RM analysis Minna Ruokolainen

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Evaluation of DA study plans

Group 1

Group 1 studied the question whether the decision to vaccinate the whole Finnish population was right or should the vaccination campaing has been left undone at all. The assessment of decision not to launch vaccination campaing in Finland was done by comparison situation in Mexico where was not carried out vaccination campaing. Also the possibility to vaccinate only the priority and risk groups was considered. The analysis would have been carried out from June 2009 to March 2011.

Ministry´s point of view

• Relevance: The content of the plan is quite relevant to the purpose of the analysis. The possibility of chosen the selective vaccination campaing (only priority and risk groups would have been vaccinated) that was mentioned as one of the decision variables was finally not dealed with in the plan.
• Pertinence: The time point when this analysis would be done is after the epidemic - ´lessons to learn´-type analysis. So the Ministry would carry out and also easily adapt this type of analysis in the future, when a new, similar type of influenza epidemic will breaking out. The Ministry might consider if this analysis could be apply on the coming epidemics when they will assess shall we launch a massive vaccination campaing or not.
• Usability: The idea of the plan could be grasped. It increased ministry´s understanding of swine flu case and it could be used later on planning and managing the vaccination strategies and campaings. But if the Ministry liked to use this analysis in the future for giving the support for decision of the extant of vaccination campaing, it would need quite much gathering the information before hand. The number of variables of the analysis is quite large and some of the variables seem to be quite difficult to estimate/calculate e.g. ´actions by the pharmaceutical companies to get the vaccines ready in time´ or ´approval of the vaccines by international authorities´?
• Acceptability: The results of this analysis would be acceptable. Although the results are not yet available, we think that the final results will be as the group 1 estimates: the final decision to vaccinate whole population in this swine flu case was the right one.

Citizen´s point of view

• Relevance: The relevance of content from the citizen´s point of view is quite good. Even though the comparison between Finland and Mexico might be confusing. Also my understanding of variables and DALY´s is not clear. What is DALY, how it is calculated and what is the purpose of DALY? How should I read the results?
• Pertinence: The purpose of analysis is relevant. I, as a citizen, would like know to why this massive vaccination campaing was chosen to launch in Finland. At the time of ´normal´seasonal flu the vaccination is recommened only for the risk groups, but during the swine flu episode the vaccination was recommended for everyone. From this analysis I could find at least some explanations for the campaing.
• Usability: The usability of this plan is based on the better understanding what were the Ministry´s reasons for the massive vaccination campaing: even though this plan shows that there were risks, but still the benefits of vaccination were bigger that risks. I can also apply the information to the coming influenza vaccination campaing, when considering should I take the vaccine or not. But still there is a doubt that the Ministry or someone who is responsible for this vaccination campaing should have known the possible side effects and chosen the other vaccine. Should I trust to the authorities next time when this type of campaing will be launched?
• Acceptability: The acceptability of results for citizen might be confusing althought the results show that vaccination campaing was useful. Especially when the utility of vaccination campaing is studied afterwards and the adverse sife effects (narcolepsy) are known.

Group 2

Group 2 studied how vaccination impacted on the swine pandemic in Finland: was the massive vaccination campaing right decision or should it had been limited to the priority and risk groups. The stydied altervatives were: vaccination of whole population with Pandemrix or vaccination only those most at risk with Pandemrix and others with routine vaccine. The study would have been carried from June 2009 to 2011.

Ministry´s point of view

• Relevance: The content of DA plan is quite relevant to the purpose of the analysis. But if this assessment is carried out after the swine flu epidemic when the side effects of vaccination were known, could it be possible and/or relevant to assess the option that the groups which were in risk because chosen vaccine (in the case of Pandemrix children and teenages) should have not been vaccinated, instead of compare the massive campaing and selective campaing with Pandemrix?
• Pertinence: The purpose of analysis is relevant for the purposes of Ministry - much in the similar way than the DA plan of group 1. The Ministry could also use this type of analysis in the future - before the coming influeza epidemics. By using this analysis is possible to weight if the selective vaccination campaing is enough or should it be more effective to launch massive campaing. As well as the Ministry could weight the risks of using Pandemrix and consider if the risk for small subgroup is acceptable.
• Usability: The idea of the plan could be grasped. It increased ministry´s understanding of swine flu vaccine and could be used later on planning and managing the vaccination strategies and campaings. But Ministry can also ask if the use of Pandemrix even only for the small subgroup of the whole population is reasonable and acceptable?
• Acceptability: The results of this analysis would be acceptable. Although based on the present DA plan it is not very clear how the calculations and analyses will be done, and even the results are not yet available, I think that the final results will be acceptable. In the future analysis results will be also applicable in coming influenza epidemics.

Citizen´s point of view

• Relevance: The relevance of content from the citizen´s point of view is not very good. The comparison between Pandemrix and ´normal´ influenza vaccine confuses me. Also my understanding of variables and DALY´s is not clear enough to understand the relevance. What is DALY, how it is calculated and what is the purpose of DALY? How should I read the results?
• Pertinence: I don´t see that the purpose of the analysis is very relevant in the my point of view. This comparison of two vaccine is not very clear. Why people are divided into two groups? Who decide which group for example I or my chilren belong? I just want to know should I take the vaccine and is it safe!
• Usability: The usability of this analysis is not very dood for me. I don´t understand why there are two different vaccines? I could ask is the Pandemrix better vaccine if it is given only to the risk groups? Who are in the risk gruop and who are not and who decide whether I am in risk group or not? I don´t understand why Pandemrix is given even to the risk group, if the side effects of it are not known? I consider taking the vaccine at all if both advances and side effects are unclear.
• Acceptability: My acceptance of results is quite dependent on which group I belong.

