1. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Multiple Objective Decision Analysis for Potassium Iodide Distribution in Nuclear Incidents L. Robin Keller Tianjun “Mike” Feng and Qiang “David” Zeng UC Irvine

2. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Multiple Objective Decision Analysis for Potassium Iodide Distribution in Nuclear Incidents A National Academy of Sciences book advises states and local jurisdictions to use a multiple objective decision analysis process to evaluate plans for distribution of potassium iodide (to protect against thyroid cancer) when there will be radioactive iodine exposure due to an accident or terrorism at a US nuclear power plant. The decision process features were proposed following public hearings involving multiple stakeholders with divergent political perspectives and varying assumptions about scientific evidence

3. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004

4. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Health Risk If a nuclear incident (from an accident or terrorism) occurs and radioactive iodine is released … People exposed to the plume could have an increased risk of thyroid cancer due to inhalation –Young children & fetuses most at risk –Thyroid cancer is very rare for children, this could increase that risk, but it would still be quite rare (Thyroid gland is located beneath the voice box (larynx), produces thyroid hormone; helps regulate growth and metabolism)

5. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Disaster at Chornobyl Nuclear Power Plant in Ukraine in 1986

6. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Chornobyl People were not told of plant disaster for days, so exposed to plume and inhalation risks Children and pregnant/nursing mothers ate leafy vegetables and drank milk from exposed cows over weeks, so received high doses of radioactive iodine from ingestion All who later got thyroid cancer were ≤ 4 years old (including fetuses) at exposure 3 thyroid patients died- 2 from bad anesthesia in surgery and 1 from parents not giving child thyroid pills (thyroid cancer highly treatable)

7. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Protective Measures Primary: Evacuate Secondary:Shelter in place Supplemental: Take potassium iodide (KI) right before exposure to radioactive iodine to -“fill up thyroid” with stable iodine -block out radioactive iodine from getting into the thyroid to protect against all nuclear incident risks, not just radioactive iodine

8. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 United States Nuclear Power US Nuclear Power Plants are a different, safer design (compared to Chornobyl) Assume ingestion pathway would be controlled in the US

9. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Process Background Massachusetts Congressman Edward J. Markey’s law 1 passed directing National Academy of Sciences to conduct a study on best way to distribute KI National Research Council of National Academies received funding via Centers for Disease Control 1. Law 107-188 sect. 127

10. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Process Background, continued Keller joined as decision analyst on committee of experts: –thyroid cancer physicians –radioactive safety experts –nuclear power plant safety –emergency management Committee received oral or written public testimony from experts at agencies and organizations

11. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Timeline May-Sept. 2003: Committee met monthly in DC (and once at UCI and Woodshole, MA offices of National Academy of Sciences) Oct. 03: Book sent to external reviewers Dec. 03: Prepublication briefings to agencies NRC, EPA, National Stockpile, FEMA) and to staff of Congressman Markey/Senate majority leader Bill Frisk, MD. Dec. 03: Released to public http://www.nap.edu

12. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Characteristics of Decision Problem Political process calls for “scientific” perspective –Committee membership primarily experts on radiation, thyroid cancer, nuclear power plants: not policy experts Discussion of KI separated from other ways to improve public health and safety KI seen as the anti-nuke pill – as if it will protect everyone from all radiation for sure … framed as a “sure- thing” One side refuses to allow cost to be considered –Not-so-hidden agenda – get rid of nuclear power plants Agency experts often said there is no one-size-fits-all solution

13. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Types of Alternative Actions Predistribute to households, schools, hospitals, etc. –Via mail –Via voluntary pick up Stockpile at evacuation reception centers Do not pre-distribute

14. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Objectives Hierarchy a.1.1. Max. Availability for Children & Pregnant Women a.1.2. Max. Availability for Other Residents a.1.3. Max. Availability for Mobile Population a.2.1. Max. Number of People who Know Where Pill is a.2.2. KI Taken at Optimal time if No Evacuation a.2.3. KI is Taken at Optimal Time if Evacuation a.2.4. Ensure KI is Stored to Assure Stability a.3.1. Correct KI Dose Given (and Taken) for Age a.3.2. First KI Dose Not Taken Too Late a.3.3. Adverse KI Side Effects (non-thyroid cancer) Minimized a.1. Maximize KI Availability a.2. Optimize Ability to Take KI on Time a.3. Minimize Harm from Inappropriate KI Administration b.1. KI Procedures Don’t Impede Evacuation b.2. Avert Mortality and Morbidity from Radiation or Accidents b.3. Minimize Panic/Anxiety due to KI Procedures b.4. KI Procedures’ Resource Use Not Excessive b.5. Simple KI Procedures before/during Incident b.6. Educate Public to Respond to Nuclear Incident A. Minimize Radioactive Iodine Risk to Thyroid B. Minimize Harm from Other Aspects of Incident MINIMIZE RADIATION HEALTH RISKS

15. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Note: minimizing cost is not an objective

16. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 See Excel spreadsheet Use of sliders for weights on objectives Gives “wiggle room” to see how different alternatives for KI distribution can be best in different situations

17. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Sample Display of Overall Value of Plans- Results Depend on Weights on Objectives and Planning Region

18. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Insights Instead of choosing a specific location (like San Onofre, CA), we created 3 hypothetical regions (rural, suburban, urban) and showed how they might vary on their performance on the objectives

19. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Urban Site Example Minimize Radiation Health Risks to PublicRelevant Characteristics of Urban Site Example A. Minimize Radioactive Iodine Risk to Thyroid a.1. Maximize KI Availability a.1.1. Max. Availability for Children and Pregnant Women Residents100,000 -student school system a.1.2. Max. Availability for Other ResidentsLarge resident population a.1.3. Max. Availability for Mobile PopulationPopulation increases by 25% from mobile workers a.2. Optimize Ability to Take KI on Time a.2.1. Max. Number of People who Know Where Pill isPossible new residents won't be covered by earlier predistribution a.2.2. KI Taken at Optimal Time if No EvacuationPossible hurricane or ice storms might impede evacuation a.2.3. KI Taken at Optimal Time if EvacuationDelays possible if evacuation impeded by traffic or weather a.2.4. Ensure KI is Stored to ensure StabilityKI might be stored in cars/wallets a.3. Minimize Harm from Inappropriate KI Administration a.3.1. Correct KI Dose Given (and Taken) for AgeLarge population of children a.3.2. First KI Dose Not Taken Too LateWeather or traffic might impede evacuation to KI stockpile site a.3.3. Adverse KI Side Effects (nonthyroid cancer) MinimizedSome pre-existing thyroid cases in large population of older adults or mobile workers B. Minimize Harm from Other Aspects of Incident b.1. KI Procedures Don’t Impede EvacuationTransport network barely able to handle routine peak loads b.2. Avert Mortality and Morbidity from Radiation or AccidentsTransport network barely able to handle routine peak loads b.3. Minimize Panic/Anxiety due to KI ProceduresLarge crowds possible b.4. KI Procedures’ Resource Use Not ExcessiveLarge population to cover for KI/predistribution and communication costs b.5. Simple KI Procedures before and during IncidentMultiple nearby jurisdictions b.6. Educate Public to Respond to Nuclear IncidentEmergency planning zone in one political jurisdiction *Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ)

20. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Suburban Site Example Minimize Radiation Health Risks to PublicRelevant Characteristics of Suburban Site Example A. Minimize Radioactive Iodine Risk to Thyroid a.1. Maximize KI Availability a.1.1. Max. Availability for Children and Pregnant Women ResidentsYoung families, expanding schools and day care, extensive busing a.1.2. Max. Availability for Other ResidentsMany working-age residents employed outside EPZ a.1.3. Max. Availability for Mobile PopulationRapidly developing population, near major metro. area a.2. Optimize Ability to Take KI on Time a.2.1. Max. Number of People who Know Where Pill is Possible new residents won't be covered by earlier predistribution a.2.2. KI Taken at Optimal Time if No EvacuationOccasional major snowstorms might impede evacuation a.2.3. KI Taken at Optimal Time if EvacuationOccasional major snowstorms might impede evacuation a.2.4. Ensure KI is Stored to ensure StabilityKI might be stored in cars or wallets a.3. Minimize Harm from Inappropriate KI Administration a.3.1. Correct KI Dose Given (and Taken) for AgeLarge population of children a.3.2. First KI Dose Not Taken Too LateWeather or traffic might impede evacuation to KI stockpile site a.3.3. Adverse KI Side Effects (nonthyroid cancer) MinimizedSome pre-existing thyroid cases in older or retired residents B. Minimize Harm from Other Aspects of Incident b.1. KI Procedures Don’t Impede EvacuationTransport network might not be able to handle peak loads b.2. Avert Mortality and Morbidity from Radiation or AccidentsBuses available for children, two interstates + rural two-lane roads b.3. Minimize Panic/Anxiety due to KI ProceduresMany day-care facilities, power plant second largest employer b.4. KI Procedures’ Resource Use Not Excessive Moderate-size population to cover for KI predistribution and communication costs b.5. Simple KI Procedures before and during IncidentTwo counties b.6. Educate Public to Respond to Nuclear IncidentEmergency planning zone in two counties *Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ)

21. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Overall ObjectivesRelevant Characteristics of Rural Site Example A. Minimize Radioactive Iodine Risk to Thyroid a.1. Maximize KI Availability a.1.1. Max. Availability for Children and Pregnant Women ResidentsSmall schools, extensive busing, few children a.1.2. Max. Availability for Other ResidentsVery small resident population of 15,000 in agricultural area a.1.3. Max. Availability for Mobile PopulationPower plant largest employer in county a.2. Optimize Ability to Take KI on Time a.2.1. Max. Number of People who Know Where Pill isFew residents a.2.2. KI Taken at Optimal Time if No EvacuationUnlikely winter snows or spring river flooding could block main roads a.2.3. KI Taken at Optimal time if EvacuationUnlikely winter snows or spring river flooding could block main roads a.2.4. Ensure KI is Stored to ensure StabilityKI might be stored in leaky barns a.3. Minimize Harm from Inappropriate KI Administration a.3.1. Correct KI Dose Given (and Taken) for Age/Body sizeSmall population of children a.3.2. KI Taken at Optimal TimeWeather or traffic might impede evacuation to KI stockpile site a.3.3. Adverse KI Side Effects MinimizedSmall Chance of pre-existing thyroid cases in middle-aged residents B. Minimize Harm from Other Aspects of Incident b.1. KI Procedures Don’t Impede EvacuationEntire KIPZ can normally evacuate in < 3 hours b.2. Avert Mortality and Morbidity from Radiation or AccidentsTwo-lane and farm roads b.3. Minimize Panic/Anxiety due to KI ProceduresSchool buses available for children; Power plant largest employer b.4. KI Procedures’ Resource Use Not Excessive Small population to cover for KI predistribution and communication costs b.5. Simple KI Procedures before and during IncidentOne county jurisdiction b.6. Educate Public to Respond Appropriately to Nuclear Plant IncidentEmergency planning zone in one county Rural Site Example

22. University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Conclusions Don’t aggregate to too high a level Give decision makers “wiggle room” Software with sliders allows real-time decision aiding and sensitivity analysis Decision analysts can play a significant role in structuring consideration of major political issues by serving on National Academy committees