CASE 6: A Rapid Risk Assessment Tool: Determining the Risk of New/Emerging/Re-Emerging Infectious Diseases in Canada
The protagonist, Dr. Anna Moreno, is an epidemiologist at the Public Health Agency of Canada (PHAC), where she manages the Public Health Risk Sciences Department. Her role includes managing monthly meetings and advising when it is necessary to use the Rapid Risk Assessment (RRA) tool to conduct an analysis of any emerging infectious disease relevant to Canada. The case presents a fictitious situation in which a series of outbreaks of an influenzalike infectious disease have occurred in certain regions of the Americas. In response to outbreaks of severe respiratory and influenza-like symptoms within the Americas and the more than 100 associated deaths over the past month, the World Health Organization has declared the unknown infectious disease a Public Health Emergency of International Concern (PHEIC). Anna has a meeting that morning, and she will need to prepare an approach to create a working group responsible for conducting an RRA for this unknown disease. Challenges arise because the existing scientific evidence and literature about the disease is limited and Anna will need to defer to the expert knowledge of her team while minimizing expert opinion bias. Given the general standards of RRAs, the assessment should be conducted within the next 24 to 48 hours. Knowing that the outcomes of the risk assessment will set the landscape for the PHAC’s response to the PHEIC, Anna and her team will need to ensure the assessment is conducted in a timely and efficient manner. The results of the RRA will be presented to upper management before being disseminated to the general public. Finally, the case includes a case study, based on true events, of the initial application of the tool to the 2015 Zika virus disease outbreak. Although the initial assessment led to the conclusion that Canadians were at minimal risk, unexpected subsequent Zika outbreaks in 2016 revealed the need to refine and adapt the RRA tool. This case study emphasizes the importance of completing a risk assessment at multiple time points throughout the course of a disease to capture the complexities of evolving information and circumstances.
The pedagogical value of presenting this case is rooted in presenting a real-world situation and exposing students to the complexities of translating foundational public health practices to social contexts that do not allow for typical solutions. Although it is necessary to learn concrete knowledge in a classroom environment, this information serves as a foundation to build on through experience within the public health field. Being immersed in real-world situations is imperative for enabling students to visualize how this knowledge may not translate perfectly during a public health event. This case will complement the focus on emergency preparedness and monitoring and managerial control mechanisms emphasized in the course MPH 9010- Managing Health Services. This level of public health response provides direction and recommendations for all sectors in the face of urgent events, such as infectious disease outbreaks.
After reading the case, students should be able to:
1. Explain the need and importance of a rapid risk assessment.
2. Discuss the evolution of infectious disease outbreaks and the impact of research development on rapid risk assessment.
3. Understand how tools are used to estimate the likelihood of a disease being introduced to Canada and the potential impact it might have on Canadians.
1. Apply the outcomes of the risk assessment to inform future public health strategies and risk communication.
2. Develop the ability to suggest improvements for the rapid risk assessment tool and reflect on challenges faced during its utilization.
Case Study Questions
1. In what situations are rapid risk assessments, compared with standard risk assessments, most important?
2. What is the main purpose of a rapid risk assessment?
3. What are some limitations to rapid risk assessments?
4. What are some factors that may impact the outcomes of a rapid risk assessment over time?
1. Review of the Case Study: Zika Virus Disease
- Discuss and brainstorm external factors that are likely to affect risk assessment over time. An example spider map is provided in the teaching note.
2. Future Challenges for Anna
- Create a bullet point list to outline the challenges and a strategy to overcome them. An example list is also provided in the teaching note.
3. Risk Communication Class Activity
- Assign one representative from each learning team to present the findings from the rapid risk assessment and make a statement to the Canadian public who has been waiting to hear from public health.
- Were there any challenges faced when using the tool?
- Were there any weaknesses to the algorithms?
- Is there anything not included in the algorithm that you believe should be considered?
Emergency preparedness, infectious disease, outbreak management, rapid risk assessment, risk assessment, rapid risk assessment tools, risk communication, Zika virus disease
Di Carlo, C., Ahmad, R., Thériault, J., Darnell, R. (2022). A Rapid Risk Assessment Tool: Determining the Risk of New/Emerging/Re-Emerging Infectious Diseases in Canada. in: Darnell, R. & Sibbald, S. L. [eds] Western Public Health Casebook 2021. London, ON: Public Health Casebook Publishing.