Twinning between national immunization technical advisory groups: an innovative approach to strengthening evidence-informed immunization policy in the Americas

Sanwogou N.J.; Evans-Gilbert T.; Lopez G.M.; Bonvehí P.; Wharton M.; Kfouri R.; Stecher D.; Verne E.; Melgar M.; Figueroa J.P. · Vaccine: X (2026) · DOI: 10.1016/j.jvacx.2026.100907

Resumen

Background National Immunization Technical Advisory Groups (NITAGs) play a key role in evidence-informed immunization policy. To strengthen their capacity, a regional twinning initiative was introduced in the Americas to promote peer-to-peer collaboration. Methods A descriptive mixed-methods evaluation was conducted of the NITAG twinning initiative implemented through the Regional NITAG Network of the Americas (RNA) and the Pan American Health Organization (PAHO)-led Evidence-informed Vaccine and Immunization Decision-making and Appraisal in the Americas (EVIDA) Initiative. Informed by the World Health Organization (WHO) Guidance on NITAG Twinning, which outlined principles for twinning and criteria for pairing NITAGs. Data sources included a 2023 Twinning Interest Survey, 2023 NITAG Maturity Assessment Tool (NMAT) assessment, and a 2024 Progress-Review Survey of twinning partnerships. Data were analyzed using descriptive statistics and thematic synthesis. Results Interest in twinning was high, with nearly all NITAGs willing to participate. Priority areas included strengthening evidence-informed recommendation processes, operational capacity, and policy integration. NMAT results showed most NITAGs were at Basic or Developing levels of maturity, with weaker performance in operations, independence, and secretariat support. Survey and NMAT findings, considered alongside WHO twinning criteria, helped identify complementary strengths, capacity needs, and contextual factors when proposing twinning partnerships. These findings were used to define 12 twinning partnerships. Six partnerships remained active during the first year, supported by agreements and/or workplans. Activities covered technical immunization topics and NITAG governance and operations, with some partnerships also addressing evidence-to-recommendation methods. Key enabling factors included institutional stability, Ministry of Health support, secretariat capacity, leadership engagement, time, perceived mutual benefit, and regional coordination. Constraints included political instability, institutional turnover, limited secretariat capacity, and communication challenges. Conclusions NITAG twinning is a feasible approach to strengthen institutional capacity and support evidence-informed immunization decision-making. Its feasibility and sustainability depend on stable institutional environments, organizational support, and sustained engagement. Formal twinning may not be necessary or appropriate for all NITAGs where regional or subregional mechanisms already provide effective opportunities for peer exchange. Further evaluation is needed on long-term outcomes and scalability. Copyright