Three Papers on PODS SNS Distribution, Vaccination Strategies, and POD Throughput

1. Three Papers on PODSSNS Distribution, Vaccination Strategies, and POD Throughput Presented by Marty O’Neill II

2. The First Paper: Resource Allocation for Demand Surge Mitigation during Disaster Response Hina Arora, T.S. Raghu, & Ajay Vinze

3. Modelpopulation, regions, and stockpile There are T-1 regions and one SNS stockpile location. k is a node in the system where k=1 is the stockpile and k=2,3,…,T are the regions Pk is the population of region k, and P is the population across all regions. mk is the susceptible population of region k GARk is the gross attack rate of region k nk is the expected number of infected individuals, and nk = GARk * mk S courses of antivirals are available. Treatment requires 1 course. Prophylaxis requires 4 courses. Sk is the maximum stockpile allocation for region k using CDC’s equitable allocation approach Sk = (Pk / P) * S

4. Modelprophylaxis & outcomes • For each region k, pPxskis the proportion of mk provided with prophylaxis treatment.This will consume a total of 4 * (pPxsk * mk) courses of antivirals from the stockpile. • Health outcomes w: • wd – death • wh – hospitalization • wo – outpatient care • wn – ill, but seek no medical care • Using The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention from EID by Meltzer, Cox, & Fukuda, • The number of expected health outcomes nw,kfor each region k is • nd,k = 0.00202 * nk • nh,k = 0.00791 * nk • no,k = 0.46276 * nk • nn,k = 0.52731 * nk

5. Modelprophylaxis cost/benefit analysis ep,wis the expected effectiveness of prophylaxis averting a particular health outcome w vw is the value saved per person by averting a particular health outcome w Total savings: Total cost: Susceptibles are then reduced by mk * pPxsk * ep … which leads to a reduction in expected infections and expected health outcomes due to infection.

6. Questions How much of the CDC stockpile should be pre-allocated? How does GAR impact cost and savings? How does implementation of transshipment impact savings? • Current policy is 100% • 60, 80, & 100% were examined • Lower vs. higher GAR examined • When stockpile has enough to go around, all thee cases perform equally well. • Lower vs. higher GAR examined • When stockpile has enough to go around, all thee cases perform equally well. • Transshippment vs. no transshipment

7. Proportion of max savings vs. Proportion of Total Infectedlower GAR (above) and higher GAR (below) SNS SNS

9. Comments • Paper studied Influenza PODs, but with focus on possibility of exponentially growing pandemic • How could their methodology of studying transshipping be applied to cost/benefit analysis of different mobile/temporary POD scenarios for Anthrax or Smallpox?

10. The Second Paper: A Dynamic Network with Individual Mobility for Designing Vaccination Strategies Lia Mao & Ling Bian Focus is on Influenza vaccination

11. Modeled Social Network (These are the same.) Day time Night time daytime Intercommunity travelersare assigned communitiescloser to each other usinga distance-decay function Note: This is in geographic space.

12. Vaccination Methods Modeled • Travel-based – target intercommunity travelers • Contact-based – target individuals having larger numbers of direct contacts • Random – individuals are randomly selected for vaccination Vaccination is assumed to occur BEFORE outbreak begins.

13. Different Networks Modeled(with N = 5000) * * Maximum Connected Component

14. Vaccination Results% Infected Under-connected Network Over-connected Network

15. Vaccination ResultsSpatial Patterns Under-connected Over-connected Travel-based Contact-based Random

16. Conclusions from Paperand Final Notes • Travel-based strategy shows best results. • PODs can be established at transportation hubs. • Travel-based works best because of model assumptions. • Constraints in this model were on vaccination supplies, not time.

17. Last (but not least)… The Third Paper: Modeling and Optimizing the Public-Health Infrastructure for Emergency Response Eva K. Lee, Chien-Hung Chen, Ferdinand Pietz, & Bernard Benecke Focus is on “mass dispensing of medical countermeasures for protection of the general population.”

18. Within a POD • Assess client health status • Assess client eligibility to receive service • Assess implications of each case and refer for further investigation if necessary • Counsel clients regarding services and associated risks • Administer services • Educate clients regarding adverse events • Document services • … Example POD Flowchart

19. POD Placement Methodology • Given the population, how many PODs are needed?All PODs shouldn’t have to be equal in number of booths. • Where should we place these PODs?

20. Population Distribution/Location Methodology Census Population Data in Census Blocks Population Density of each block Overlay Grid(square mile) Calculate Population of Each Grid Cell Using Densities Problem:Assumes population’s spatial distribution is uniform within census blocks

21. POD Location Model

22. Overall Comments • Resource distribution, allocation, and reallocation are currently being studied for SNS distribution. • Results of computational models underscore importance of successful mitigation through treatment. • POD throughput analysis and optimization has been investigated. However, not enough attention has been paid to the geographic distribution of the population’s service requirements.