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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 needs to described and 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. Using Opasnet allows e.g. convenient follow-up and commenting of exercise progress, commenting, discussing, and learning from other groups/individuals works, as well as dissemination of results to a broader audience. The basics of using Opasnet will be taught in the lecture on 4.3. 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 recommended that there would be at least one person with fluency in Finnish in every group as some materials related to the swine flu case are available only in Finnish. Otherwise there are no constraints to group formation.

Work out and write down a plan for a decision analysis study to assess the goodness of actual or counterfactual decisions in the swine flu case. Consider your role as making and reporting the plan so that a skilled assessor can build a model, run the model, and produce meaningful results according to it. You may focus on certain specific aspect(s) case, but also remember to relate your analysis to the complex big picture of the overall swine flu case as well. Each DA study plan is written (containing text, tables, diagrams, images, etc.) on its own page in Opasnet. The plans can be structured e.g. according to the following example:

1. Background description
   • e.g. decisions and actions in the swine flu case
2. Scope
   • purpose of the study
   • question(s) addressed in the study
   • the relation of the study to the swine flu case
   • relevant actors related to the study
   • roles of different actors related to the study
   • spatial and temporal boundaries the study
   • expected outputs and possible impacts of the study
   • intended (imaginary?) use of the study
3. 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
   • means, methods, and tools (e.f. software) needed for the study
   • description of a (executable) calculative DA model
   • description of the execution of the model
   • analyses on the model, its parts, and its results (e.g. uncertainty, sensitivity, VOI, applicability, ...)
4. (Expected) results

The groups are recommended to start working on the plan gradually alongside the lectures and classroom exercises already from the very beginning of the course. The task may appear difficult to grasp in the beginning, but it should become clearer and more comprehensible as the course progresses.

Important milestones for the DA study plan:

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

Part 2: Risk management actions and options report

This part is intended as individual work, but builds on the group works done in the part 1 of the exercise. The considerations upon risk management actions and options in the swine flu case need not, however, be limited to the aspects considered in the DA study 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 case that are not addressed in the DA study plans. Again, feel free to focus on certain aspects of the case according to your own interest.

Write a brief report on risk management in the swine flu case in Finland. In your report, both describe how risk management actually took place and consider possibilities how they could have taken place in the swine flu case. The report can be structured e.g. according to the following example:

1. Description of risk management in the swine flu case
   • risks managed?
   • benefits?
   • decisions and decision makers?
   • other roles?
   • outcomes?
   • evaluation - strengths and weaknesses?
2. Alternatives to risk management in the swine flu case
   • point out the alternatives in relation to what actually happened
   • consider how such alternative arrangement would be different (e.g. better or worse) to what actually happened.
   • discuss e.g. the feasibility and potential impacts of such alternative arrangements
3. Conclusions and recommendations for future public health RM

Also include in your report consideration the role of risk management in bridging analysis and practical actions in terms of, e.g.:

• identification of societally important needs for knowledge
• framing and making of useful analysis that serves societal needs
• analysis as a means for societal learning and development
• turning analysis results into intended practice

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 alongside the final DA study plans. Based on the feedback from the final seminar it is possible to make improvements on the report, and comment others reports, 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 4.3. 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 to Opasnet
  • purpose and history of Opasnet
  • technical foundation: Mediawiki
  • philosophy behind Opasnet: trialogue
• Guided tour to structure, content and functionalities of Opasnet
  • browsing, searching and reading Opasnet content
  • structure of Opasnet
  • ways of contributing to Opasnet
  • creating a user account / logging in
  • creating a new page
  • page (object) types?
  • categorization
  • editing
  • commenting
  • discussion
  • structured argumentation
  • help & examples
  • edit conflicts
  • wiki-markup vs. wikiwyg
  • problems with browsers?
  • text, styling, tables, images, documents
  • Heande? → password
• Exercises
  • create a user account for yourself
    • user name
    • user information
    • my preferences
  • create a DA study plan page with your group
    • page type?
    • name
    • categorization
    • page structure
    • content?
  • create an individual RM analysis page for yourself
    • page type?
    • name
    • categorization
    • page structure
    • content?
  • Browsing, searching, commenting, and discussing information in Opasnet
    • Find an interesting page in Opasnet and comment on it
    • comment box
    • discussion page

In the lecture/exercise on 1.4., the focus is on specifics of discussion and structured argumentation in wiki-mediated broad collaboration. The course participants are encouraged to actively discuss their own and others exercise works in Opasnet.

Evaluation of the case study exercises

The case study exercises are considered to be worth 3 ECTS in total, of which the decision analysis study plan is 2 ECTS, and the risk management analysis is 1 ECTS. Correspondingly, the grade of the DA study plan contributes to 2/3, and the RM analysis 1/3 of the overall exercise grade (which contributes to 2/3 of the whole course grade). Activity in commenting and discussing the exercises in Opasnet will be considered as a positive factor in deciding upon the exercise grades (e.g. rounding up).

The main point is not to write long and detailed reports. Instead, the idea is to try to make good use of the theoretical and practical issues taught on the course in the context of a real-world risk management and decision analysis problem. When evaluating exercises, following qualities will be expected:

• clear and focused scoping
• clear description of the connections to the "big picture"
• coherent connections between different aspects of the case
• general clarity of thought and its expression
• application of (at least some of) the knowledge and methods provided in lectures, exercises and discussions along the course
• good reasoning (e.g. arguing for or against) the statements made

As the course is being taught for the first time, and there is no strong prior experiences on having students make such exercises, the evaluation criteria are quite flexible. As clear grading principles can not yet be provided, the grading will be made quite much by relating the quality of the exercise reports to each other, rather to any predefined golden standard.