Development of a resource modelling tool to support decision makers in pandemic influenza preparedness: The AsiaFluCap Simulator

Abstract

Background: Health care planning for pandemic influenza is a challenging task which requires predictive models by which the impact of different response strategies can be evaluated. However, current preparedness plans and simulations exercises, as well as freely available simulation models previously made for policy makers, do not explicitly address the availability of health care resources or determine the impact of shortages on public health. Nevertheless, the feasibility of health systems to implement response measures or interventions described in plans and trained in exercises depends on the available resource capacity. As part of the AsiaFluCap project, we developed a comprehensive and flexible resource modelling tool to support public health officials in understanding and preparing for surges in resource demand during future pandemics.

Results: The AsiaFluCap Simulator is a combination of a resource model containing 28 health care resources and an epidemiological model. The tool was built in MS Excel© and contains a user-friendly interface which allows users to select mild or severe pandemic scenarios, change resource parameters and run simulations for one or multiple regions. Besides epidemiological estimations, the simulator provides indications on resource gaps or surpluses, and the impact of shortages on public health for each selected region. It allows for a comparative analysis of the effects of resource availability and consequences of different strategies of resource use, which can provide guidance on resource prioritising and/or mobilisation. Simulation results are displayed in various tables and graphs, and can also be easily exported to GIS software to create maps for geographical analysis of the distribution of resources.

Conclusions: The AsiaFluCap Simulator is freely available software (http://www.cdprg.org) which can be used by policy makers, policy advisors, donors and other stakeholders involved in preparedness for providing evidence based and illustrative information on health care resource capacities during future pandemics. The tool can inform both preparedness plans and simulation exercises and can help increase the general understanding of dynamics in resource capacities during a pandemic. The combination of a mathematical model with multiple resources and the linkage to GIS for creating maps makes the tool unique compared to other available software.

Figure 1

Schematic overview of the AsiaFluCap Simulator structure and processes.

Figure 2

Epidemiological results and impact on resource capacity during a mild and severe scenario. Simulations made with the tool for a region in Lao PDR (Vientiane Prefecture and Vientiane Province, n = 1,099,889), using actual available resources. We assumed that 12% of the total resource capacity was available for treatment and care of pandemic cases. A: A mild baseline scenario. B: A severe baseline scenario for the same region. The bar charts directly below the graphs display the moment of depletion or, in case of occupied resources, the periods of shortages in hospital staff. Bar charts below display the available resources, and required quantities, gaps and surpluses.

Figure 3

Geographical distribution of estimated resource gaps across provinces in Lao PDR for three pandemic scenarios. For demonstration purposes, the AsiaFluCap simulator was used to run for each province a mild (A and D), moderate (B and E) and severe (C and F) pandemic influenza scenario, assuming a basic reproduction number of 1.4 and contact reduction of 10%. The maps show surpluses and gaps in hospital beds and ventilators (A, B, and C), and oseltamivir (D, E, and F) for each pandemic scenario.