When developing a new vaccination recommendation, STIKO usually needs to address a set of key question. These questions fall within the five categories:

1. pathogen characteristics;
2. characteristics of the target disease;
3. vaccine characteristics (effectiveness/efficacy, safety);
4. vaccination strategy (e.g. number needed to vaccinate; vaccination coverage needed to reach the vaccination goal; potential population-level effects of the vaccination),
5. implementation of the recommendation (possible obstacles; potential acceptance of the vaccine in the population; other preventive measures; if a valid analysis is available: cost-effectiveness of vaccination).
   

Finally, based on these key questions, a risk-benefit assessment is conducted by STIKO and the overall public interest in the vaccination is considered. Besides individual risks and benefits, STIKO considers also risks and benefits on the population-level.

In 2011, STIKO implemented a new Standard Operating Procedure (SOP), which was developed by the STIKO working group on methods. The exchange with other national and international immunization technical advisory groups during two international workshops, which were funded by the German Federal Ministry of Health, supported this development.