The Korea Expert Committee on Immunization Practices (KECIP), operating under the Infectious Disease Control Committee within the Korea Disease Control and Prevention Agency (KDCA), plays a vital advisory role in shaping immunization policies.1 KECIP was established under Article 10-2 of the Infectious Disease Prevention Act and Article 3-3 of its Enforcement Decree, along with its 15 sub-committees, was constituted to develop guidelines for the prevention and management of vaccine-targeted infectious diseases and address key vaccine-related issues in Korea.2 The KECIP has been served as an advisory body for the management of vaccine-targeted infectious diseases, with the primary objectives of designating and revoking infectious diseases requiring vaccination, establishing criteria for vaccination implementation, methods, policies for vaccine-targeted infectious disease management, and eradication plans.

Given the increasing complexities of vaccine science and emerging infectious diseases, such as coronavirus disease 2019 (COVID-19), there is a pressing need to enhance the functions and procedures of KECIP. This enhancement is imperative to provide timely, objective, and transparent recommendations.3 To address this, a policy study was conducted, reviewing the current status of KECIP and similar committees worldwide, consulting domestic and international experts, and examining the operations of renowned committees, including the Strategic Advisory Group of Experts on Immunization and the US Advisory Committee on Immunization Practices. This study aimed to propose improvements to KECIP based on the findings collected from surveys and expert consultations.

This study targeted the expert advisory panel of KECIP. Participation in the survey was solicited via e-mail from 40 experts identified by the KDCA, 19 of whom participated in the survey. The data were collected through an online survey conducted between January 15th and 19th, 2024.

The survey questionnaire developed by the authors was modified based on input from an infectious disease specialist and the head of the relevant department within the KDCA. The questionnaire comprised 47 multiple-choice questions aimed at improving KECIP across nine key topics (Table 1): 1) Composition and structure of KECIP (5 items), 2) Submission of agenda to KECIP (3 items), 3) Preparation of materials and time for agenda deliberation by KECIP members (12 items), 4) Proposal of opinions from the perspective of vaccine manufacturers, citizens, and patients at KECIP meetings (7 items), 5) Impact of decisions made by KECIP (3 items), 6) Selection of expert committee members of KECIP (6 items), 7) Selection and role of the KECIP chairperson (4 items), 8) Role of committee members at KECIP meetings (3 items), and 9) Disclosure of results of KECIP meetings (4 items). The Korean questionnaire is presented in Supplementary Data 1.

The multiple-choice questions used a 5-point scale, ranging from “strongly disagree” to “strongly agree.” For analysis purposes, the responses of “strongly disagree” and “disagree” were combined into “disagree,” while responses of “strongly agree” and “agree” were combined into “agree.” The survey results were tabulated using the number and percentage of respondents for each item’s scale. Excel (MS Office Excel 2018; Microsoft, Redmond, WI, USA) was used to construct the tables.

A total of 19 experts participated in this survey, representing various fields of expertise: five in internal medicine (infectious diseases), four in pediatrics (infectious diseases), three in preventive medicine, one in pediatrics (other than infectious diseases), one in family medicine, one in public health epidemiology, one in statistics, one in microbiology, one in immunology, and one in a consumer group. The sex distribution was as follows: 14 male and five female. Regarding the experience in their fields, eight respondents had 26–30 years of experience, five respondents had more than 30 years, four respondents had 21–25 years, and two respondents had 16–20 years. In terms of experience within KECIP, 13 respondents had 1–5 years of experience, two respondents had 6–10 years, one respondent had 11–15 years, two respondents had 16–20 years, and one respondent had more than 30 years of experience. The responses to the 47 survey questions on the nine topics regarding the improvement of KECIP are represented in Table 1.

Most respondents (73.7%) agreed with the current KECIP member count (15 people) and supported the maintenance of subcommittees (84.2%). Nearly all participants (94.7%) believed that the subcommittees should handle new vaccine agendas. Furthermore, the majority of respondents (89.5%) emphasized the need for establishing a dedicated crisis response team. However, opinions on the term length of KECIP were divided (36.8% disagreed, 42.1% agreed, and 21.1% were neutral). Opinions were divided on whether the KDCA thoroughly reviewed the agenda and provided detailed materials (47.4% agreed, 31.6% were neutral). Most participants felt that the KDCA’s self-evaluation was necessary (73.7%) and the majority of respondents (94.7%) indicated that incomplete data submitted by the vaccine manufacturer should prompt resubmission. The participants stressed the need for thorough preparation, including the background materials and laws (100% agreement). Adjusting the meeting size and time according to the agenda weight was favored (94.7%). Expert committee members were expected to review the data carefully (84.2%) and maintain confidentiality (94.7%). Moreover, there were concerns about insufficient clinical and epidemiological data for deliberation (42.1% agreed, 26.3% disagreed, and 31.6% were neutral). The distribution of meeting materials in advance was contentious (47.4% disagreed, 36.8% were neutral, and 15.8% agreed). Those seeking more preparation time suggest 1–2 weeks.

