RM analysis Enembe Okokon

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DARM DA study exercise Group 1

Group 1 considered the appropriateness of a decision to vaccinate the whole population as against a decision not to vaccinate. Overall, this would seem the preferred course of action in light of the occurrence of a pandemic. It would be useful to consider the two options for future reference in the event of another outbreak.

From the standpoint of the Ministry of Social and Health Affairs

• Relevance: I find the content fairly relevant to the stated purpose. The second variable dealing with vaccination of risk groups and priority groups is not reflected in subsequent analysis and it is not part of the stated goal.
• Pertinence: This approach is pertinent to the desired goal to stop spread.
• Usability: The idea is applying wholesale vaccination. It takes into account the dynamics of H1N1 transmission, laboratory supported case detection and evaluation of action post-vaccination.
• Acceptability: The plan is acceptable in principle. It could broaden our grasp of strategies to respond to pandemics. However much depends on the quality of data from both countries.

From the standpoint of a citizen

• Relevance: Citizens would generally be aware of past vaccination campaigns in similar circumstances, therefore this would be relevant.
• Pertinence: The citizen may not appreciate why this undertaking is coming after everyone has been vaccinated.
• Usability: The logic behind the variables and calculations will be difficult to grasp.
• Acceptability: The conclusion will help enlist citizen support for future vaccination.

DARM DA study exercise Group 2

The options were vaccinate everyone with Pandemrix or vaccinate only those most at risk with pandemrix and others with routine vaccine.

From the standpoint of the Ministry of Social and Health Affairs

• Relevance: This plan would be relevant considering that the vaccine had only undergone phase-1 trial and the side-effect profile is poorly understood.
• Pertinence: The plan seeks to protect those most at risk with the new vaccine while other groups take the routine vaccine.
• Usability: This balances between the need to limit the unknown and the pressure to act now.
• Acceptability: It may be seen as another delay plan. While ministry follows the argument here, if little difference exists between both scenarios in terms of DALY, it may go ahead and vaccinate everyone.

From the standpoint of a citizen

• Relevance: Persons with aversion to vaccination will be somewhat reassured by possibilities of not vaccinating everyone.
• Pertinence: A good question would be, “if a vaccine exists, why am I not allowed to take it also.”
• Usability: the logic would be easy to follow for a citizen who realizes that vaccination and use of a new drug are both fraught with risks.
• Acceptability: Citizen would consider the plan applicable if the analysis shows clear difference between both options.

DARM DA study exercise Group 3

Group 3 sought to prevent or restrict the importation of swine flu cases by installation of thermal scanners at the airport. As a ‘stand alone’ method this may not be effective in containing spread. Strong limitations would be the incubation period of swine flu as well as validity parameters of the scanners. The practicality of installing these scanners at all entry possible points could be undermined if one considers the freedom of movement within the Eurozone.

From the standpoint of the Ministry of Social and Health Affairs

• Relevance: This method is relevant for the stated purpose of case detection.
• Pertinence: The plan would be more useful as a support to other concrete measures such as vaccination.
• Usability: The idea is clearly stated.
• Acceptability: The Ministry would accept this plan in support of others. The plan would also enhance collaboration between the Ministry of Social & Health Affairs and the Ministry of Transportation.

From the standpoint of a citizen

• Relevance: This is relevant for containment at entry points.
• Pertinence: It seems very practical, and it gives the assurance that something is actually being done. There may be fears about and resistance to being scanned
• Usability: The general logic is easy to grasp, and it raises citizen awareness on the why and how of spotting possible cases of H1N1.

• Acceptability: Results from this plan would be convincing.

DARM DA study exercise Group 4

Group 4 considered options between delaying vaccination while hygiene campaign is being used as a stop-gap measure and immediate vaccination of the whole population. The question is well defined.

From the standpoint of the Ministry of Social and Health Affairs.

• Relevance: The plan does not seem to focus on the core objective of emphasizing hygiene while delaying vaccination (as stated). The advantage of the hygiene interlude does not seem to reflect.
• Pertinence: This plan is non-specific with respect to swine flu as an index. There will be need to reconcile between the mode of transmission of a highly transmissible infection and the appropriateness of personal hygiene.
• Usability: The plan is usable.
• Acceptability: The variables and calculations will justify the results.

From the standpoint of a citizen.

• Relevance: The plan addresses the objective
• Pertinence: Vaccination delay may not allay citizen fears in the face of a global pandemic. Other supportive action will have to taken to boost confidence.
• Usability: Much will depend however on the information campaign. As a citizen, I would need convincing as to why vaccination should be delayed when a vaccine exists.
• Acceptability: The probability of swine flu spread with delayed vaccination and with immediate vaccination is key. The results in this analysis would address that. Also, a risk-benefit analysis between vaccination side-effects and swine flu would be helpful.

Overall Evaluation

I think the various plans are complementary. One should consider that different lines of action could be followed at the same time in the fight against a pandemic. The challenge would be the resource outlay. Considering that the analyses left out the pertinent issue of costs, the cost implication will be missed out if more than one these plans were being considered. Also, the usefulness of the analyses to another nation who may want to benefit from the Finnish experience but does not have similar resource base would be undermined. Most of the analyses showed consistency of thought from a stated objective through an actual assessment to meaningful results that are comparable between options. The variables seem practical and actually possible to derive. None of the plans, however, presents a format for citizen participation or broad based participation for that matter.

EXTRA: also include consideration/evaluation of the example swine flu/narcolepsy model (discussed in 8.4. lecture) in your report/presentation.

Evaluation of Narcolepsy/Swine Flu Model

The model weighted several decisions namely; to vaccinate everyone, to vaccinate no one and lastly to vaccinate all excluding persons aged 5-19 years. It compares DALYs from each of these scenarios and also considered the value of information, had the decision been taken to delay vaccination till more information was available.

From the Standpoint of the Ministry of Social and Health Affairs

• Relevance: The model does seem to factor in most variables that could make a difference in any of the stated alternative decisions. It additionally considers the impact of excluding the age range affected most by the narcolepsy. This addresses the major question of concern in the swine flu/narcolepsy saga.
• Pertinence: While the analysis is very applicable within the focused objectives, ministry and policy makers would always be interested in cost.
• Usability: The causal diagram does highlight many factors that would influence swine flu transmission and outcome as well as narcolepsy.
• Acceptability: I may not be convinced with some assumed values and probabilities within the model. Then again, the value of information analysis has shown that the difference from the initial results obtained would be negligible. This would be a useful tool for addressing vaccination skeptics.

From the standpoint of a citizen

• Relevance: The analysis addresses the stated purpose.
• Pertinence: It does seem rather very technical. I would want a breakdown of the model into a format an layman can make sense of.
• Usability: It would help me understand the multiplicity of factors that interplay in the swine flu/nacolepsy case, thus it could stimulate discussion among various stakeholders within the community.
• Acceptability: The results would convince me if broken down into layman’s terms.