Other criteria identified include disability or quality adjusted life years lost, hospitalizations, morbidity, and epidemic potential for the disease in question plus issues of equity and the possibility of disease eradication. Many countries report that they rely more and more frequently on local data and where reported universally indicate a preference learn more for local data. Local data may be particularly relevant for diseases with highly variable epidemiology or for vaccines that behave differently in different populations. Committees not only use, or in some cases require local data but in most cases also make recommendations on additional local

research and data that are needed before a decision can be made. Economic evaluation data are considered by Selleck Afatinib all committees with the exceptions of Australia and Canada (where a separate advisory

committee evaluates economic issues). However, only the United Kingdom’s committee uses specific cost-effectiveness cut-offs for making recommendations on including vaccines in the public vaccination schedule. Five countries report that their committee considers financial sustainability when reviewing evidence (Iran, Korea, Oman, Sri Lanka, and Switzerland). The Sri Lankan committee reports that it does not recommend a vaccine unless it is certain that the country can sustain financing regardless of the availability of donor support such as through the GAVI mechanism. The other four committees do not report how financial sustainability issues affect committee

recommendations. In contrast to these five countries, the remaining countries included in the supplement indicate that until financing aspects are taken into consideration by the government after issuance of committee recommendations. In general countries use all sources of data available to them. This may include peer-reviewed articles, findings of other NITAGs, WHO documents, regional data (for example, Oman shares data with other gulf countries), and local data (published or unpublished). Beyond the use of data and publications from WHO, six countries report on the influence of WHO recommendations for final committee decisions. In three instances (Honduras, Oman, and Switzerland) the committee to date has supported all WHO recommendations. Three committees (South Africa, Thailand, and the United States) state that they modified WHO global recommendations to the local national circumstances. Twelve NITAGs indicate the process by which final recommendations are made and in seven cases this is by consensus and in five by voting. Among groups that vote, this usually occurs by majority vote. NITAG recommendations may have considerable implications for vaccine sales and thus most of the included manuscripts emphasize that committee members must be independent of pharmaceutical industry influence.