Multiple Objective Decision Analysis for Potassium Iodide Distribution in Nuclear Incidents

1. Multiple Objective Decision Analysis for Potassium Iodide Distribution in Nuclear Incidents L. Robin Keller Tianjun “Mike” Feng and Qiang “David” Zeng UC Irvine

2. Multiple Objective Decision Analysis for Potassium Iodide Distribution in Nuclear Incidents A National Academy of Sciences book advises states and local jurisdictions to use a multiple objective decision analysis process to evaluate plans for distribution of potassium iodide (to protect against thyroid cancer) when there will be radioactive iodine exposure due to an accident or terrorism at a US nuclear power plant. The decision process features were proposed following public hearings involving multiple stakeholders with divergent political perspectives and varying assumptions about scientific evidence

4. Health Risk If a nuclear incident (from an accident or terrorism) occurs and radioactive iodine is released … People exposed to the plume could have an increased risk of thyroid cancer due to inhalation • Young children & fetuses most at risk • Thyroid cancer is very rare for children, this could increase that risk, but it would still be quite rare (Thyroid gland is located beneath the voice box (larynx), produces thyroid hormone; helps regulate growth and metabolism)

5. Disaster at Chornobyl Nuclear Power Plant in Ukraine in 1986

6. Chornobyl • People were not told of plant disaster for days, so exposed to plume and inhalationrisks • Children and pregnant/nursing mothers ate leafy vegetables and drank milk from exposed cows over weeks, so received high doses of radioactive iodine from ingestion • All who later got thyroid cancer were ≤ 4 years old (including fetuses) at exposure • 3 thyroid patients died- 2 from bad anesthesia in surgery and 1 from parents not giving child thyroid pills (thyroid cancer highly treatable)

7. Protective Measures Primary: Evacuate Secondary: Shelter in place Supplemental: Take potassium iodide (KI) right before exposure to radioactive iodine to -“fill up thyroid” with stable iodine -block out radioactive iodine from getting into the thyroid to protect against all nuclear incident risks, not just radioactive iodine

8. United States Nuclear Power • US Nuclear Power Plants are a different, safer design(compared to Chornobyl) • Assume ingestion pathway would be controlled in the US

9. Process Background • Massachusetts Congressman Edward J. Markey’s law1 passed directing National Academy of Sciences to conduct a study on best way to distribute KI • National Research Council of National Academies received funding via Centers for Disease Control 1. Law 107-188 sect. 127

10. Process Background, continued • Keller joined as decision analyst on committee of experts: • thyroid cancer physicians • radioactive safety experts • nuclear power plant safety • emergency management • Committee received oral or written public testimony from experts at agencies and organizations

11. Timeline • May-Sept. 2003: Committee met monthly in DC (and once at UCI and Woodshole, MA offices of National Academy of Sciences) • Oct. 03: Book sent to external reviewers • Dec. 03: Prepublication briefings to agencies NRC, EPA, National Stockpile, FEMA) and to staff of Congressman Markey/Senate majority leader Bill Frisk, MD. • Dec. 03: Released to public http://www.nap.edu

12. Characteristics of Decision Problem • Political process calls for “scientific” perspective • Committee membership primarily experts on radiation, thyroid cancer, nuclear power plants: not policy experts • Discussion of KI separated from other ways to improve public health and safety • KI seen as the anti-nuke pill – as if it will protect everyone from all radiation for sure … framed as a “sure-thing” • One side refuses to allow cost to be considered • Not-so-hidden agenda – get rid of nuclear power plants • Agency experts often said there is no one-size-fits-all solution

13. Types of Alternative Actions • Predistribute to households, schools, hospitals, etc. • Via mail • Via voluntary pick up • Stockpile at evacuation reception centers • Do not pre-distribute

14. a.1.1. Max. Availability for Children & Pregnant Women a.1. Maximize KI Availability a.1.2. Max. Availability for Other Residents a.1.3. Max. Availability for Mobile Population a.2.1. Max. Number of People who Know Where Pill is A. Minimize Radioactive Iodine Risk to Thyroid a.2. Optimize Ability to Take KI on Time a.2.2. KI Taken at Optimal time if No Evacuation a.2.3. KI is Taken at Optimal Time if Evacuation a.2.4. Ensure KI is Stored to Assure Stability a.3.1. Correct KI Dose Given (and Taken) for Age a.3. Minimize Harm from Inappropriate KI Administration a.3.2. First KI Dose Not Taken Too Late a.3.3. Adverse KI Side Effects (non-thyroid cancer) Minimized MINIMIZE RADIATION HEALTH RISKS b.1. KI Procedures Don’t Impede Evacuation b.2. Avert Mortality and Morbidity from Radiation or Accidents B. Minimize Harm from Other Aspects of Incident b.3. Minimize Panic/Anxiety due to KI Procedures b.4. KI Procedures’ Resource Use Not Excessive b.5. Simple KI Procedures before/during Incident b.6. Educate Public to Respond to Nuclear Incident Objectives Hierarchy

15. Note: minimizing cost is not an objective

16. See Excel spreadsheet • Use of sliders for weights on objectives • Gives “wiggle room” to see how different alternatives for KI distribution can be best in different situations

17. Sample Display of Overall Value of Plans- Results Depend on Weights on Objectives and Planning Region

18. Insights • Instead of choosing a specific location (like San Onofre, CA), we created 3 hypothetical regions (rural, suburban, urban) and showed how they might vary on their performance on the objectives

19. Urban Site Example

20. Suburban Site Example

21. Rural Site Example

22. Conclusions • Don’t aggregate to too high a level • Give decision makers “wiggle room” • Software with sliders allows real-time decision aiding and sensitivity analysis • Decision analysts can play a significant role in structuring consideration of major political issues by serving on National Academy committees