The opinions varied regarding the representation of vaccine manufacturers’ views, with most respondents being neutral (47.4%) and a few agreeing (31.6%). Additionally, there was a consensus (78.9%) that vaccine manufacturers should clarify queries at KECIP meetings. Regarding the public input, opinions were divided into a slightly higher percentage of agreement (36.8%) and remaining neutral (31.6%). Many believed that citizens/consumers should have the opportunity to participate in KECIP meetings (57.9%) and that a written proposal was not adequate for their input (63.1%). However, the respondents disagreed that a written proposal was sufficient for vaccine manufacturers’ opinions (47.4%). Regarding the consumer representation in KECIP, most disagreed (47.4%), with a few being neutral (26.3%), and a few agreed (26.3%).

The majority of respondents (94.7%) agreed that KECIP members should be notified of the KDCA’s final decisions after meetings. Several respondents (84.2%) believed that KECIP decisions should influence the KDCA’s final decisions. However, opinions vary on whether KECIP should remain solely advisory, with more disagreements (42.1%) than agreements (31.6%). All participants prioritized expertise as the primary criterion for the selection of expert members. Several participants (89.5%) emphasized the need to check for conflicts of interest, and 78.9% advocated the exclusion of members with ties to pharmaceutical companies. Most participants (94.7%) agreed to disclose their interests. While 84.2% of respondents permitted participation in relevant expertise, those with conflicts were excluded from decision-making. The establishment of specific selection principles was deemed necessary by 73.4% of respondents, including years of experience, verifiable research performance, and ethical considerations.

A vast majority of respondents (94.7%) believed that the chairperson should prepare in advance to streamline meetings, gather expert opinions, and refine questions. Additionally, 89.5% of respondents supported the chairperson’s authority to lead and make decisions regarding the meeting’s privacy. Similarly, 94.7% of respondents agreed that the chairperson could take the steps necessary for fair proceedings. However, opinions varied regarding whether the chairperson should simply facilitate, with 47.3% of respondents disagreeing, 31.6% of respondents agreeing, and 21.1% of respondents being neutral. Furthermore, most participants (94.7%) agreed that the expert committee members offered adequate scientific and technical advice on the implementation of immunization. Additionally, 78.9% believed they should advise on the KDCA’s laws and regulations. Similarly, 94.7% of participants supported the notion that expert committee members should provide fair and objective opinions during meetings. Regarding the disclosure methods, the majority of respondents (78.9%) suggested varying methods based on the agenda, and an equal proportion of respondents (78.9%) advocated public access to expert committee meetings, with certain parts being held privately. However, regarding confidentiality in disclosure, 57.9% of respondents disagreed with its necessity, 21.1% of respondents agreed, and 21.1% of respondents remained neutral. The opinions were evenly divided on making the results public for accountability: 36.8% disagreed, 31.6% were neutral, and 31.6% agreed.

Given the growing emphasis on the importance of preventing infectious diseases and the expanding goals and targets of immunization efforts, this survey provides a timely opportunity to reflect on the role of KECIP and its future directions. The National Immunization Technical Advisory Group serves as a crucial resource and decision-making body, providing evidence-based guidance to the national authorities amidst complex health systems and global interdependence.4 During this survey, new challenges regarding the appropriate composition, role, qualification requirements, and selection methods of the committee were identified alongside KECIP’s existing functions of reviewing data, developing recommendations, and publishing updated national guidelines and immunization schedules.5

Overall, most respondents supported maintaining the current member count and having subcommittees handle new vaccine agendas, while emphasizing the need for establishing workgroups. Opinions varied on the term length of KECIP and the thoroughness of agenda reviews by the KDCA. Most respondents stressed the importance of thorough preparation, careful data review, and maintaining confidentiality. There were concerns about insufficient clinical and epidemiological data, as well as varying opinions on public input and representation of vaccine manufacturers’ views. While most agreed that KECIP decisions should influence KDCA’s final decisions, opinions were split on whether KECIP should remain advisory. Criteria for expert member selection, the role of the chairperson, and disclosure methods were also discussed, highlighting the need for transparency and expertise in decision-making processes.

While KECIP has regulations that allow the establishment of a subcommittee, the current structure and functioning of this subcommittee are not well defined. In contrast, countries such as the United States,6 the United Kingdom,7 and Australia8 use subcommittees or work groups to thoroughly examine specific topics and clarify issues, thus facilitating well-informed and efficient decision-making processes. The survey findings and discussions within the expert advisory subcommittee strongly emphasize the necessity for workgroups in South Korea. To enhance the efficiency of these workgroups, it could be beneficial to distinguish between permanent and non-permanent groups and regularly reassess their roles and research topics. Through the active participation of these workgroups, KECIP will be able to efficiently evaluate current vaccine usage and respond appropriately to the development and introduction of new vaccines.

The findings of this study underscore the critical role of KECIP in shaping national vaccination policies. With the increasing complexity of vaccine science and the emergence of new infectious diseases, there is a pressing need for robust and informed guidance from expert committees, such as KECIP. To fulfill this advanced role, KECIP should adopt a more inclusive approach to agenda setting, allowing for bottom-up suggestions and ensuring transparency in the decision-making process. Standard operating procedures should be developed to clarify the roles and operational methods of work groups. The committee should ensure that the experts participating are free from conflicts of interest, and it should explore avenues to incorporate diverse viewpoints while maintaining their expertise.

In conclusion, this study provides valuable insights into the current status and future directions of KECIP. Moving forward, efforts to strengthen KECIP’s capacity and effectiveness are essential for addressing evolving public health challenges and ensuring the continued success of vaccination programs in South Korea.