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Making Decisions Using Data

Watch as Svea Closser discusses how to effectively use surveillance data to make informed decisions (Step 3.12)
SVEA CLOSSER: So as we’ve covered, there’s a huge number of decisions that could be informed by the data we just reviewed. But let’s look at a couple examples here. One particularly intense use of data is something called a polio emergency operations center. The idea for polio emergency operations center started in Nigeria. Now this idea is also at national and subnational levels in Nigeria, Afghanistan, and Pakistan. And there’s also an international polio emergency operations center at the CDC in Atlanta. What they do at the centers as they work intensively with that are to make decisions. The culture at emergency operations centers are what they call a war room culture where the walls are covered and data.
Experts work closely together to analyze, interpret, and make decisions based on that data. The idea is that there’s rapid and continuous data in review and analysis. So decisions can be changed or modified as new data comes in about the effectiveness of what’s happening and that there’s intensive review of performance indicators so that issues with campaign quality for example, can be identified and addressed. So to close out this section of the course, I want you to think for a minute about how data can be used to make some key decisions. So the first decision I would like you to think about is the question of how many campaigns you would do and where they should be.
So let’s think about an area you know well. Let’s assume that there’s some polio circulating in that area. What kind of data would you need to know the number of vaccination campaigns you need and the geographic spread they should have? Pause the video for a minute, and take some time to list the kinds of data you might use to make that decision.
So there’s a huge number of potential answers here. Here are some of the most obvious to me. The first would be data on where polio cases are. Clearly, you need to be doing campaigns in areas with ongoing polio transmission. So that’s a basic first step. I would probably also want data from environmental surveillance. If there is polio virus in the community, I would want to know that and make sure I did a campaign there. You might also use non polio AFP data to understand where children have gotten fewer doses of polio vaccine. There may be parts of the country that don’t have active polio transmission. But if vaccination coverage isn’t that good, they could still be at risk to importation.
And there’s a huge number of other data sources you could use as well. You could use information about where migrants are moving, for example, to supplement this. But the point is that making operational decisions like where to do a polio campaign is really helped when you have the data to make that decision. So a second example decision I’d like you to think about is in this area you know well, what should your social mobilization strategy be to encourage parents to accept polio vaccine? Take a minute, and think about the data you would need to make this decision. You can pause the video. So again, this is a question for which there are many potential answers.
But here are a few of the clearest ones to me. First, once again, I would still want to know where the polio cases are. I want to focus my attention on the places that have ongoing polio transmission. Next, I’d want to know why children are getting missed. Are parents refusing, or are vaccination teams not reaching the household? If parents are refusing, why are they refusing? Are they concerned that polio vaccine has some side effects? Are they refusing an attempt to demand services from their government. These are going to require very different social mobilization strategies I might also want data on the demographics of parents in high risk areas and maybe demographic data on refusal families.
Is it families that are impoverished but are most likely to be affected by polio as is often the case? Are there refusals in these populations, and maybe are they connected to bad experiences those families have had with the health system in the past for example? These are all kinds of information that can help me think about what would be an effective social mobilization strategy in this context. And here as before, there could be many other sources of data that would also be useful. The point here is that the polio program has used a huge amount of data from a number of different sources to understand not only where polio is spreading, but why.
And this kind of approach is really useful in eliminating a disease.

Svea Closser, MPH, PhD
Bloomberg School of Public Health, Johns Hopkins University, USA

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Collecting and Using Data for Disease Control and Global Health Decision-Making

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