Biomedical Engineering Reference
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involvement in vaccination (Gidengil et al. 2009 , 2010 ; Hurley et al. 2010 ; Freed et al.
2008a , 2011b ; Campos-Outcalt et al. 2010 ; Coleman et al. 2009 ; Clark et al. 2011 ).
13.3.4
Organizations Issuing Vaccination Recommendations
The number of vaccine-treatable diseases and licensed vaccines has increased
signifi cantly over the last decades. Three types of organizations help consumers,
physicians, governments, and private insurers defi ne priorities: national technical
advisory groups (NITAGs), national medical societies, and the WHO.
13.3.4.1
National Technical Advisory Groups
NITAGs are committees which develop recommendations on new vaccine introduc-
tion and vaccination schedules to national governments (Gessner et al. 2010 ). 13 The
NITAG in the United States is the ACIP. Established in 1964, ACIP recommends
licensed new vaccines to be incorporated into the routine immunization schedule
and reviews older vaccines to consider revising its recommendations, among other
tasks. ACIP guidance is sought routinely whenever a new vaccine is licensed or
when there is a change in licensed specifi cations. In addition, ACIP designates those
vaccines to be included in the federal Vaccines for Children (VFC) Program, which
pays for vaccine administration to almost 50 % of American children under 6 years
of age (Smith et al. 2009 ; Smith 2010a ).
ACIP recommendations are made primarily on the basis of the burden of disease,
vaccine effectiveness, and safety. Formal economic evaluation, e.g., through cost-
effectiveness analysis, also plays a role in ACIP decision-making (Smith 2010a ).
ACIP recommendations are subject to approval of the Director of the CDC, which
are part of the US Department of Health and Human Services (HSS). Except for the
VFC designation, ACIP has no direct role in vaccine fi nancing, purchasing, and
administration. These decisions are made by other federal agencies, state health
departments, and private insurers. However, ACIP recommendations are generally
regarded as national policy, followed by public and private insurers, and set the
standard of practice for physicians (Smith 2010a ; Berndt et al. 2009 ).
Well established NITAGs can be found in all regions of the world. 14 In an inter-
national survey (Bryson et al. 2010 ), the presence of a NITAG was reported in 61 %
13 Some NITAGs have broader mandates to work in other areas of communicable disease control
(Gessner et al. 2010 ).
14 For example, the NITAG in the UK is the Joint Committee on Vaccination and Immunisation
(JCVI) (Hall 2010 ). Australia has the Australian Technical Advisory Group on Immunisation
(ATAGI) (Nolan 2010 ), China the Experts Advisory Committee on Immunization Program
(EACIP) (Zheng et al. 2010 ), and South Africa the National Advisory Group on Immunization
(NAGI) (Schoub et al. 2010 ). More information on NITAGs can be found in Vaccine 28S (2010).
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