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Joint Committee on Vaccination and Immunisation

The Joint Committee on Vaccination and Immunisation (JCVI) advises the Secretary of State for Health and Welsh Ministers on vaccination and immunisation policies. As an academic primary care physician, I am a strong supporter of evidence-based immunisation schemes and also believe - as far as is practical - in open policy-making in which evidence that government bodies use to make their decisions is made public. In a letter published in the British Medical Journal , I commented on the use by the JCVI of unpublished data and refusal of the JCVI to make public all the evidence it uses.

The Chair of the  JCVI, Andy Hall, states that the Joint Committee on Vaccination and Immunisation (JCVI) does not make public all the evidence it uses for its decisions because this would lead to scientists refusing to send their work to the committee before it was published in a peer reviewed journal. However, he does not supply any evidence supply evidence that academics would refuse to supply unpublished data. With the impact of research being a key component of the Research Excellence Framework that will judge universities on their research, it is likely that academics would be very keen to have their work used by policy-making bodies. Andy Hall also did not give any examples of where the use of unpublished evidence has resulted in decisions that have led to improved health outcomes or reduced mortality.

Andy Hall also states that the processes the committee uses are “at least as robust as those of scientific journals.” However, the peer review processes used by medical journals are flawed, errors in articles are common, and many factual errors and methodological problems are not detected until after publication. Andy Hall did not expand on how the JCVI aims to deal with these problems in the unpublished evidence it receives.

I believe that the JCVI should have substantially more rigorous procedures for peer review than scientific journals because its decisions have major implications for public health, health outcomes, and healthcare spending. Furthermore, decisions on immunisation policy are partly subjective. For example, chickenpox vaccination is part of the childhood immunisation schedule in the USA but not in the UK. Hence, immunisation committees in different countries can look at the same evidence but reach different conclusions. Public policy making is not an exact science but should as far as possible be based on robust publicly available evidence that can be fully assessed by external stakeholders.

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