When data permit, specific rules of evidence – such as those followed by the US Preventive Services Task Force – are used to judge the quality of data and to make

decisions regarding the nature and strength of recommendations. In the absence of data or when SCR7 clinical trial data are inadequate, expert opinions of voting members and other experts are used to make recommendations. Other considerations and inputs used in formulating policy recommendations include clinical trial results and information provided in the manufacturer’s labeling or package insert; equity in access to the vaccine and responsible management of public funds; recommendations of other professional liaison organizations; and the feasibility of incorporating the vaccine into existing immunization programs. ACIP WGs often review WHO recommendations as a secondary source of information in their deliberations. In the U.S. setting WHO recommendations (vaccine position papers) may not be as relevant as they are in the WHO check details Regions and countries. In general, differences between ACIP’s recommendations

and WHO recommendations are relatively minor and reflect differences in epidemiology and clinical presentations between the US and the developing country setting. Draft recommendations are subjected to extensive review by scientific staff of the CDC, other relevant federal agencies, ACIP members, liaison representatives and external expert consultants. WG members or ACIP members may identify a need for additional data, corrections in data content and modifications of the interpretation of the data and may critique or challenge expert opinions. Occasionally surveys are considered, e.g. surveys of parents already concerning acceptance/knowledge of a vaccine or surveys of immunization

providers. Public comments are solicited during each ACIP meeting and are considered in the decision-making process. These inputs are synthesized by the WG in an iterative process, and options are presented to the ACIP for final consideration and vote. WG meeting minutes are not available to the public, as WGs are not governed by the laws and procedures of the US Federal Advisory Committee Act. WG meetings are closed, internal meetings for the purpose of fact-finding and data review; neither involve deliberation nor voting on specific policy recommendations; nor do they include the entire membership of the ACIP.