Blood Safety and Environmental Health II

Blood Safety and Environmental Health II

• Ontario and Quebec experienced an epidemic of West Nile virus in 2002.
• Public concern arose about the risk of infection and potential blood-borne transmission.
• Canadian and US blood systems implemented nucleic acid amplification testing (NAT) to screen donors for West Nile virus.
• This case highlights policy issues, including evidence-based decision-making, framing, trade-offs, cost-effectiveness, ethical considerations (precautionary principle), and federal-provincial responsibilities.

Agenda

• Environmental Health: Vector-borne disease primer, blood safety and the Krever Commission (1997), framing.
• Specific Topics: Public Health and the Naylor Report (2003), precautionary principle, risk management science (FMEA), cost-effectiveness analysis, and ethical decision-making.

Related Readings (Chapter 1)

• Federal vs. Unitary models
• Canadian Federalism (Constitution Act, 1867)
• Framing
• The Precautionary Principle
• Public Health
• Canada Health Act
• Economic Analysis (Cost-effectiveness)
• Screening

Learning Objectives

• Understanding the importance of vector-borne diseases (VBD) and blood safety.
• Summarizing the Krever Commission's and Naylor Report's significance in blood safety.
• Identifying the role of framing in policy instrument selection.
• Explaining the precautionary principle's origins and impact on policy.
• Summarizing risk management science and precautionary principle usage in public health.
• Differentiating between cost-effectiveness and cost-utility analyses.
• Defining and using the Incremental Cost-Effectiveness Ratio (ICER).

Naylor Report (2003): Emerging Infectious Diseases

• COVID-19 is highlighted as a recent example of an emerging infectious disease.
• Diseases have existed but increased in incidence or geographic spread.
• More than 30 previously unknown viral and bacterial diseases emerged since 1973.

General VBD Overview

• Vector-borne diseases (VBDs) are transmitted via infected arthropods (like mosquitoes or ticks).
• Examples: West Nile Virus, Eastern Equine Encephalitis, Zika, and Lyme Disease

West Nile Virus

• First recognized in Africa in the 1930s.
• Circulates between birds and bird-biting mosquitoes.
• Mosquitoes that transmit the virus are called "bridge vectors".
• First detected in New York in 1999 then spread.
• First human cases in Ontario were in 2002, becoming a significant public health issue in that year.

Mosquitoes and VBDs

• VBDs (West Nile, Eastern Equine Encephalitis, and Zika) are viral.
• 80% of individuals are asymptomatic.
• Severe cases include brain inflammation, muscle weakness, paralysis, and death.
• Flu-like symptoms are common, including fever, headache, body aches, and fatigue.

Framing (Problem Identification)

• Nature of the condition (potential or available tests).
• Alternative policy options.
• Risk to blood supply (Krever Commission).
• Zero tolerance (Precautionary Principle).
• Costs of action versus inaction (economic implications).

Understanding the Nature of the Problem

• Important to understand the known information about emerging issues.
• How to keep on top of emerging issues.
• Having available tests when issues arise.
• Action plans for emergencies (pandemic planning).
• Policy options should be considered.

Precautionary Principle

• Action should be taken to prevent potential harm, regardless of scientific uncertainties.
• This should be considered given possible threats that could cause irreversible damage.
• The Rio Declaration (1992) emphasized this principle in environmental protection.
• Application in public health often involves controversial policies when scientific understanding is incomplete.
• Precautionary principle gives humanity a mechanism to help with regulation based on human and environmental health.

Risk Management Science

• This approach systematically identifies, evaluates, and prioritizes potential risks of adverse health effects from exposure to hazardous agents.
• Aims at minimizing, monitoring, and controlling adverse events through resource applications.

Risk Assessment and Management

• Step-by-step process of assessing risks to public health.
• Assessing site-specific information, hazard identification, toxicity assessment, exposure assessment leads to risk characterization.
• Risk characterization feeds into options, balancing public health against social and economic factors.

Failure Modes and Effects Analysis (FMEA)

• A structured approach for identifying potential failures in a process or system.
• Steps in the process, failure modes (what could go wrong), failure causes (why would the failure happen), and failure effects (what would be the consequences).

Economic Evaluation

• Consideration of both costs vs. consequences in alternative policies.
• Methods for evaluating economic implications of health programs/measures.
• Costs encompass direct (e.g., lost wages) indirect costs (lost wages, lost opportunities), and intangible costs.
• Evaluating consequences (natural units or health indexes) for evaluating public health measures.

Cost-Effective Evaluation

• Comparing the costs and effectiveness of different interventions.
• "Natural Units" are used to measure health outcomes: heart attacks, kilos lost, life years gained.

Cost-Consequence Analysis

• Separate consideration of costs and consequences.
• No comparison ratio, instead specific outcomes are measured.
• Outcomes are often consequences like "number of patients treated".

Cost-Utility Analysis

• Compares interventions that have different health outcomes, using a quality-adjusted life year (QALY) or similar measure.

Cost-Benefit Analysis

• Compares all costs and all benefits to assess overall value.
• A comprehensive assessment that often includes ethical considerations.

Ethical Decision-Making

• Various ethical frameworks are used in public health policy, including structural functionalism, virtue ethics, principles and utilitarianism (cost analysis).

Krever Commission and Naylor Report

• Public health policy in Canada is heavily affected by intergovernmental relations, which sometimes results in confusion and overlaps.

Public Health Renewal in Canada (2003)

• Public health in Canada is often viewed as a provincial concern, but federal involvement is sometimes necessary.
• Canadian public health systems, especially, have demonstrated the capability to address public health challenges and outbreaks.

Trade-offs

• The principle that "infinite desires chase a finite number of resources" is relevant in public policy planning.
• Tradeoffs are generally recognized and must be considered in any analysis.

Types of Economic Evaluations

• Key metrics for various evaluation types (e.g Cost Analysis, Cost-Effectiveness, Cost-Utility, Cost-Benefit), their measurements (both of costs and consequences).

Explore the intersection of blood safety and environmental health in the context of the West Nile virus outbreak in Ontario and Quebec. This quiz covers important topics such as evidence-based decision-making, risk management, and ethical considerations related to public health policies. Test your knowledge of the frameworks that govern health and safety regulations.