Title: Responsive Operational Research Facility
Funder: Department of Health and Social Care

Abstract: BACKGROUND This call is for a responsive operational research facility. Therefore it is not possible to specify completely what work will be done as this will depend on the needs of the Department. We sketch some possible approaches to addressing the research priorities outlined in the call document. Aims in relation to the issue to be addressed According to the call document, the aims are to contribute to four issues A methodology for the disinvestment in Immunisation and other public health programmes. Communication of Information on Health Emergencies to COBR. Alternative Decision procedures to Cost effectiveness and Cost Benefit analysis. The Threshold. RESEARCH PLAN AND METHODS 1. Disinvestment Running a vaccination programme is about balancing risks within a fixed budget. Ultimately judgements about the risks associated with disinvesting from a particular programme must be made by scientific experts. Eliciting judgements from experts about the likelihood or severity of the consequences of different investment strategies should be performed by analysts with training in best practice in structured expert judgement elicitation to avoid inadvertently biasing experts. Elicitation may be in group or individual settings and care should be taken to adequately present expert disagreement to decision makers. It should be recognised that disinvestment might be mooted for several reasons &ndash; a vaccine may be less effective than hoped, there may be falling threat of disease, strain substitution or competing technology - and these decision problems have different characteristics. 2. Health Emergencies The key issue is providing information on strategic uncertainties (such as the likely disease trajectory over time) under various action options. Probabilistic methods representing information (such as median and p5/ p95 mortality trajectories from pandemic flu) are the most theoretically well grounded way of communicating uncertainty but it should be recognised that not all decision makers are comfortable with probabilistic thinking. Being clear about and consistent in what sources of uncertainty are captured in a probability distribution is important (for example if a probability distribution is based on a single model or expert at the very minimum this should be clearly stated). Mapping the main causal chains which impact on socially relevant objectives may also be useful for putting forecasts in context &ndash; for example in the case of pandemic flu different patterns of mortality may have differential impacts on economic activity &ndash; even if modelling through to these other consequences is not practical. 3. Alternative Decision procedures There is widespread interest in the use of Multicriteria Decision Analysis (MCDA) in health technology technology assessment currently. It is important that MCDA methods are used to capture important concerns not incorporated in current health economic analysis in a transparent way and to ensure that decisions about different vaccines are made consistently (ie there is no special pleading on the part of one technology). This involves technical upfront work in the identification and definition of relevant criteria, the design of scoring schemes and the recommendation of a scoring approach (who should be involved, how should information be presented and so forth) and overall evaluation function. 4. The Threshold. In our view the threshold is critically about the social value of health and should be addressed through either survey or interactive focus group / Citizen s jury approaches structured via MCDA methods. THE TEAM The team is co-led by two senior researchers with a background in operational research and health economics and a track record of successful publication and policy influence. POTENTIAL IMPACT / INFLUENCE The call is for a responsive facility and so topics addressed will be of direct and immediate relevance to DH and Ministers.

Lay abstract: The Department of Health (DH) wants to commission a research team to help them address important questions about how best to protect the population from infectious diseases. The questions that are most important to the DH change over time and so the DH wants a team that is able to work flexibly and responsively to ensure that the research done is relevant to the decisions they face. That said, the DH has outlined some of the questions it might like the team to address, which mostly concern different aspects of how data and expert opinion can be used to inform decisions concerning infectious diseases that reflect society s values. We are a team led by Professor Alec Morton of the University of Strathclyde that has experience in conducting responsive research to inform policy relating to infectious diseases and different ways that patients and the broader public can be involved in spending decisions. The expertise we will bring is in (i) risk assessment and (ii) establishing what a given risk reduction is worth. In risk assessment we stress the fundamental role of disease-specific scientific expertise and will draw on the field of Structured Expert Judgement to explore how best to ask experts for assessments of unknown quantities (such as the likely level of disease in a population if there is a vaccination programme), to reconcile any disagreements between experts, and to present their assessments, reasoning and uncertainty in a way that supports decision making. In establishing what a given risk reduction is worth, we stress the fundamental role of public and stakeholder values in weighing risk against cost. Just as there are good and bad ways of eliciting expert assessments, there are good and bad ways of interacting with the public and stakeholders to understand the value they attach to reducing risks from infectious diseases. We will draw on the field of Multicriteria Decision Analysis to explore how to do this in a clear and reflective manner. Our strand of Patient and Public Involvement will ensure that the design and conduct of this research benefits from a range of public perspectives.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: INFECTION;GENERIC HEALTH RELEVANCE