ACIP unanimously recommends adoption of an evidence-based system

During a meeting today in Atlanta, the Advisory Committee on Immunization Practices unanimously recommended adopting a system to assess, describe and communicate the evidence and information upon which the panel’s recommendations are based.

During the ACIP meeting in June, a proposal was made to implement a system that would classify research supporting the panel’s decisions as high or low quality depending on a study’s methodology and limitations. At today’s meeting, the Evidence-Based Recommendations Work Group (EBRWG) presented a more detailed explanation of how the system would work.

“Our principles have been focusing on transparency; being able to use evidence of varying strengths; considering individual and community health; adopting or adapting a system that may already exist; continuously striving to improve the process; and applying the process to new recommendations, as well as existing recommendations without reinventing older ones,” said Jon Temte, MD, PhD, panel member and chair of the EBRWG.

In this updated description of the system, a letter grade — A, B, C or D — would be assigned to research supporting the committee’s decisions. An ‘A’ grade indicates strong research with few limitations and suggests that future data would be unlikely to affect ACIP recommendations. A ‘D’ grade, however, indicates that the panel’s decision is based on little scientific data and that future studies would likely alter the recommendation.

Additionally, the grade-based system characterizes the committee’s decisions recommending for or against a vaccine or its indications, as a Category I recommendation and a Category II recommendation would be comparable to a permissive stance.

During the meeting, panel members also expressed concerns similar to those discussed in June. Carol Baker, MD, chair of the ACIP, said evaluating information and evidence is helpful, but assigning letter grades would present a communication challenge. Recommendations driven by expert opinion as opposed to randomized, double blind studies, for example, may be discounted or viewed as weak by patients, parents and insurance payers because they would receive a ‘D’ grade, even though the recommendation is sound.

Other issues addressed by the committee included the amount of time and work that would be required to grade all scientific evidence, factoring in information on cost-effectiveness, effect of vaccination and the populations affected by the recommendation.

After suggested amendments to the proposal were introduced — including removal of grading and instead adding a detailed evidence narrative that delineates all information supporting ACIP recommendations — the panel unanimously recommended for implementation of the evidence-based system.