Category:DARM exercise

Instructions for the case study exercise

The global AH1N1 (swine flu) pandemic, vaccinations to fight the pandemic, and the side-effects of the vaccines have been topics of much debate during the last couple of years in many parts of the world. In Finland the hottest debates have recently related to the suspected connection between the Pandemrix vaccine and the unexpected increase in the prevalence of narcolepsy among young people. The swine flu case provides an example of a complex, multifaceted risk management problem in which there are multiple interrelated decisions to be made by multiple different decision makers, uncertainty about the outcomes of the decisions, and many possibilities for value conflicts.

Various different points of views have been taken both to criticize as well as defend the decisions and actions that have been taken to manage different risks in the swine flu pandemic and the vaccination campaign. Of course history could have taken other courses if different decisions and actions had taken place. With hindsight, i.e. when we already know what actually happened, it is of course easier to judge past decisions. Many of the things we know now, were not known in the situations when the decisions e.g. on launching a general vaccination campaign in Finland or choosing the vaccine to be used were made.

The discourse on what could or should have been done and why goes on and opinions fly about, but not much systematic analysis exists yet. Possible questions to be address in such a systematic analysis are e.g.:

• Based on the knowledge that existed at the time of the decisions, can it be considered that the right decisions made?
• If not, can we know which decisions should have been made instead?
• Would the historical counterfactuals that we can now picture have been realistic and feasible alternatives?

Imagine that the Ministry of Social and Health affairs of Finland is developing new approaches and increased capacity to managing public health risks, and wants to learn from the swine flu case. That is why they they are asking these questions from you, an (future?) expert in protecting and promoting public health. In order to work out a response to the Ministry, you need to familiarize yourself with the swine flu case and analyze the decisions and actions taken in the case. Also you must consider and reason where, how, and why different decisions and actions could or should have been taken. Eventually the work also needs to described, explained in a report to the Ministry. This is the case study exercise.

The case study exercise is done in two parts:

1. Plan of a decision analysis (DA) study to shed light on the questions asked by the Ministry (group work)
2. Report on risk management (RM) actions and options, which considers, points out, and argues how things could or should have been managed otherwise (individual work)

It is probably impossible to provide a thoroughly conclusive answer to any of the above mentioned questions, but a lot can still be learned by trying to answer them with a systematic analysis. Feel free to focus on those aspects of the swine flu case that are of most interest to you and your group members. There are no single right solutions, and it is only good if different groups/individuals come out with quite different kinds of plans and considerations.

In order to successfully accomplish the exercise, consider making use of e.g.:

• the theory lectures and classroom exercises on decision analysis (DA) and risk management (RM) on this course
• classroom discussions on the swine flu case as a DA and RM problem
• related materials listed and linked to on the course web-page
• the demonstrator DA model
• other assessments in Opasnet
• descriptions of assessment and variable objects
• all other related information e.g. on the web and libraries
• your own expertise and opinions
• other groups'/individuals' exercise works

The two parts of the exercise are explained in more detail below. Both parts of the exercise will be made in the Opasnet web-workspace. The basics of using Opasnet will be taught in the lecture on 3.3. 9-12 in computer classroom MC9 (also see below for more information on that).

(NOTE: It is smart to check the times and locations mentioned above and below from the schedule on the course web-page in case of possible changes.)

Part 1: Decision analysis study plan

This part is intended as group work (~3-4 people/group). It is preferred that there would be at least one person with fluency in Finnish as some materials related to the swine flu story are available only in Finnish. Otherwise there are no limits to the group formation.

Work out a decision analysis plan, according to which a skilled assessor can build a model, run the model, and produce results that are useful for answering the questions you are asked (see above). You may focus on certain specific aspect(s) of the complex swine flu/vaccination problem, but also remember to keep the big picture in mind as well. The DA study plan can be structured e.g. according the following example:

1. Background description
   • purpose of the study
   • main question(s) considered in the study
   • the relation of the study to the whole swine flu/vaccination case
   • relevant actors related to the case/study
   • roles of different actors related to the case/study
   • timeline of the events considered in the study
   • expected outputs and possible impacts of the study
2. Decision analysis study plan
   • decisions and decision options considered in the study
   • outcomes of interest that the decisions (are considered to) have influence on
   • the relationships between the decisions and outcomes of interest (e.g. as a network of variables)
   • different sources of information needed/used in the study
   • analysis of the model and its parts (e.g. uncertainty, sensitivity, VOI, applicability, ...)