Group 3

The group 3 studied whether the use of thermal scanners together with PCR-tests and together with the quarantine of swine flu ´positive´persons, has been an effective method for preventing the swine flu spreading to Finland from abroad. The time point of study would have been spring 2009, before any swine flu cases were confirmed in Finland.

Ministry´s point of view

• Relevance: The content of the plan is relevant in the relation of purpose.
• Pertinence: The pertinence of DA plan is good. The analysis could be done before epidemic will spread to Finland and it might be possible at least ´win some time´ before the epidemic will spread to Finland. In this case the Ministry will have more time to consider carefully the different altervatives to protect Finnish population from swine flu and also gather more information about different vaccine options and possible side effects if this plan .
• Usability: Ministry is not very convinced of the final usability of this approach. Even though it might be possible to have more time for final decision, the total prevention of swine flu spreading might not be possible with this approach. There seems to be several uncertainty factors in DA; e.g. usability, validity, and reliability of scanners as well as PCR-test method, incubation time of swine flu etc... The scanners and possible quarantine might also arouse a lot of criticism and fear in public. We in the Ministry also have suspicions, how the quarantine of possible and also confirmed patients could be organised in practise? And how many passengers with virus need to escape the controll (scanners, tests) to cause the outbreak of epidemic in Finland? Is one enough? There is no given estimate about the time frame: how long this scanning and quarantine of passangers need to be continued? Also the question of money is very important to Ministry: what are the final costs of this approach? Ministry has a doubt that the costs of this approach might be higher that the final benefits especially if the prevention will not anyway be total. Ministry´s opinion is that this analysis might be used together with other preventing methods like hygiene campaing for postpone or at least weaken the epidemic untill the effectiveness and safety of vaccine is properly tested. In that way this approach might be useful with later coming epidemics.
• Acceptability: The results and conclusions are acceptable. As the group 3 also states the scanners and PCR-test are probably not enough effective to prevent spreading of swine flu to Finland.

Citizen´s point of view

• Relevance: The content of the plan is quite relevant in my point of view. But the analysis itself seems to be quite complicated and it contains many variables which are not very easy to understand.
• Pertinence: The purpose of the plan is relevant in the point of my needs. I see that it is important protect Finland from swine flu and I am very interested to know could it be somehow done. This seems quite concrete analysis.
• Usability: I can grasp the idea of analysis, but the analysis itself and it´s variables are not very clear for me. The use of scanners and PCR-tests and especially the quarantine worry me if I will need to travel abroad e.g. because my work. How long the quarantine might last and who is paying the possible costs and lost of my salery etc...
• Acceptability: As fas as I understant the results of analysis are relevant. I can believe that using of these scanners, tests and quarantine is not possible to protect Finland from swine flu.

Group 4

The group 4 studied the effects of possibly postponing the swine flu vaccinating. The epidemic would have been controlled with an extensive hygiene campaign until the swine flu vaccine would have been properly tested and possible adverse side effects have been detected. The time point of study would have been spring 2009.

Ministry´s point of view

• Relevance: The content of plan is quite relevant in the relation to the stated purpose.
• Pertinence: The purpose of plan is very well in relation of Ministry´s need. The Ministry would like to have more time for more careful consideration and comparison of different alternatives in the case of influenza epidemic.
• Usability: The usability of plan is high. The analysis enable the Ministry a possibility to ´buy´ some extra time for consideration the decision of vaccination campaing and type of vaccine more carefully. But in the Ministry´s point of view, there should be given an estimate, how long could be waited untill the decision of further actions about the vaccination campaing need to be make. This estimate would be important because the flu is keeping on the spreading among the Finnish population in spite of hygiene campaing. But altogether this type of analysis will be usuful also in the future influenza epidemics.
• Acceptability: The results of plan are acceptable to Ministry. If the results after the calculations will be as the group 4 expects the decision of the postponing of vaccination together with lauched hygiene campaing, would have been very worthy of attention, because the vaccine was not tested well enough. And as the group 4 has stated this analysis could had been usuful to the Ministry in the situation of spring 2009.

Citizen´s point of view

• Relevance: The content of plan is quite relevant in my point of view. Although the analysis itself and its variables are not very clear to me. Also I am not sure what the outcomes, estimated DALY´s, should tell me about the useability of puting off the vaccination campaing.
• Pertinence: The purpose of plan is quite relevant. I think it is good to estimate if the vaccination campaing will be able to postpone, because I really want to be sure that the vaccine is safety to take and it will not have any adverse side effects.
• Usability: The usability of plan is good. I will follow the hygiene campaing if the authorities give good explanations for them. For me the safety of vaccine is important.
• Acceptability: As far as I understand the results of analysis are acceptable for me. It would be much easy for me to accept the hygiene campaing and follow the given instructions if I knew the reasons for them. If it is possible to postpone starting point of vaccination with the hygiene campaing untill the knowledge of authorities about the safety of vaccine is reasonable, I would be happy to follow it.

Evaluation of Swine Flu model

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• Pertinence:
• Usability:
• Acceptability: