Quantitative analysis of trade-offs and model input sensitivities in public health

Abstract

With the global eradication of poliomyelitis approaching, global and national policy makers need to develop policies for the post-eradication era. While the disappearance of the naturally circulating wild poliovirus will substantially decrease the risk of poliomyelitis disease, risks of reintroduction of the virus through circulation of vaccine-derived poliovirus, unintentional release from a vaccine manufacturing site or laboratory, and intentional virus release continue to exist. Therefore, policy makers face important choices among available polio risk management policies, including possible continued vaccination, and need to consider the trade-offs between cost, benefits and risks among these policies. This dissertation consists of the main components of a decision analytic model to help inform policy makers about these trade-offs. This includes a description of the full set of decision options, an inventory of available cost data, quantitative estimation of the risks associated with each policy, a dynamic infection transmission model to estimate the size of potential outbreaks, and an investigation of available methods to analyze the important sensitivities and uncertainties in such a dynamic decision model.