Developing evidence-based immunization recommendations and GRADE

Area of Science:

• Immunology and Public Health
• Evidence-Based Policy Making
• Global Health Strategy

Background:

• The Strategic Group of Advisory Experts (SAGE) advises the World Health Organization (WHO) on vaccine and immunization policies.
• WHO utilizes evidence-based vaccine position papers, with recent ones based on SAGE recommendations since 2006.
• The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is used to rate evidence quality for recommendations.

Purpose of the Study:

• To describe the evolution and adaptation of the GRADE approach for immunization policy development.
• To highlight SAGE's role in refining evidence assessment for vaccine recommendations.
• To ensure WHO immunization policies are based on comprehensive and relevant evidence.

Main Methods:

• Review of SAGE's advisory processes and working group methodologies.
• Analysis of the integration of the GRADE approach into WHO immunization policy development.
• Documentation of collaborative efforts to enhance GRADE for vaccine-specific evidence.

Main Results:

• SAGE identified limitations of the standard GRADE approach for immunization-specific issues, such as population-level effects and safety surveillance data.
• Collaborative interactions led to key enhancements of the GRADE methodology to better accommodate vaccine-relevant evidence.
• The adapted GRADE approach has been integrated into the development of SAGE and WHO immunization recommendations.

Conclusions:

• The GRADE approach has been successfully adapted to better suit the complexities of immunization evidence.
• Enhanced GRADE facilitates the development of robust, evidence-based vaccine policies by WHO.
• Ongoing refinement of the GRADE approach will ensure continued alignment with the full spectrum of relevant evidence for immunization recommendations.