations and on introducing a systematic approach for making evidence-based recommendations.

WHO/Europe guidance for NITAGs on an adapted evidence-to-recommendation process

WHO/Europe recommends that NITAGs use a systematic approach to develop evidence-based recommendations on immunization policy and practice. SAGE and long-established NITAGs have extensive experience in using this approach, called the Evidence to Recommendation (EtR) process.

WHO/Europe in collaboration with RKI developed a guidance document on an EtR process adapted to the needs and level of maturity of the recently established NITAGs. This guidance document is based on NITAG training materials developed in 2019 by WHO/Europe in collaboration with WHO headquarters and the Centers for Disease Control and Prevention (CDC) of the United States of America.

NITAG support during the COVID-19 pandemic

During the COVID-19 pandemic, NITAGs have faced challenges in developing recommendations for COVID-19 vaccines and vaccination. The lack of evidence on vaccine product characteristics and disease epidemiology on the one hand, and the rapidly evolving information about COVID-19 and newly developed COVID-19 vaccines on the other, make it difficult for NITAGs to use their routine procedures.

In response, WHO/Europe developed a series of webinars to facilitate dissemination and understanding of the recommendations made at global and regional levels by SAGE and ETAGE on COVID-19 vaccines and vaccination. During these webinars, countries had the opportunity to share their experiences on developing COVID-19 recommendations and on vaccine roll-outs. Polls conducted during the webinars were used to tailor future webinars and evaluate the effectiveness of these interventions.

Collaboration with ETAGE and SAGE

SAGE develops recommendations on global vaccine and immunization policies and strategies. ETAGE adapts, where necessary, the global recommendations to fit the specificities of the Region. The participation of NITAGs in ETAGE and SAGE meetings increases NITAGs’ awareness and understanding of global and regional immunization priorities, and gives NITAGs the opportunity to provide national input in ETAGE and SAGE discussions.

NITAGs from 33 Member States of the Region participated in SAGE meetings held on 5–7 October 2020, 5 January 2021 and 8 February 2021. This participation facilitated national adaptation of global recommendations on the prioritization of target groups for vaccination against COVID-19, and on the use of specific COVID-19 vaccines.

Networking and peer-to-peer learning of NITAGs

NITAGs in the Member States of the Region are diverse. Some are long-standing, well equipped, and have acquired considerable experience and expertise. Some are recently established and have limited capacity and resources.

WHO/Europe facilitates the sharing of experiences between NITAGs at regional training sessions, meetings and webinars. This encourages learning from the best practices of long-functioning NITAGs.

The Global NITAG Network (GNN), initiated in 2016, provides a platform for NITAGs to share experiences and best practices at a global level. The platform is open to NITAGs around the world.

The European Union (EU)/European Economic Area (EEA) NITAG collaboration is a network of NITAGs from EU and EEA Member States. Initiated by the European Centre for Disease Prevention and Control (ECDC) in 2018, it aims to develop an EU/EEA-wide system to share existing and new scientific evidence on public health outcomes of vaccines authorized in the EU and their use in immunization programmes.

The NITAG Resource Center (NRC) provides a database of different resources for NITAGs, such as recommendations developed at global, regional and local levels, systematic reviews on immunization topics, and relevant articles.