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)
• Basic hygiene campaign
• Prevention of increase in the prevalence of the swine flu is probable
• Possible side effects of the vaccination

Vaccination decision postponed

• Development and launching of a more extensive 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)
• 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 extensive hygiene campaign than with basic hygiene campaign and no other 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

Vaccination

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

Vaccination decision postponed

• implementation of more extensive hygiene protocols

Indicators

• Regarding swine flu, Disability-adjusted life years (DALY) will be considered as deaths caused by swine flu attested by medical professionals.
• Regarding adverse effects of vaccination, DALY will be considered as deaths caused by complications due to vaccination.
• Regarding adverse effects of vaccination, Quality-adjusted life years (QALY) will be considered as all complications (excluding death) and adverse effects that last for a time period of one month or more caused by vaccination.

Vaccination

• DALY from swine flu
• DALY from adverse effects of vaccination
• QALY from adverse effects of vaccination

Vaccination decision postponed

• DALY from swine flu

Other variables

• Related to DALYs from swine flu
  • Transmission speed of swine flu among the Finnish population
  • Rapidity and willingness of seeking medical attention after appearance of flu symptoms
  • Accessability of medical care (e.g. distance to health center)
  • Readiness of public health centers to manage increased flow of patients (e.g. number of personnel)
• DALY from adverse effects of vaccination
  • Age
  • Current health status
  • Quality of monitoring after vaccination
  • Time period of monitoring after vaccination
  • Professional skills of health care workers (pharmacists, doctors, nurses and people responsible of injection)
• QALY from adverse effects of vaccination
  • Age
  • Current health status
  • Professional skills of health care workers (pharmacists, doctors, nurses)

----#: . 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