Evaluation of National Immunization Technical Advisory Groups (NITAGs) of Middle-Income Countries in the WHO European Region; a synopsis

Wiebe Külper-Schiek ^1* Liudmila Mosina ² Lisa Ann Jacques-Carroll ² Annika Falman ¹ Thomas Harder ¹ Eduard Kakarriqi ³ Iria Preza ⁴ Arman Badalyan ⁵ Gayane Sahakyan ⁶ Oxana Romanova ⁷ Veronika Shimanovich ⁸ Sanjin Musa ⁹ Dinagul Bayesheva ¹⁰ Nurshay Azimbayeva ¹¹ Zuridin Nurmatov ¹² Vera Toigombaeva ¹³ Ninel Revenco ¹⁴ Vaeceslav Gutu ¹⁵ Ljiljana Markovic-Denic ¹⁶ Branka Bonaci-Nikolic ^16,17 Dilorom Tursunova ¹⁸ Nigora Tadzhiyeva ¹⁹ Ole Wichmann ¹ Siddhartha Sankar Datta ²

• ¹ Robert Koch Institute (RKI), Berlin, Berlin, Germany
• ² WHO Regional Office for Europe, Copenhagen, Denmark
• ³ Institute of Public Health (Albania), Tirana, Tirana, Albania
• ⁴ WHO Country Office for Albania, Tirana, Albania
• ⁵ Yerevan State Medical University, Yerevan, Yerevan, Armenia
• ⁶ Armenia National Center for Disease Control and Prevention, Yerevan, Armenia
• ⁷ Belarusian State Medical University, Minsk, City of Minsk, Belarus
• ⁸ Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
• ⁹ Institute for Public Health of the Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
• ¹⁰ Astana Medical University, Astana, Kazakhstan
• ¹¹ Ministry of Health (Kazakhstan), Astana, Kazakhstan
• ¹² National Institute of Public Health, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
• ¹³ Department of General and Clinical Epidemiology, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
• ¹⁴ Nicolae Testemiţanu State University of Medicine and Pharmaceutics, Chisinau, Moldova
• ¹⁵ National Agency for Public Health (Moldova), Chisinau, Moldova
• ¹⁶ Faculty of Medicine, University of Belgrade, Belgrade, Serbia
• ¹⁷ Clinic of Allergy and Immunology, Clinical Center of Serbia, Belgrade, Serbia
• ¹⁸ Committee for Sanitary Epidemiology Welfare and Public Health (Republic of Uzbekistan), Tashkent, Uzbekistan
• ¹⁹ Tashkent Medical Academy, Tashkent, Uzbekistan

Introduction: A National Immunization Technical Advisory Group (NITAG) provides independent guidance to Ministries of Health (MoH) and policymakers, enabling them to make informed decisions on national immunization policies and practices. As of 2022, 50 of the 53 countries in the World Health Organization (WHO) European Region (the Region) had established a NITAG, with 58% of all NITAGs and 66% of those in middle-income countries (MICs) in the Region meet all six WHO process indicators of NITAG functionality. However, many newly established NITAGs in MICs in the Region experience challenges in terms of their functioning, structure, and outputs.Methods: To address these challenges and achieve the goal of evidence-informed decision making on immunizations, the WHO Regional Office for Europe and the Robert Koch Institute (RKI) implemented a project to strengthen the functioning of MIC NITAGs of the Region through comprehensive evaluations of nine NITAGs and development and implementation of improvement plans.Results: All evaluated NITAGs are formally established and complete the most important aspects of NITAG functioning. The main challenge for all NITAGs is the lack of a well-staffed Secretariat to establish annual workplans and develop NITAG recommendations following a standardized process.Discussion: The evaluation identified NITAGs' strengths and challenges and some challenges have been addressed through improvement plan implementation. WHO and RKI will continue to evaluate NITAGs and support development and implementation of improvement plans. WHO and NITAG partners will continue to provide training on the standardized recommendation-making process and advocate increased MoH support to NITAGs, including dedicated Secretariat staff.