NITAGs should also clearly be distinguished from National Regulatory Authorities, which have licensing, testing, inspecting, quality control and post marking surveillance functions. Finally, NITAGs should be distinguished from disease-specific technical advisory working groups, such as those on polio, measles, and hepatitis, which are formulated to focus SKI606 on one disease for a specified

time period and deliverable(s) and whose recommendations and work would be better harnessed under the umbrella of a NITAG as noted above. If a NITAG is to succeed, there are modest but required costs for its establishment and functioning both in terms of managerial support and financial investments that are required if it is to succeed. NITAGs will also potentially add some delays in the immunization and program decision making process given that without a NITAG a decision could be made instantaneously—though such a decision is unlikely to be evidence based, robust, thoughtful and useful. Attention does need to be paid to avoiding undue delays that might be caused by inertia on the part of a NITAG or its secretariat.

As an alternative to a NITAG, some very small countries and countries with limited technical resources may prefer collaboratively to explore a sub-regional or inter-country mechanism to provide independent and expert advice rather than rely on an individual country approach. This, however, requires a genuine willingness to accept extra-national recommendations BIBW2992 mouse as well as the necessity for this inter-country group to understand and appreciate the specific situations and needs of individual countries. In some countries such as the United States of America, Canada and India, professional organizations such as the National Academy of Pediatrics or other similar groups may have established a national advisory process to issue recommendations on vaccine use that are intended Oxalosuccinic acid for their members [10] and [11].

In such situations it is important to ensure close liaison between these groups and the NITAG so that one will not end up with conflicting recommendations that would be counterproductive and undermine the credibility of either group. As an example, such a situation with issuance of different recommendations by the US Advisory Committee on Immunization Practices and the Committee on Infectious Diseases of the American Academy of Pediatrics (the so-called Red Book Committee) existed in the past in the United States. Over the years, however, these two committees have worked increasingly closely and now publish harmonized immunization recommendations [7] and [12]. The following discussion identifies elements that need to be well defined in the membership and mode of operations of a NITAG. The proposed structure for NITAGs outlined below may in part be seen as an example towards which to aim, but it is well accepted that establishing a fully functional NITAG may take a number of years.