DARM DA study exercise group 4

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Scope

Purpose

The purpose of this decision analysis study is to examine the effects of possibly postponing the decision of vaccinating the population of Finland. The objective would have been to control the epidemic with a massive hygiene campaign until the swine flu vaccine would have been properly tested and researched with the same criteria that apply to other vaccines so that potential adverse effects would have been detected. After proper testing and research have been made a new decision about vaccination can be made based on new data about Pandemrix and the current threat of the disease.

Question to be answered: What would happen to the prevalence of swine flu if the vaccination of the population would be postponed and reconsidered after proper testing and extensive hygiene campaign?

Boundaries

This decision analysis is restricted to deal with decision making in Finland concerning which measures to take to prevent the pandemic from spreading in Finland. The group we are concentrating on is the whole Finnish population.

This decision making took place in 2009 when it became apparent that the swine flu would eventually reach also Finland. At this time governments worldwide began investigating possible approaches to prevent and restrict the spreading of the disease and to minimize the number of deaths.

Scenarios

Vaccination

• Prevention of increase in the prevalence of the swine flu is probable.
• Possible side effects of the vaccination.

Vaccination decision postponed

• Prevention of increase in the prevalence of the swine flu is probable.
• Slight increase in the prevalence of swine flu is possible. The prevalence of swine flu is expected to be significantly lower with hygiene campaign than without any actions.

Intended users

This study is directed to the Finnish Ministry of Social Affairs and Health.

Participants

This study is initiated by Sallamari Tynkkynen and Kati Iso-Markku, first year students of Master’s Degree Program in General Toxicology and Environmental Health Risk Assessment in the University of Eastern Finland. All the users of Opasnet are free to participate in this open assessment.

Definition

Vaccination

• Vaccination program of the whole population by Public Health Care system (requirements: money, time, personnel)
• Prevention of increase in the prevalence of the swine flu is probable
• Possible side effects of the vaccination

No vaccination

• Development and launching of a national hygiene program, special focus on places where diseases often first appear and start to spread from; hospitals, military bases, schools, kindergartens, work places (requirements: money, time, personnel)
• Slight increase in the prevalence of swine flu is probable. The prevalence of swine flu is expected to be significantly lower with hygiene campaign than without any actions.
• New decision point after receiving study results made according to protocol about Pandemrix.
  • Examine the effects of the performed hygiene campaign on the occurrence of swine flu
  • Is there still need for vaccinations or was the hygiene campaign efficient enough on its own?
  • If there is a need for vaccinations, is Pandemrix safe enough based on the new knowledge of adverse effects?

Add a legend for your diagram.

Decision variables

----#: . Ideally, a decision variable is something that can be decided by a single decision-making body, and it contains options that are exclusive and mutually exhaustive. This means that the options don't overlap and together they form a set that logically contains all possible options. For example, if your options are vaccine or hygiene campaign, you are saying that doing both or doing neither one are not options. You can easily argue that doing neither one is obviously so bad idea that there is no need to consider this (but I'd like to see that argumentation). But with the option do both, the arguments are not at all obvious and if you are planning to leave that out, it requires good argumentation. --Jouni 07:26, 27 March 2011 (EEST) (type: truth; paradigms: science: comment)

----#: . You could actually consider an assessment where a hygiene campaign is done anyway (which is a straightforward thing, because there actually was a campaign), and the focus is on delaying/not delaying the vaccination. On the other hand, if you want to look at a better campaign that actually was done, then you should include that. --Jouni 07:26, 27 March 2011 (EEST) (type: truth; paradigms: science: comment)

Vaccination

• decision to vaccinate the whole population with Pandemrix as soon as possible, starting from risk groups.

----#: . This can be considered as the base case, i.e. what actually happened, to which the below decisions/options are compared to. --Mikko Pohjola 16:20, 25 March 2011 (EET) (type: truth; paradigms: science: comment)

No vaccination

• decision not to vaccinate.
• implementation of new hygiene protocols:
  • national plan for improving hygienic practices.
  • informing general public about implementation of new hygienic practices.
  • demanding proper testing and research for the vaccine.

Vaccination

• new decision after proper studies according to protocol.

No vaccination

• new decision after proper studies according to protocol.

----#: . Perhaps this "new decision after proper testing" decision could be dealt with so that you estimate the delay caused by the demand for proper testing and estimating its impacts. --Mikko Pohjola 16:20, 25 March 2011 (EET) (type: truth; paradigms: science: comment)

Indicators

Vaccination

• DALY from swine flu
• QALY from swine flu
• QALY from adverse effects of vaccination
• DALY from adverse effects of vaccination, if deaths occur (e.g. anaphylactic shock)

No vaccination

• DALY from swine flu
• QALY from swine flu

Possible later vaccination

• DALY and QALY variables from the no vaccination time period
• DALY from swine flu after starting of vaccinations
• QALY from swine flu after vaccinations
• QALY from adverse effects of vaccination
• DALY from adverse effects of vaccination, if deaths occur (e.g. anaphylactic shock)

----#: . "value variables" are basically explicit descriptions of opinions (e.g. "human life is priceless and can not be estimated in monetary values"). Value variables do not need to considered in this exercise. --Mikko Pohjola 16:20, 25 March 2011 (EET) (type: truth; paradigms: science: comment)

Other variables

   * Other variables: any variables that link to the causal network and are within the boundaries of the assessment.

----#: . Try to identify a) the variables that are needed to make a continuous causal chain from decision variable(s) to indicator(s), b) possible other variables needed to estimate the indicator result(s). Based on this you can consider how the calculation could be done (if you had the numbers) --Mikko Pohjola 16:20, 25 March 2011 (EET) (type: truth; paradigms: science: comment)

----#: . This is now the ciritcal point in your assessment. --Jouni 07:26, 27 March 2011 (EEST) (type: truth; paradigms: science: comment)

Analyses

EXTRA