Overview: Assessing &

Managing Risk For Acute

Public Health Events

Dr Sukhvinder Singh Sandhu

Disease Control Division
Ministry of Health Malaysia

OBJECTIVES
At the end of this session, participants
should be able to:
a) Understand the importance of
conducting risk assessment;
b) Comprehend the concept of risk
assessment;
c) Aware of existence of multiple
methodologies to conduct risk
assessment.

What is RISK in Public

Health?
Risk is the probability or likelihood that
an adverse health outcome will occur
following exposure to a hazard and the
possible consequences associated with
this
RISK = LIKELIHOOD x
CONSEQUENCES

CONTEXT

RISK: The Differences In World

View Between Experts & Public
Experts View

Publics View

Scientific

Intuitive

Focused on acceptable risk

Focused on safety (no risk)

Changes with new information Tends to be fixed

Compares risks

Focuses on discrete events

Uses population average

Focuses on personal
consequences

A death is a death

It matters how we die

Source: World Health Organization, 2012. Rapid Risk Assessment of Acute Public Health Events.
Geneva, Switzerland. WHO

Do we need to manage risks in

public health?
Obligation to reduce morbidity and mortality

Requirement to manage health resources appropriately

Need to predict, plan and understand what levels of risk to accept

Essential to translate the experts languages to achieve sensible

understanding
Economic Impact of
Selected Infectious
Diseases
Most of the economic
impact of pandemics
stems not from
mortality but from
behavioral change, as
people seek to avoid
infection (Burns et al.,
2008)

What is RISK
ASSESSMENT?
Systematic process for gathering,
assessing and documenting information
to assign a level of risk for a potential acute
public health event
Also need to state a level of confidence
and indicate the limitations in reaching a
decision on the level of risk at that particular
point in time
Realistically, determine potential risk of an
acute event by assessing the likelihood
that the event will worsen and the

The Benefits of Conducting

Risk Assessment
Reduces or prevents diseases in affected
populations and reduces negative social
and economic consequences
Defensible decision-making
Implementation of appropriate and timely
control measures
More effective operational communication
More effective risk communication
Improved preparedness

What type of risk assessments (RA)

are used for an acute public health
events?
Event notification RA

Simple and descriptive

Assess risk of real event occurring
Used by rumor surveillance officer for Event-Based Surveillance (EBS)

Rapid response RA
Rapid decision for action 1 hour preparation, 1 hour meeting,
immediate decisions
Assesses risk of event (likelihood and consequences) and determines
immediate action
Used at surveillance team; and / or
Used for high impact public health event with involvement of more than
one Ministry

Medium term RA
More in-depth assessment
More time to have inputs, more time to implement outcomes

Post humanitarian disaster RA

Multiple potential hazards / threats post disaster
(e.g. communicable disease, NCD, mental health and health system
following humanitarian disasters)

The Basis of Risk Assessment

Already doing it automatically

Use a systematic approach
Document the findings
Regularly reviewed (maybe done at preset
intervals) and updated when additional new
information becomes available
Complemented by a log for decisions and
actions based on available information
Contain a record of uncertainties (gaps in
knowledge) and assumptions made

Risk Assessment Tool:

The Guidance Documents

WHO: Rapid Risk Assessment

of Acute Public Health Events
Describing the conceptual
and principles of risk
assessment
An all-hazards approach
Recognizing RA capacity
as a complement to
effective use of Annex 2
decision instrument of the
International Health
Regulation (IHR) 2005
The Risk Management
Cycle

Detection, Confirmation &

Triage
Of A Public Health Event

Outcome Of Triage And

Confirmation

Proposed Action

Reported event is proved to be

a false rumour

Discard the event

Event is confirmed but is not

an immediate public health
risk

Monitor the event and undertake risk

assessments as new information becomes
available

Risk communication and media communication

about the event may be needed to address the
public perception of risk

Risk communication and media communication

about the event may be needed to address the
public perception of risk
Event is confirmed and may be
considered an immediate
public health risk

