RM analysis Jukka-Pekka Männikkö

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Take the perspective of the Ministry of Social and Health affairs. Consider yourself managing a project of developing capacity to manage major public health risks. In your project you want to take account of the lessons that could be learned from the swine flu case. In this exercise your task is to:

1. Evaluate all four DA study plans from the use/r point of view:
   • Of what value would each of the planned analysis be for you?
   • Make use of the properties of good assessment framework, particularly:
     • Relevance: Is content of the plan/analysis relevant in relation to the stated purpose of the analysis?
     • Pertinence: Is the purpose of the analysis relevant in relation your needs?
     • Usability: Can you grasp the idea of the plan/analysis? Does it increase your understanding of the swine flu case?
     • Acceptability: Would results/conclusions be acceptable to you? Why or why not?
2. Give an overall statement: How could/should the results of these analyses be taken into account in your project?
3. Choose (one) another perspective and repeat the evaluation of the DA study plans from that perspective
   • E.g. common citizen, medical superintendent in a health care center, health researcher, journalist, nurse in public health care, principal of an elementary school, …
   • Focus on the differences in comparison to the above evaluation
4. Write an (freely formatted) evaluation report on your own RM analysis page (see the list of links at the bottom of the page)
   • If you do not yet have a page, create. Advice, if needed, may be asked e.g. from fellow students or the lecturers
   • Aim for a clear and concise report.
   • Active commenting of of other groups individuals works can earn you pluses that will be considered in the overall grading of the course
5. Present your main findings in the final seminar 11.-12.4.
   • Improvements on the report page can be made up to the final evaluation in the end of April

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

Decision analysis exercise Group 1

• Relevance

Group 1 states evaluating the impact of H1N1 vaccination in Finland as the purpose of their decision analysis. The questions to be addressed are:

1. Was the decision to vaccinate everybody the right one?

and

2. Would it have been better if vaccinations were not done?

Against this background the groups analysis seems relevant. Group 1 evaluates the possible effects and outcomes of the decision to vaccinate the whole population, risk groups only or the possible decision not to vaccinate anyone. Group 1 suggests use of DALY:s to evaluate the impacts of the vaccination decisions.

• Pertinence

Decision analysis of group 1 is relevant for the Ministry of Social Affairs and Health. Evaluation of side effects against benefits of the vaccinations is important. It should be noted, however, that no such data would have been available at the time of the actual vaccination decisions.

• Usability

Group 1 decision analysis contains much useful information. The calculation of DALY:s requires more work to provide actual quantitative information.

• Acceptability

Conclusion of group 1 DA is that the benefits of vaccinations exceed the harmful side-effects caused by the vaccination. The conclusion is drawn based on relevant information about narcolepsy and about the number of cases in Finland. This is acceptable for the Ministry of Social Affairs and Health.

• Overall statement

Group 1 DA contains much useful information and seems to be objective and based on facts. The quantitative information provided by the analysis requires more work to provide information which could be used in risk calculations.

Decision analysis exercise Group 2

• Relevance

Group 2 states evaluation of impacts of H1N1 vaccination in Finland as the purpose of their DA. Outputs which they will consider are number of new cases of swine flu before and after the vaccination and side effects likely to arise from vaccination. Boundaries are set to priority and target groups. The actual analysis however considers the vaccination of whole population and risk groups. No estimations about number of cases before and after the vaccination is provided. It seems that purpose and boundaries of this DA are not up to date. (10.04.2011)

• Pertinence

Group 2 DA contains much useful information for the Ministry of Social Affairs and Health. Decision analysis contains a broad causal diagram which lists many of the affecting factors related to outcomes of vaccinations. Information about calculation of DALY:s is provided.

• Usability

Actual quantitative information and results are missing, and thus this DA is not fully usable for the Ministry of Social Affairs and Health.

• Acceptability

Results of the DA are not provided, although the content so far seems relevant. Group 2 states in their DA background chapter, that their aim is to "support the decision to vaccinate by weighing the rationale at various levels of the decision chain". This raises a question about the objectivity of this kind of analysis which is aiming to a certain result from the beginning.

• Overall statement

Group 2 DA provides much useful information but remains incomplete. Purpose and boundaries of the study plan should be updated.

Decision analysis exercise Group 3

• Relevance

Purpose of Group 3 DA is to answer the following question:

Can the use of thermal scanners combined with PCR tests prevent the spreading of swine flu to Finland if all passengers arriving from abroad will be scanned at the border control points?

The DA contains relevant information about scanners and the factors affecting the spread of swine flu but provides no answer tho the question at hand.

• Pertinence

It seems unlikely that this DA would be relevant to the Ministry of Social Affairs and Health. Use of thermal scanners is a costly procedure and it does not seem likely that it would be effective. Swine flu can spread in the airplane and the newly infected people would not have fever yet.

• Usability

Group 3 DA contains relevant information about swine flu in general but does not provide an answer to the question determined in the purpose of this DA. There are many factors which prevent the usability of this kind of approach to limiting swine flu. One factor which has been left out of the analysis completely is the limitations to individual freedoms caused by such drastic quarantine measures. It does not seem to be in proportion to the threat caused by swine flu in a country of high quality medical care such as Finland. Effectiveness of thermal scanners and quarantine is questionable. The person who has fever caused by swine flu is likely to either stay at home or seek medical attention on their own anyway, so why would quarantine be needed at all?

• Acceptability

The quality of information in the group 3 DA seems acceptable for the Ministry of Social Affairs and Health. It is, however, very unlikely, that the use of thermal scanners and quarantine of travelers with fever would be acceptable for the Ministry or the people subjected to these measures. It does not seem to be in proportion to the threat caused by swine flu.

• Overall statement

DA study of group 3 has some useful information but lacks the overall resolution. The point of view taken in this DA seems quite limited and issues related to limitations of individual freedoms are not considered. It is not likely that any accurate conclusion about the effects of thermal scanners on the spread of swine flu could be drawn.

Decision analysis exercise Group 4

• Relevance

• Pertinence

• Usability

• Acceptability

• Overall statement