The Role of National Immunisation Technical Advisory Groups (NITAGs) in Strengthening National Vaccine Decision-Making: A Comparative Case Study of Armenia, Ghana, Indonesia, Nigeria, Senegal and Uganda

National Immunisation Technical Advisory Groups (NITAGs) provide independent technical guidance to national policymakers and programme managers to support evidence-based and locally relevant immunisation policy and programme decisions. This study examined NITAGs in 6 low- and middle-income countries, or LMICs (i.e., Armenia, Ghana, Indonesia, Nigeria, Senegal, and Uganda), with a focus on functionality, quality of recommendation development, and integration with national decision-making bodies and processes. It was carried out as part of the Supporting Independent Immunization and Vaccine Advisory Committees (SIVAC) Initiative (2008-2017), which centred around advocacy: raising the profile of NITAGs in the global agenda through collaboration with academic institutions, participation in conferences and partner meetings, and publication of articles.

The study used a mixed-method case-series design, including semi-structured interviews, NITAG meeting observations, and document review. Data were analysed thematically. Table 1 in the paper lays out the findings in detail but, in short, 5 NITAGs had been legally established with terms of reference and appeared well functioning, with Ghana's in development. All NITAGs had standard operating procedures and nomination procedures to ensure a range of expertise, generally comprising 10-15 core, 1-5 secretariat, and several ex-officio members. Aside from economics, NITAGs reported a wide range of member expertise.

Furthermore, interviewees described NITAGs as instruments of country ownership that can use evidence to tailor immunisation investments to country-specific epidemiology and health systems. Each NITAG studied was situated in a specific political, economic, and cultural context. For example, Ghana highlighted political challenges in establishing a NITAG, while Indonesia, a majority Muslim country with strong community anti-vaccine sentiment, highlighted socio-cultural challenges in addressing local sensitivities around vaccine use.

Four NITAGs used formal conflict-of-interest procedures, although some interviewees commented that implications were not always understood. NITAGs valued local data, and limited evidence suggested NITAG presence might reinforce data production through surveillance and local research studies. All observed meetings demonstrated due process, and evidence-based decision-making processes were generally followed, with a critical role played by working-group data syntheses and assessments.

With regard to transparency, while most NITAG members appeared willing to share governance documents, most did not have websites, though some shared recommendations through the NITAG Resource Centre. All NITAGs allowed non-member observers by prior arrangement. In terms of interaction with national decision-makers and stakeholders, interaction format and channels varied, but were usually through chairpersons and/or secretariat. Interviewees noted collaboration with national decision-making bodies (e.g. ICC - interagency coordinating committee, national regulatory authority) as important, but not always well defined or understood, and sometimes reflecting a fragmented institutional landscape. This was potentially worsened by parallel committees overseeing vertical programmes (e.g., polio national certification committees) and sometimes mitigated by NITAG members' cross-memberships in other bodies (e.g., Senegal, Uganda). NITAGs were seen as well integrated with Ministry of Health (MoH) decision-making, and MoH interviewees were positive about NITAG contributions, indicating that NITAGs had an important role.

In conclusion, the findings show that, despite challenges, NITAGs were able to function satisfactorily in LMICs and provided valuable contributions to evidence-based decision-making. Findings also indicate that NITAGs' role could extend over time, from steering and reviewing the overall immunisation programme, to addressing vaccine confidence issues and harnessing local research to produce needed context-specific data.