Strengthening in-country evidence-based decision-making capacity for immunization has been a priority of the World Health Organization (WHO) Regional Office for Europe (Regional Office) and was adopted as a strategic goal in the 2015–2020 European Vaccine Action Plan (EVAP) [1].

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of national experts that provides evidence-based recommendations to policy-makers and immunization programme managers, assisting them in making sound immunization policy and programme decisions [2]. NITAGs are valued for their roles in strengthening country ownership and public confidence [3] in the national immunization programme, and ensuring a nationally owned, independent evidence-based decision-making process [4]. The indicators WHO uses to assess NITAG functioning are: (1) the provision of a legislative basis for the NITAG, (2) the availability of written terms of reference, (3) representation of at least five disciplines¹ within NITAG members, (4) conducting annual NITAG meetings, (5) advance sharing of the meeting agenda and documents, and (6) declarations of interest by NITAG members [5].

The Regional Office focuses on extending the benefits of vaccination to all communities through a process of evidence-based decision-making in the countries, and advocates for all countries to establish and strengthen NITAGs. The advocacy from the Regional Office has resulted in raising awareness of a NITAG’s value and has generated political will to establish these committees. The Regional Office has targeted its efforts to strengthen the evidence-based decision-making capacity of newly-established NITAGs in low- and middle-income countries (LMICs) — countries with the most limited human and financial resources. From 2011 to 2014, the Regional Office held five training workshops for NITAG chairs, members, and secretariats (referred to as representatives hereafter) from 25 countries (approximately four participants per country) to improve NITAGs’ functioning and ability to make evidence-based recommendations. The Regional Office facilitated networking among long-functioning and recently established NITAGs for sharing best practices. During 2014–2018, NITAG representatives from Albania, Armenia, Belarus, and Georgia visited the Joint Committee on Vaccination and Immunisation, United Kingdom, and the Health Council of the Netherlands.

The Regional Office, WHO HQ, and CDC used the training materials available through the NITAG Resource Center [9] as well as best practices from well-functioning NITAGs and experience of partners to develop the updated set of training materials tailored to the specific needs based on the level of maturity of NITAGs in LMICs. In addition, whenever possible, methods and processes from WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization were used and adapted to the national setting. It was piloted with NITAG representatives from countries eligible for the Vaccine Alliance (Gavi) support² (approximately four participants from each country) at a workshop in May 2018 in Denmark. The materials were revised and finalized based on the feedback received from the participants and facilitators.

The final set of training materials for the structured four-day training includes presentations, group exercises, hands-on activities, peer-to-peer exchange of information, and relevant vaccine-specific examples.

During session one of the workshop, NITAG representatives present their work and share their achievements and challenges. This helps to integrate the existing experience of the participants, increase understanding of the training’s relevance to their needs, and encourages active involvement during the training. Furthermore, NITAG representative presentations help facilitators understand the differences in various NITAGs’ functioning, which allows better facilitation of group exercises and discussions, keeping in mind each country context.

The second session of the training covers NITAG composition and helps participants understand the procedural requirements for ensuring proper NITAG functioning. The third and fourth sessions address the methods and tools to develop an evidence-based recommendation from a policy question. The final session of the training outlines effective strategies for NITAGs to communicate evidence-based recommendations to policy- and decision-makers.

An important training element is participation of representatives of well-functioning NITAGs who share best practices for each training topic, facilitate working groups and serve as a resource. The updated materials were used to conduct a four-day training in Montenegro in April 2019. The topics covered during the 2019 workshop in Montenegro are listed in Table 1.

At the global level, WHO has conducted a systematic assessment of strengths and shortcomings of existing NITAG training materials and methods, including the materials developed in the WHO European Region. The aim is to provide a new standard set of training materials to all WHO regions, addressing the training needs in most country situations. This work includes identification of key additional materials to be developed with particular attention to instructional design and complementary teaching methods, such as videos, role playing, and a broad array of case studies. Key materials will be translated into the main WHO languages. It is anticipated that the training material package will be finalized with the support of an ad hoc Global NITAG Network (GNN) [13] working group and published on the NITAG Resource Center website [14] for wide use in the NITAG community.

However, more needs to be done to ensure training impact. The Regional Office used follow-up technical support and on-the-job-training to encourage NITAGs to use a robust evidence to recommendation framework to make recommendations. Other approaches such as conducting additional in-country trainings, may also be used. The effect of training significantly depends upon the existence of a strong Secretariat capable of providing adequate support to a NITAG in introducing this systematic approach in developing recommendations.

To ensure continued progress, global and regional partners such as WHO and CDC should continue providing technical support to recently established NITAGs from LMICs and advocate to MoHs for sustained support to NITAGs and their Secretariats, including provision of necessary human and financial resources. Building sustainable in-country expertise in decision-making on vaccine related matters requires long term commitments from countries and investments in ongoing technical assistance [4,15].

The portfolio of vaccines and related issues (e.g., product delivery techniques, formulations, schedules) continues to expand, and countries face complex problems, including shifting health priorities, increasing resource constraints and issues with demand and acceptance of vaccines. In this challenging context, as we move into the next decade, the development of functional and trusted NITAGs will become even more important to add credibility to the policy-making process and for successful implementation of national immunization programmes.

The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.