A Risk Analysis Framework for Prioritizing and Managing Biosecurity Threats

Multi-criteria decision analysis for supporting the selection of subclinical mastitis screening tests to use in large- and small-scale dairy farms in Türkiye

The production of high-quality and safe milk is closely associated with the udder health of dairy cows. While there are many mastitis diagnostic tests/methods available, choosing the most appropriate diagnostic test for a sustainable udder health control program could be a challenge. This study was aimed at selecting tests for the screening of subclinical mastitis on small- and large-scale dairy farms in Türkiye, using multi-criteria decision-making methods. An integrated approach employing the analytical hierarchy process (AHP) and technique for order preference by similarity to ideal solution (TOPSIS) together was used to select subclinical mastitis screening tests for on-farm use. While the AHP determines the weights of the evaluation criteria, the TOPSIS provides a final ranking. Nine different subclinical mastitis screening (SCM) methods (DeLaval somatic cell counter, PortaSCC test, California mastitis test (CMT), rapid culture, portable/hand-held electrical conductivity meter, infrared thermography, leukocyte esterase strip test, milk pH, UdderCheck test) were analyzed on the basis of five selection criteria (the market availability of the test, the diagnostic accuracy of the test, the cost of the test, the cow-side use of the test, and the practicality of the test). The selection criteria were determined based on literature review and stakeholder input. The weighting of the criteria with the AHP was based on the pairwise comparison of the criteria by stakeholders. The criteria were weighted from 1 to 9 according to their relative importance as follows: "1: equally important," "3: moderately important," "5: strongly important," "7: very strongly important," "9: extremely important," and "2, 4, 6, 8: intermediate values." Final ranking of SCM tests with the TOPSIS was based on the stakeholder evaluations of fulfillment of the criteria by the alternatives. The most appropriate screening test for both large- and small-scale dairy farms was determined to be the CMT. The CMT is a very useful, easy to perform, and low-cost tool for detecting subclinical mastitis. Being a major element of udder health control programs, the CMT, if regularly used on dairy farms in Türkiye, would enable the culling of chronically infected animals and the reduction of mastitis-associated economic losses. Furthermore, regular CMTs would contribute to reducing milk SCC and improving milk quality. In conclusion, multi-criteria decision-making methods not only provide a systematic approach that may assist both veterinarians and farmers in deciding on the best choice among the different tests available for the screening of subclinical mastitis but also offer potential benefits to policymakers, researchers, and other industry stakeholders.

A framework for supporting health capability-based planning: Identifying and structuring health capabilities

The COVID-19 pandemic has highlighted that health security systems must be redesigned, in a way that they are better prepared and ready to cope with multiple and diverse health threats, from predictable and well-known epidemics to unexpected and challenging pandemics. A powerful way of accomplishing this goal is to focus the planning on health capabilities. This focus may enhance the ability to respond to and recover from health threats and emergencies, while helping to identify the level of resources required to maintain and build up those capabilities that are critical in ensuring the preparedness of health security systems. However, current attempts for defining and organizing health capabilities have some important limitations. First, such attempts were not designed to consider diverse scenarios and multiple health threats. Second, they provide a limited representation of capabilities and lack a systemic perspective. Third, they struggle to identify capability and resource gaps. In this article, we thus propose a new framework for identifying and structuring health capabilities and support health capability planning. The suggested framework has three main potential benefits. First, the framework may help policymakers in planning under high levels of uncertainty, by considering multiple realistic and stressful scenarios. Second, it can provide risk analysts with a more comprehensive representation of health capabilities and their complex relationships. Third, it can support planners in identifying resource and capability gaps. We illustrate the use of the framework in practice considering an outbreak scenario caused by three different health threats (COVID-19, Ebola, and Influenza viruses).

Health Decision Analysis: Evolution, Trends, and Emerging Topics

Health remains one of the most challenging realms for decision makers and policy making while critical for the well-being of humans, the stability of societies, and the development of economies. Decision making in this field ranges from medical doctors identifying the best treatments for patients, healthcare companies selecting the most promising drugs for development, healthcare providers deciding for adequate levels of resourcing, health regulators deciding whether to approve a new medicine or health technology, to regional and national health departments identifying how to increase the health security of regions and countries. In this positioning paper, and introduction to this Special Issue, we present the history, evolution, and trends of health decision analysis and suggest that these developments and news trends can be conceptualized as an emerging field of applied research for our discipline: Health Decision Analysis.