WHO Immunization Advisory Committees

1 Immunization Advisory Committees FINAL REPORT Prepared for the world health organization By the Child health Evaluation and Research (CHEAR) Unit Division of General Pediatrics, University of Michigan Gary L. Freed, , , Director Report Authors: Gary L. Freed, MD, MPH Margie Andreae, MD Kara Switalski, MPH Leah Abraham August 2008 2 INTRODUCTION Immunization Advisory Committees (IAC) are used by many nations to determine the specific vaccines recommended for use in a particular country. These Committees generally bring together a panel of experts to access the wide spectrum of issues involved in the decision to recommend a vaccine. The charge of these Committees may include additional responsibilities such as information dissemination, advocacy and oversight of Immunization programs.

2 Countries may also have a separate committee, called an Interagency Coordinating Committee (ICC). The goal of an ICC is to bring together domestic agencies and international donors/advisors to coordinate efficient and effective use of resources [1]. These are often separate and distinct from the technical Immunization Advisory Committees . A recent study of IACs in 10 large industrialized nations in Western Europe revealed significant variation in the structure, function and authority of these Committees [2]. The variation was often a function of the political, social and economic environment in which the committee and the specific government operated. Results demonstrated variation existed in a number of domains including composition of the committee, basis and process for decision-making, and authority of the committee.

3 For example, some Committees made decisions through member voting while others operated by consensus. Many Member States in the EURO region are now developing their own IACs. As such, a broad understanding of the different models of such Committees would be helpful in providing the options available to them. The findings from the 10 developed nations present only a limited view of the range of programs currently in place across the region. Further, many developed and developing countries will benefit from an exposure to the different methods employed by nations in this region. They can use such information to assess the structure of their own programs and consider options to improve their function. The WHO has set goals to reduce the incidence of several vaccine preventable diseases across the EURO region.

4 Of significant interest is the manner in which Member States approach recommendations regarding the hepatitis B and Haemophilus influenzae, type b (Hib) vaccines specifically what factors influence the decision to recommend these and other vaccines. It is unclear whether the presence or absence of an Immunization Advisory committee in specific countries has an impact on these policy decisions. As such, there is a need for a more comprehensive assessment of the IAC structure and function across the EURO region. To achieve that goal, we sought to study the current status of Immunization Advisory Committees of these nations. In addition, we examined the recommendations regarding the use of hepatitis B and Hib vaccines and the factors that influenced these decisions.

5 3 METHODS Sample There are fifty-three Member States that comprise the EURO Region of the world health organization (WHO). To gain an understanding of the process of Immunization recommendation development and implementation throughout the region, all Member States were selected to participate. Survey Instrument In collaboration with WHO, we developed a structured questionnaire to be administered electronically. The survey contained thirty-nine items and was designed to be completed in fifteen minutes or less. The survey focused on membership of the Immunization Advisory committee, the Committees meeting process, and decision-making. Specific questions addressed the recommendation process for hepatitis B and Haemophilus influenzae, type b (Hib) vaccines.

6 The questionnaire was a composite of fixed-choice and short-answer questions. The survey and accompanying cover letter were translated from English to Russian by a professional translation service. Eleven Member States of the former Soviet Union and Eastern Europe were provided with surveys in Russian and given the opportunity to complete the survey in Russian. Questionnaire Administration The first mailing of questionnaires was sent electronically in April 2008 to managers of the Expanded Programme on Immunisation (EPI) and, where applicable, to Immunization program managers. The e-mail contained an attached personalized cover letter signed by the Director of the EURO Immunization program, Dr. Srdan Matic, and the survey instrument.

7 Heads of WHO country offices within the EURO Region and Deputy Ministers of health in the Russian-speaking countries were informed of the study and received the information electronically. The cover letter also specified that the focus of the survey was on the IAC ( , the technical committee), not the ICC (if present) in each country. Respondents had the option to return the completed survey by e-mail, fax, or complete a web-based version of the survey. Three additional mailings were sent to non-respondents in April and May 2008. In addition, follow-up contact was made with countries when data were missing or clarification was needed. Data Analysis Frequency distributions were calculated for all survey items. All free text from short answers was transcribed verbatim from the surveys.

8 Responses in Russian were translated to English by a professional translation service. Chi-square analysis was conducted to assess differences between the Russian-speaking and English-speaking nations for some items and between countries with an IAC and without for other items. The study was approved by the University of Michigan Medical School Institutional Review Board. 4 OVERALL RESULTS Response Rate Of the 53 Member States (henceforth referred to as countries ) contacted, 47 completed the survey. This yielded an overall response rate of 89%. The response rate of English-speaking countries (93%, N=39) was greater than that of Russian-speaking countries (73%, N=8). I. Immunization Advisory Committees Almost three-quarters of countries surveyed (72%, N=34) have a standing Advisory committee to make national Immunization recommendations.

9 (See Appendix A) Another 15% (N=7) have ad hoc Committees for special issues. (Table 1) The median year Committees were established is 2000, with a range from 1963 to 2007. Table 1. Country has standing Advisory committee that makes national Immunization recommendations (N=47) % (N) Yes 72 (34) No; ad hoc committee(s) for special issues 15 (7) No; no Immunization Advisory committee 13 (6) A.

10 Committee Membership The number of voting members on a committee range from 0 to 43 members and non-voting members range from 0 to 18. (See Appendix B) More than one-third of countries (39%, N=13) reported their voting members serve as long as desired by the Minister of health . Of those Committees that appoint voting members for specific periods of time (42%, N=14), the appointments range from 2 to 6 years. The majority of countries (70%, N=23) reported that some committee members are selected by the Minister of health , while half of countries (50%, N=17) reported having other members who are selected by governmental agencies. More than a quarter (26%, N=9) reported having committee members who are selected by professional organizations.