The Handbook informs clinicians about the safest and most effective vaccination strategies in Australia. The Australian Technical Advisory Group on Immunisation (ATAGI) bases its recommendations on high-quality evidence, such as well-conducted randomised controlled trials and meta-analyses. However, if high-quality studies do not exist, ATAGI refers to less rigorous studies, such as uncontrolled clinical trials, case series or other observational studies. ATAGI consults other clinical guidelines, if relevant, to help frame recommendations in the Australian setting.
ATAGI also reviews immunisation handbooks produced by comparable countries. If published sources are inadequate, recommendations are based on expert opinion.
However, developing recommendations can have limitations and challenges as a result of:
- unaddressed scientific questions
- complex medical practice issues
- continuous new information
- differences in expert opinion
Despite these limitations, ATAGI seeks to provide clear and relevant recommendations, where possible.
Since July 2020, ATAGI has been moving towards the use of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for developing Handbook recommendations. This aligns with the recommendation of the National Health and Medical Research Council (NHMRC) of Australia for the development of its guidelines.
The GRADE approach was developed by the GRADE Working Group. It offers a framework for rating the quality of the available evidence in a systematic review, and developing and grading the strength of healthcare recommendations in guidelines. The GRADE approach also offers transparency to the recommendation development by using a standard format for presenting the evidence-to-decision process.
It has since been widely recommended by international guideline development bodies such as the World Health Organization (WHO). The WHO Strategic Advisory Group of Experts (SAGE) on Immunization and the Advisory Committee on Immunization Practices (ACIP) of the USA have used GRADE for developing some of their recommendations on use of vaccines.