Although it is physically published irregularly (the last edition was in 2006) every alteration to the advice is posted on the website and a “patch” is provided which can be printed and pasted into the hard copy of the book. The chairman of the committee speaks on the work of the committee at see more meetings of Immunisation Coordinators in

England annually and when requested in Scotland, Wales and Northern Ireland. The committee functions well and in general has not had specific problems. A general concern has been how we ensure that the committee keeps up to date with the latest evidence. There are many vaccines involved in the programme and the committee would like to see any relevant evidence that might affect existing policy on these at each meeting. However the volume of work in carrying out rolling systematic reviews makes this impossible. Of course the committee members are themselves all involved

in vaccination – either research or programme delivery – and the Nutlin3a secretariat in Department of Health are constantly exposed to new information, therefore the committee relies on these sources to keep the committee up to date. The committee would ideally like each cost-effectiveness analysis to be carried out by at least two groups using different methods. This has occurred with the work on modelling of influenza A H1N1v epidemiology and vaccination. However to do this for each question facing the committee

is beyond the infectious disease modelling capacity of the UK—although the UK is very well supplied with such expertise. The growth of interest in this area of science and the extensive training now ongoing should resolve this limitation in time. A result of the changes resulting from the NHS Constitution is that we need to strengthen the committee in economics and infectious disease modelling expertise. In addition the committee has been criticised for a lack Thalidomide of openness—this is a topic the committee regularly reviews and plans to take steps to improve transparency in the near future. JCVI is an independent committee which advises Ministers of Health in the UK on vaccine policy. It has been successful in that the Government has, to date, implemented the advice. However the processes of the committee are constantly being criticised (unfairly in the opinion of the committee, which is strongly protective of its independence and regards it as vital to its role) either by the vaccine industry for not allowing them sufficient access to the committee or by the public for being too influenced by the vaccine industry. In addition there is constant pressure to increase openness and transparency in the committee activities. This is likely to lead to changes in the near future, although ensuring that any changes made are not detrimental to its role and function. The author state that they have no conflict of interest.