A doctor holds a needle syringe and gauze over a patient

To advance expert advice on vaccination policy beyond COVID-19, improve coordination and confidence

It was an integral part of public health policy making activities Dealing with expert advisors and transparent discourse With federal agencies responsible for major policy decisions. With regard to vaccines and immunization efforts, this work has long involved the circulation of multiple streams of scientific evidence by publicly meeting expert advisory bodies—a Transparency believed to enhance public confidence In the final decisions reached – and close engagement with federal agencies that ultimately shape policies and regulations.

How does the government seek expert advice?

The federal government receives expert advice through Several Federal Advisory Committees. For example, the Advisory Committee on Vaccines and Related Biological Products (VRBPAC) advises the Food and Drug Administration (FDA) on the safety and effectiveness of experimental new vaccines, and the Advisory Committee on Immunization Practices (ACIP) provides guidance to the Centers for Disease Control and Prevention (CDC) on the optimal use of vaccines. Authorized or approved, the National Vaccine Advisory Committee (NVAC) advises the Office of the Assistant Secretary of Health in the Department of Health and Human Services on national vaccination activities and strategies to ensure adequate vaccine supply and optimal use of vaccines (as shown in Figure 1).

Figure 1: Major US Federal Advisory Committees Related to Vaccines, Vaccination Programs, and Their Activities Related to COVID-19 Vaccines, 2020-22

Sources: US General Services Administration, FACA Law Database and Advisory Commission websites. NB: These advisory committees usually meet three times a year.

Since the onset of the pandemic, vaccination decisions have appeared in nearly real time, been widely disseminated across news outlets and social media, and exposed to misinformation that has contributed to confusion and indecision. Urgent questions about which vaccines should be authorized for use and for whom, which groups should receive the limited number of initial doses, and many others, all require a quick resolution. However, historically respected processes that incorporate expert panel guidance have been formidably challenged, highlighting weaknesses in the mechanisms that support evidence-based policymaking during a crisis and possibly contributing to eroding trust in public health agencies and their recommendations during, and most likely Then. , the crisis.

Historically, outside expert advice has enhanced the quality and transparency of public health decision-making. And in the best of worlds, during a crisis like the COVID-19 pandemic, this approach has the potential not only to support the work of health officials but also enhance public understanding and confidence in decisions. These roles are especially important when the scientific evidence Limited, vague, or rapidly developing.

During the COVID-19 pandemic, policy makers and the public have relied heavily on these committees. For example, since the beginning of the pandemic, the Centers for Disease Control and Prevention (CDC) ACIP, a group that meets in person three times a year on dates scheduled months in advance, has held 25 meetings dedicated in whole or in part to coronavirus vaccination. Many of these meetings were announced publicly only days before they were to take place. These formal online public meetings are supported by dozens of working groups and support group meetings to gather, discuss, and prepare for full group deliberations.

Decision making in times of crisis

Panels of experts provide the ability to understand volumes of information, which is published quickly and in recent times, often initially via non-peer-reviewed prepress servers. These expert groups also bring important collective knowledge when dealing with many unanswered questions and unknown outcomes. In some ways, these challenges are not atypical for all decision-making processes during a crisis, when incomplete information, great uncertainty, and the need to operate under stressful time constraints are common. But during a crisis, there are many inputs that policy makers must consider, absorb and act on, with expert advisors’ advice being just one stream.

Unfortunately, the pandemic has shown us that during a crisis, the views of expert committees can also be reduced or diminished. For example, in August 2021, the White House preempted open and public discussions and recommendations from VRBPAC and ACIP when announcing a plan to provide COVID-19 vaccine booster footage to the public:

Pending final evaluation by the Food and Drug Administration (FDA) and recommendations from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). Under this plan, a booster dose will be given, eight months after the individual’s second dose, starting the week of September 20. “

This atypical announcement, which publicly predicted a specific outcome prior to the deliberations and recommendations of expert panels, and subsequent decisions by the health agencies they advise, was a marked departure from well-established and evidence-based decision-making.

After deliberations of VRBPAC and FDA authorization of booster doses for a narrower group of citizens than expected for the August 2021 White House announcement, the CDC recommended a booster dose for adults over 65 years of age, and adults ages 18 to 64 Those who have medical treatment. conditions, and adults are at a high risk of exposure because of where they live or work. This last group was included despite an unfavorable vote from ACIP, a political action that, while within the purview of a CDC director, is extremely rare in the committee’s nearly 60-year history.

VRBPAC discussions about reinforcements were noteworthy for deliberating and recommending that certain populations be boosted with additional doses since this is a more common conversation about ACIP fees and activities. Like much of the work related to COVID-19 vaccines and the broader response to the pandemic, conversations about boosters by the two groups were based on a wide range of considerations and corresponding types of experience, often beyond the usual scope of each individual committee. In this regard, the pandemic has shown us that during a crisis, traditional models—such as the typical separate approach of each advisory body—can be replaced by alternative models—such as bringing groups together to trade collaboratively. This approach could have improved the quality of advice provided and received by the public. It would also have facilitated the participation of additional experts and expertise – such as social sciences, communication, and ethics, to name a few. These areas of expertise were closely related to the situation but were not represented in these types of expert committees.

Such an approach would not be unprecedented. In 2009, the NVAC and ACIP held joint meetings when they were tasked with creating priority groups for limited supplies of the H1N1 influenza vaccine. Currently, the delayed performance of the COVID-19 booster vaccination effort—with more than 80 million Americans yet eligible for a booster dose—may partly reflect the remaining consequences of the way in which the evidence and the importance of the booster doses discussed and reported by political appointees, health officials, and their expert advisors in recent months.

Transparency builds trust

Ultimately, the value of expert advice and the process by which it is obtained comes not only from the informed and independent guidance provided by members of the Committee, but from the rigorous, transparent and open deliberative process by which it is given, in both routine and crisis times. The significant challenges to COVID-19 vaccine policy making highlight the importance of preserving the many assets of traditional expert advisory mechanisms while also noting the need to adapt to reflect the unique pace, difficulties, and questions associated with public health decision-making in any crisis. This type of screening based on the experiences of the COVID-19 pandemic would enhance the remaining work on COVID-19 vaccination as well as prepare for future health emergencies.

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