Undertake a rapid risk assessment and state the

level of confidence in the assessment
Provide recommendations for decision-makers,
including which actions should be taken and
which should have the highest priority
Undertake additional risk assessment and modify
recommendations for decision-makers as new

Steps in the Risk Assessment of

Public Health Events
Assembling the risk assessment team
Formulating risk questions
Undertaking the risk assessment
- Hazard assessment
- Exposure assessment
- Context assessment

Risk characterization
- To consider the use of the risk matrix

Documenting the level of confidence in the

risk assessment

Steps in the Risk Assessment

of
Public Health Events (2)

The Risk Matrix

The Risk Assessment
Process

Level of Overall Risk &

Proposed Actions

Level of Confidence
in the Risk Assessment
It is important to document the risk
assessment teams level of confidence in the
assessment and the reason for any limitations

This will depend on the reliability,

completeness and quality of the
information used and the underlying
assumptions made with respect to the
hazard, exposure and context

ECDC: Operational Guidance

On Rapid Risk Assessment
Methodology
Introduce standardized
evidence-based

methodology for rapid risk assessment (RA)

Provide operational tool to facilitate rapid RA:
a) Information table for rapid RA
b) RA algorithms
- first option combining both probability and impact
- second option assesses probability and impact
separately

ECDC: Operational Guidance

On Rapid Risk Assessment
Methodology (2)

Option 1: Single Algorithm combining both probability and

ECDC: Operational Guidance On Rapid

Risk Assessment Methodology (3)
Completed RRA information table RA algorithms (to
assess the risk posed by the threat)
Risk Assessment Algorithms
First option:
Combined approach
Greater simplicity
Combines probability and impact into a single algorithm
resulting in a single overall risk level

Second option:
Assesses probability and impact separately
Avoids over-simplification
Provides a more accurate assessment in situations where
there is a high probability low impact disease or a low
probability high impact disease

It should be noted that the rapid risk assessment may

change over time in light of new information or events,
and should be updated accordingly

ECDC Rapid Risk Assessment Reports

The Website: http://
ecdc.europa.eu/en/publications/risk_assessment/Pa
ges/default.aspx
MERS-CoV: 21st Update (October 2015)

ESR: Risk Assessment Tool

(DAISY) For Emerging Human
Infectious Diseases

The guiding principles many current risk assessment

tools are based on static elements that are inherent to
the infectious disease
Disease Attribute Intelligence System (DAISY)
demonstrated how one can incorporate changing
elements of risk during disease emergence
Method of DAISY development
- Identifications of 25 key attributes
- Key attributes grouped into 3 categories, i.e. threat /
hazard, vulnerability and exposure
- Media, economic and social risk attributes (of infectious
diseases or biological agents of concern) were included but
considered separately
- Five scenarios of appropriate scoring were assigned to each
attribute

DAISY Attributes
& Risk Scores

DAISY Applications
Monitoring of a single disease
To assess risk from a specific emerging disease
Risk ranking for a group of specific infectious diseases
Ranking risk from a specific infectious disease across
regions

DAISY Applications (2)

Monitoring of a single disease
To assess risk from a specific emerging disease
Risk ranking for a group of specific infectious diseases
Ranking risk from a specific infectious disease across
regions

Definitions Used By Different

Sectors
And Disciplines

The Food Safety Risk Analysis (Codex

Approach)

The Risk Management

Cycle
(Acute Public Health
Event)
The Import Risk Analysis (OIEs
Approach)

The Risk
Management
Cycle:
Occupational
Safety &
Health
Approach

Assessing & Managing Risks:

The Take Home Messages
Provide evidence-base for interventions
Communicate the potential magnitude of the
risk in a systematic and transparent way
Supports defendable and proportional
decision making where information is limited
and the level of uncertainty is high
The framework allows documentation of
evidence and gaps in knowledge
A continuous process should occur many
times during an event

THANK YOU