the national advisory committee on immunizing agents was initially established in 1964 with a mandate to provide advice on immunizing agents to the department of national health and welfare , and to make recommendations on immunizing agents that appeared to warrant special consideration to the dominion council of health . in 1975 ,
the mandate was revised to focus on advice related to the introduction of new vaccines in canada and to assist in the development of immunization programs . in 1978 ,
the name of the committee was changed to the national advisory committee on immunization , reflecting the revised mandate for consideration of procedures related to immunization and immunization coverage . over the years
, naci has evolved from providing advice on only a few vaccines to now providing technical guidance for > 50 different authorized vaccine products to prevent 24 different diseases ( 4 ) .
naci is a highly regarded scientific advisory committee that has been recognized globally as one of 15  well - established national immunization technical advisory groups  ( 5 ) that can be regarded as a resource in establishing similar groups in other countries to enhance the use of evidence - based decision - making processes in the development of immunization programs and policies . in canada , the national advisor on healthy children and youth has recognized the importance of the work of naci , and recommended that  the federal government continue to support the work of the national advisory ( committee ) on immunization ( naci ) in getting valuable information to health care providers and parents  ( 6 ) .
the current mandate of naci is to provide the public health agency of canada ( phac ) with ongoing and timely medical , scientific and public health advice related to vaccines and certain immunoglobulins for both adult and pediatric populations ( 7 ) .
this is accomplished through the efforts of appointed expert members , liaison representatives from organizations with an interest in immunizations and vaccines , as well as ex officio representatives from relevant areas of the federal government , and secretariat support through the centre for immunization and respiratory infectious diseases ( 8) . the vaccine industry provides valuable information to the committee related to products in development and ongoing clinical trials , but they do not participate in naci s funding , its deliberations or in the development of its recommendations .
members are expected to express their personal opinions as informed by their professional expertise , experience and relevant evidence .
members are asked to submit conflict of interest declarations annually and provide updates as they arise .
these declarations are assessed for impact on naci deliberations and recommendations , with potential management strategies including limited participation on specific agenda items .
the intent of the committee is to ensure that unbiased expert advice , based on best practices and evidence , is provided to assist phac in informing the canadian public health community and frontline providers . as the committee has evolved , a scientific methodology and more transparent process have been embraced for making recommendations .
a search of relevant published data , along with grey literature , is conducted to understand the currently available information regarding vaccine efficacy , effectiveness , immunogenicity and safety .
the literature review is generally guided by a working group chairperson to ensure that all relevant data are reviewed .
these data are then synthesized , along with a ranking of the level and quality of evidence .
canadian epidemiology , using a variety of published and unpublished sources , is used to understand the burden of disease and the potential for improving health at a population level for a particular disease .
the committee then  puts it all together by reviewing the benefits and risks , following which the evidence is translated into scientifically grounded recommendations ( 9 ) .
once naci has made its recommendations , several products are developed to ensure that they are available to a variety of stakeholders .
naci s recommendations can be found in the canadian immunization guide ( 4 ) ( the guide ) , in advisory committee statements and in detailed literature reviews ( 7 ) .
the guide is intended to support the front - line immunizer in providing the right vaccine at the right time to the right person via the right route and at the right dose .
it also assists health care professionals in responding to questions from potential vaccine recipients or their caregivers , including providing current knowledge regarding vaccine safety . in 2014
, the guide has been moved from its traditional book format to an internet - based  ever - green format .
this change allows for timely updating of information and improvements in providers ability to obtain the most accurate information .
advisory committee statements provide details of the canadian epidemiology related to the disease under consideration , an overview of the efficacy , effectiveness , immunogenicity and safety of a particular vaccine , and a summary of naci s recommendations for the use of that vaccine .
more details regarding the literature review that was conducted to support the development of the statement and its recommendations are often published separately .
the literature review , the advisory statement or both contain detailed tables summarizing and assessing each individual study that was considered .
the number of advisory committee statements written annually has increased over the years , reflecting the increase in the number , complexity and specific indications for use of vaccine products .
each year , this statement provides an overview of the epidemiology from the previous year s influenza season and a summary of the vaccines available in canada for the upcoming influenza season , along with their recommended usage .
recent updates to the influenza statement have included a change in the recommended pediatric dose for those six to 36 months of age from 0.25 ml to 0.5 ml ( 10 ) , a preferential recommendation of live attenuated intranasal influenza vaccine for children two to six years of age ( 11 ) , a recommendation for vaccination of egg - allergic individuals when this had previously been a contraindication ( 10 ) and the progressive expansion of the age indications for routine influenza vaccination , which is now recommended for everyone 6 months of age ( 12,13 ) .
current issues being considered include the use of quadrivalent vaccines that provide protection against both lineages of influenza b and the possible preferential use of more efficacious vaccines in certain age groups .
as new products , evidence and indications evolve , naci revisits its recommendations to keep them up to date , relevant , and based on the best and most current evidence .
vaccine development pipelines contain candidate vaccines targeted not only against infectious diseases , but also to prevent chronic diseases .
vaccine technologies are also expanding , with the potential to prevent a range of diseases that have proved to be challenging to address with current technologies .
as these new products come to market , there will be an increasing demand for rigorous , unbiased guidance to understand how they can be used to improve the health of canadians .
as the vaccine landscape becomes more complex , it may be necessary to expand this mandate to include other elements in the analysis and recommendations ; for example , the feasibility and acceptability of a new vaccine , as well as the cost effectiveness and societal impact .
additional attention must also be devoted to vaccine program considerations including vaccine uptake , vaccine hesitancy , and surveillance systems to monitor vaccination programs and vaccine safety . given this possible expanded mandate , it may be necessary to employ a different model of creating vaccine guidance and recommendations ; however , it will continue to be essential to ensure that the processes used by naci are systematic , rigorous , transparent , timely and unbiased .
over the past 50 years , naci has contributed to the practice of immunization by providing thoughtful , practical and evidence - based guidance to individual vaccine providers , as well as to provinces and territories for their publically funded programs .
naci and phac , which supports naci s work , recognize the importance of this work and are committed to continuing to provide this advice within the rapidly changing landscape of vaccine development and a possible evolving mandate of the committee . as it has been in the past 50 years , the advice of naci will continue to be vital to supporting the future delivery and uptake of the modern miracle of vaccines .
 vaccines have saved more lives than any other innovation in modern medicine . 
 national immunization committees play a vital role in the development of evidence - based recommendations for the use of vaccines . 
 the present article describes the evolution and work of the national advisory committee on immunization in canada as the group marks its 50th anniversary . 
 the article also provides insight into the future challenges that the committee is likely to face . 
THE HISTORY OF NACI
THE PEOPLE AND THE PROCESS
KNOWLEDGE TRANSLATION
FUTURE CHALLENGES
SUMMARY