Preparation of Recommendations & Decision‑Making

Organisation of Working Groups

For agenda topics requiring decisions, the Chair tasks one or more Working Groups (WGs) to review evidence and prepare a technical report. WGs are time‑bound, chaired by a core member, supported by the secretariat, and may include external experts. COI and confidentiality rules apply to all WG participants.

Development of Technical Reports

WGs define a recommendation framework and research questions. For efficacy, effectiveness, or safety questions, a PICO approach is used. Evidence is sourced (including grey literature), collected (favoring recent reviews), the search process documented, and quality assessed (e.g., GRADE, AMSTAR, CASP, SIGN). Evidence is analyzed for benefits/harms, confidence in estimates, resources, programmatic issues, and other criteria. Technical reports include an executive summary, introduction, context, methods, analysis, options, conclusions, references, and annexes.

Presentation/Discussion

Reports are circulated two weeks before meetings. Core members deliberate and reach consensus; the WG Chair drafts a recommendation note for Chair approval and signature by attending core members. Approved reports are submitted via Rwanda EPI and may be disseminated publicly after six months with appropriate caution for confidential data.

Submission to Authorities

Signed recommendations are forwarded within two weeks via Rwanda EPI. The secretariat tracks submissions and actions taken by MOH and reports back to NITAG.

Ethics

Members are bound to confidentiality and precautionary principles. Only the Chair (or delegate) communicates externally on behalf of NITAG.

Appendix 2 – Recommendation Framework (Summary)

Six broad areas are considered: (1) Disease; (2) Vaccine & immunization characteristics; (3) Vaccine intervention outcomes (safety, efficacy, effectiveness); (4) Economic considerations; (5) Health policy & programmatic issues; (6) Acceptability & equity. Critical and important elements should be systematically reviewed.

PICO approach

Population; Intervention; Comparator; Outcome – used to frame research questions, especially for efficacy, effectiveness, and safety.

Operations and Procedures

Drawing Up Work Plans

RWANDA‑NITAG develops an annual work plan prior to each fiscal year aligned to national and global immunization strategies. The Secretariat drafts the plan within two weeks after the last meeting of the previous year; core members adopt it at the first meeting of the new fiscal year. Reviews may occur semi‑annually informed by monitoring reports.

Monitoring & Evaluation Framework

The work plan is supported by an M&E plan with indicators to monitor inputs, processes, outputs, outcomes and impact. Process indicators include COI declarations, timely distribution of agendas and materials, number of meetings held (with minutes), and number of recommendations provided to MOH. Quarterly monitoring reports and a second‑year external review are planned.

Meetings

Quarterly meetings are tentatively scheduled annually. Invitations (sent at least two weeks prior) specify participants, agenda, and minutes of the previous meeting. A quorum is 50% of core members in physical attendance. Up to two extraordinary meetings per year may be called for urgent matters. Documents should be shared at least two weeks in advance. The Chair coordinates discussions and calls votes when needed (simple majority; Chair votes only to break ties).

Meeting Minutes and Reports

Minutes are circulated within one week for comments and finalized the second week for Chair approval. Minutes remain confidential; reports are not disclosed for six months to allow MOH review and action. A members‑only website area provides access to confidential documents.

Governance

Mandate & Terms of Reference

RWANDA‑NITAG advises MOH/RBC on immunization policy, including new vaccine introductions, safety/quality, and surveillance.

Roles & Duties

• Core members: participate and vote; may chair WGs.
• Ex‑officio & liaison members: participate without voting; convey institutional perspectives.
• Secretariat (EPI): organizes meetings, prepares agendas/minutes/reports, coordinates WGs, archives documents, prepares annual reports, and maintains the website.
• Chairperson: leads deliberations, official communications, and work planning; monitors member performance.

Appointment & Terms

MOH appoints core members and the Chair/Co‑Chair. Terms are five years with one possible renewal; staggered renewal after two terms maintains continuity. Non‑core members are nominated by their institutions without term limits.

Organisational Structure

Core members (Chair & Co‑Chair), ex‑officio members, liaison members, and the Secretariat hosted by the EPI Unit.

Definition

National Immunization Technical Advisory Group (NITAG): an independent expert advisory committee established by a country’s Ministry of Health to provide evidence‑based recommendations on immunization policies and strategies. NITAGs guide national decisions on vaccine introduction, schedules, and prioritization, ensuring programs are effective, safe, and tailored to the country’s needs.

• Evaluating scientific evidence on vaccines
• Advising on national immunization schedules
• Recommending new vaccines or changes to existing programs
• Supporting public health policy through expert guidance

The Rwanda NITAG was established by the Ministry of Health in December 2017 to provide recommendations on vaccine policy in line with national strategies. It is a body of national experts advising on all technical and scientific topics related to vaccines and immunization. Decisions are evidence‑based and independent of political and industry influence. The secretariat is hosted by the Expanded Programme on Immunization.

Appointment of Chair, Co‑Chair, Advisors and Members

Rwanda NITAG includes core members (independent experts serving in their individual capacity) and non‑core members (ex‑officio and liaison representatives). Only core members vote on recommendations. The Ministry of Health appoints core members and the Chair/Co‑Chair; terms are five years with one renewal.

Terms of Reference of Members

RWANDA‑NITAG provides evidence‑based advice to MOH/RBC on:

• Immunization policies and strategies
• Introduction of new vaccines and technologies
• Safety and quality of vaccines and VPD surveillance
• Any topics concerning vaccines and vaccination in general

Roles and Duties

Core members actively participate in meetings and working groups; only core members vote. Ex‑officio and liaison members contribute perspectives but do not vote. The secretariat (hosted by EPI) organizes meetings, prepares agendas and reports, manages documentation, coordinates working groups, prepares annual technical and financial reports, and maintains the website. The Chair leads deliberations and work planning and communicates with authorities and the public.

Term of Office

Core members serve an initial five‑year term; renewal for a second five‑year term is possible. Provisions exist for replacement due to non‑participation or resignation. Post second term, staggered renewal applies to maintain continuity. Non‑core members have no term limits and are nominated by their institutions.

Conflict of Interest and Bias

Members declare interests at each meeting and sign a COI form; confidentiality agreements apply during service and for five years thereafter. Specific information from other institutions may require information‑specific confidentiality agreements.