The groups should work on the plan gradually alongside the lectures and classroom exercises from the beginning of the course. The task may appear difficult grasp in the beginning, but should become clearer and clearer as the course progresses. The draft plans are presented and discussed in the lecture on 18.3. 13-16. The feedback from this session should guide the work on producing a full draft of the plan. Full drafts are presented in the lecture on 29.3. 9-12. The full drafts will considered and tested for feasibility and executability by a skilled assessor. If possible, a model can be made and run, and analysis results produced. Based on the feedback from the session and the feasibility/executability tests, the DA study plan can be worked on all the way until the final seminar on 11.4. 9-12 and 12.4. 8-11, where both the DA study plans (+ possible corresponding model results) and the risk management option considerations will be presented. If needed, further improvements are possible until the end of April, when the course grading will be made.

Guidelines for presenting the DA study plans will be provided later on this page.

Part 2: Risk management actions and options

This part is intended as individual work, but builds on the group work done in the part 1 of the exercise. Note that the considerations need not be limited to the aspects considered in the group work that one was attending. Instead, it is recommended that in this part of the exercise students also take up aspects of the swine flu/vaccination case that are not addressed in the DA study plans. Again, however, feel free to focus on aspects according to your own interest.

Write a brief assessment report on the swine flu/vaccination case in Finland. Think of your role as consulting the Ministry of Social and Health affairs in developing new approaches to risk management. The report can be structured e.g. according to the following example:

1. Brief description of how risk management was made in the swine flu/vaccination case.
2. Propose some possible alternative arrangements of managing risks in the case.
3. Discuss e.g. the feasibility and potential impacts of such alternative arrangements
4. Consider how such alternative arrangement would be different (e.g. better or worse) to what actually happened.
5. Include in your report an explanation of how risk management bridges assessment and practice, e.g.:
   • identification of needs
   • framing and making the analysis to serve the needs
   • turning analysis results into action
6. Suggest how a similar or related risk management problem should be tackled, if such occurred now or in the near future.

It is possible to start working on the exercise part 2 already at the beginning of the course, but it is recommended that most of the work be left until the latter half of the course when related theoretical issues are being discussed and the DA study plans are well on the way already. The RM actions and options reports are presented in the final seminar on 11.4. 9-12 and 12.4. 8-11. Based on the feedback it is possible to make improvements on the report until the end of April, when the course grading will be made.

Guidelines for presenting the RM reports will be provided later on this page.

Introduction to working in Opasnet

Both parts of the exercise will be made in Opasnet, i.e. this web-workspace. The necessary skills to get started will be taught in the lecture on 3.3. 9-12 in computer classroom MC9. More can be learned along the course, and some additional exercises on discussion and argumentation will be done in the lecture on 1.4. 9-12 in computer classroom MC9.

The content of the introductory lecture/exercise is:

• Introduction
  • purpose and history of Opasnet
  • technical foundation: Mediawiki
  • philosophy behind Opasnet: trialogue
• Demonstration
  • browsing, searching and reading Opasnet content
  • structure of Opasnet
  • ways of contributing to Opasnet
  • creating a user account / logging in
  • creating a new page
  • editing
  • commenting
  • discussion
  • structured argumentation
  • help & examples
  • edit conflicts
• Exercises
  • create a user account for yourself
  • create a page for your DA study plan with your group
  • plan and implement a draft structure for your DA study plan page
  • create a page for your individual RM report
  • plan and implement a draft structure for your RM report
  • Find an interesting page in Opasnet and comment on it

In the lecture on 1.4., the focus in on discussion and structured argumentation, i.e. wiki-mediated collaboration. The course participants are encouraged to actively discuss their own and others work. Activity in discussing the exercises in Opasnet will be considered as a positive factor in evaluating the exercises.

Evaluation of the case study exercises

The main point is not to write long and detailed texts of any specific topic within this course. Instead the idea is to try to make use of what has been taught on the course by combining them in relation to a practical question. Most important issues in evaluating the exercises are:

• general clarity of thought
• comprehension and description of the big picture
• meaningful connections between the aspects of the case
• application of the knowledge and methods provided in lectures, exercises and discussions along the course
• ability to argue for or against different statements or actions