Table 4.

Examples of design features demanding careful considerations of trade‐offs among quality, relevance, and legitimacy

Features	Considerations for quality, relevance and/or legitimacy	Illustrative quotes
Meeting tight timelines by recruiting experts with well‐known reputation more easily and rapidly through pre‐existing networks versus dedicating resources to manage an open call for nominations	Securing the preferred expertise can increase the quality of the advice, but recruiting from too narrowly confined networks could negatively affect diverse representation and risk bringing experts sharing very similar perspectives to the table, thereby risking diminishing the relevance and legitimacy of the advice	“there should be some kind of transparent process to make sure we get best sorts of people on these committee, and some kind of process which is nomination rather than just inviting people” (WHO interviewee 1) “I saw this in many areas, where people had a club of people they relied on to come to meetings, and that lead to a single view” (WHO interviewee 16) “if it is left up to one or a couple of people, it tends to be people they know, the networks they know, and really like‐minded participants” (WHO interviewee 20)
Securing an appropriate mix between experts recruited from reputable academic institutions and experts recruited more broadly to enhance the geographic representation in SACs	Well‐known experts from reputable institutions can strengthen the quality of the advice, but loss of geographic representation risks compromising relevance and legitimacy	“you need to take tough decisions on what are the diversity dimensions that are more important for you in this specific committee than perhaps in others” (WHO interviewee 8) “We have also seen that so‐called experts from Northern or developed countries may not even have the slightest idea of working under the conditions that our guidelines are telling them to” (WHO interviewee 14) “a lot of the expertise in the area in which we are mainly working is quite geo‐concentrated. A lot of the expertise actually, at least in the topics we discuss, is in the UK, the US, the Netherlands, and that's where a lot of the real experts, if you like, are. But obviously you can't just have meetings with people from those parts of the world” (WHO interviewee 16) “We try as much as we can to have geographic representation, but we won't compromise science and competency for a better scientific representation” (WHO interviewee 18) “we cannot have a meeting dominated by Americans and Europeans, which tend sometimes to be the case because many experts of course are in the best universities in the world, which happens to be in North America or Europe.” (WHO interviewee 22) “We need to constantly be trying to see how we cannot only, as an institution, we need to take some more proactive measures to get more engagement by the country on doing some of the scientific work. Unless we do it, our scientific advisory bodies will always be skewed” (WHO 34)
Securing an appropriate mix between experts from academia and experts working at an operational level	An overemphasis on recruiting academics to SACs could compromise the practical relevance of guidance	“We need to make sure the type of people convened on advisory committees are not just academia, we need a range of stakeholders, people that work obviously on the research, the primary research around themes, but also people that are implementers, that work on an operational level, that can give information and provide valuable aspects on how guidance could work or not work in such situations” (WHO interviewee 2) “I think it is equally important to have a balance between the technical experts and the doers, so between academics who are very well published on a topic, and people who have more operational and management experience of the same thing” (WHO interviewee 6)
Securing an appropriate mix between maintaining a fully transparent process and enabling a closed space where experts can discuss more freely without interference	Transparency is vital for SAC's legitimacy, but allowing space for closed discussions is necessary to strengthen the quality of the experts' discussions	“As you want a committee to deliberate freely, you also need to give them some space for doing so….Otherwise, you will not have this out‐of‐the‐box thinking, because people would not dare to say innovative things, because [they'd think] ‘oh, it's already quoted in the media, we haven't even looked at the likely consequences of a certain idea'. Therefore, you need to give them space and confidence, and we need to have this confidence in people that they are doing the right work, but then they need to come up with it, and make it public once they've all agreed on a certain idea” (WHO interviewee 8) “We only allow participation of experts who will come and inform the debate…why do we remove the observers? Because otherwise the committees would be dominated by organizations, or the funders, or people that are coming as observers but are actually not observing, they are influencing the debate” (WHO interviewee 12)
Securing an appropriate mix between tight management of conflicts of interests versus eliminating experts in spite of these not having a direct relationship with commercial entities with an interest in the subject matter	Management of conflict of interest crucial for quality and legitimacy, but very stringent policies risks in some technical areas, where few suitable experts are available, to compromise the quality and relevance of the advice	“…once we start applying rigidly the rules of conflict of interest, then you are supposed to identify if you belong to whatever university, and then people start asking, hold a second, the company that developed this drug is giving money somehow to the university…then that is seen as perhaps a potential conflict of interest. If we are very very strict, you end up, and this is the concern we have now, with people that are completely out of the business” (WHO interviewee 22)