OBJECTIVES:

Public health authorities (PHA) experience challenges during outbreaks of pandemic influenza. There are (1) a high public attention and pressure for fast and effective actions, (2) uncertainty regarding development and potential impact of the pandemic, (3) complexity of the decisions on selecting interventions – this involves considering multitude of criteria and interests of stakeholders. Therefore we suggest a dynamic decision analysis process, which supports comprehensiveness, transparency, and consistency in decisions regarding interventions.

METHODS:

The process design was informed by scenario analysis, multi-criteria decision analysis methodology, and adapted to the Swedish context. The process was then validated in a pilot decision conference (DC) conducted at the PHA of Sweden. The process consists of elicitation and evaluation. Elicitation comprises developing scenarios, intervention strategies, and a multi-criteria model (MCM) against which the strategies are evaluated. In the evaluation process the strategies are scored, criteria weighted, and the results analyzed.

RESULTS:

In the pilot DC we considered a mild pandemic scenario, similar to the influenza pandemic of 2009. Three intervention strategies were evaluated, based on four interventions; vaccination (VAC), antiviral treatment (AVT), antiviral prophylaxis (AVP), school closure (SC). Strategy (1) included AVT to everyone with influenza-like illness (ILI), VAC to risk-groups, (2) AVT and AVP to risk-groups, SC, and VAC to everyone, and (3) AVT to everyone with ILI, AVP to risk-groups, and VAC to everyone.

Guided by the process the seven participants outlined the MCM through a post-it session, evaluated the strategies against the criteria, and expressed criteria weights. Finally the results were aggregated and visualized. The analysis showed that strategy (1) was the most preferred.

CONCLUSIONS:

The process supports a dynamic, comprehensive, and transparent decision-making. An integrated decision-support toolset will be developed in forthcoming research along with contextualising and validating the process with Sweden related stakeholders.