HS 3400: The Bite of Blood Safety

Health Policy UWO

The case

Summer 2002, Ontario and Quebec had an epidemic of West Nile Virus form mosquitoes. Fear that it was transmitted into the blood supplies

Environmental health

• up and down stream

• we are part of the ecosystem

• built environment

Naylor Report 2003

• addressed SARS outbreak

How many diseases have emerged

30

West Nile Virus

Africa in 1930, birds and mosquitoes, New York 1999, Ontario birds 2001, Ontario people 2003

• 80% asymptomatic, 19% fever, 1% encephalitis

WNV Canada cases

High in 2003 and 2007. 100 in 2023

Framing

Risk to blood supply, zero tolerance - precautionary principle, cost of doing something vs not

Different types of screening

mass, selective, multiphasic, surveillance, case finding, surveys

When is screening justified?

condition is important, treatment available, facilities, recognizable symptoms, tests, acceptable test, natural history, agreement on who’s treated, economically balanced, continued process

Screening vs testing

screening is for healthy individuals where they may be a risk. Testing is for diagnosing those with symptoms

Rio declaration 1992

Said precautionary principle should be applied

precautionary principle principles

proportionality, non discrimination, consistency, costs and benefits, subject to review

Proportionality

tailoring measures to the chose level of protection

Non Discrimination

comparable situations should be treated in the same way unless there are grounds for doing so

Consistency

measures should be of comparable scope to those already taken in similar areas where scientific data are available

Examining costs and benefits

comparing costs of action and lack of action in both the short term and long term

Subject to review

chosen level of protection should be maintained as longas as science is inconclusive to the risk to public health

risk management science

the systematic scientific identification, evaluation, and prioritization of risks , economical application of resources

UCI Division of Continuing Education model

Risk Assessment and Risk Management

Risk Assessment

site specific information, hazard identification, toxicity assessment, exposure assessment ————> risk characterization

Risk Management

Evaluation ——→ risk management options ———> no further action, emission control, exposure control, risk communication

Failure Modes and Effects Analysis

Looks for risks before they are a thing

• failure modes, causes, and effects

FMEF criticality matrix

severity and occurrence

Krever Commission

• late 1997

• How blood supply system managed Hepatitis C and HIV 

• precautionary measures and creation of governance system that prioritizes safety

what are the 3 major reports

Krever Commission, Naylor Report, O’Conner Report

Naylor report examined the…

reactions to SARS 2003

Systems that are population focused

population health assessment, health and diease surveillance, disease and injury prevention, health protection, health promotion

How much is policy decision based on cost?

2/3

first rule of economic and first rule of politics

economics - infinite amount of desires but a finite number of goods

politics - ignore economics rule

Trade offs

act of choosing one option in favour of another

Types of costs

direct, indirect, intangible

Economic evaluation involves…

costs, consequences, outcomes, always comparative

Types of economic evaluation

cost analysis, cost effective analysis, cost utility analysis, cost benefit analysis

Cost analysis or minimization

efficacy of A and B are the same, cost is different

Cost benefit analysis

Compares ALL costs and ALL benefits, comprehensive and difficult

cost effective anaylsis

measures natural units like heart attacks, cancer cases, ect

Cost utility evaluation

Interventions with different health outcomes (QALY)

Instrumental cost effectiveness ratio

X axis is effectiveness, Y axis is cost. Choose to the right of the pay line