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Modelled encounters with public health risks: how do we predict the 'unpredictable'?

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Encounters with risk, as Hutter and Power (2005, 11) clarify, are events of problematization that 'place in question existing attention to risk and its modes of identification, recognition and definition'. Infectious diseases, as a public health risk, call for new ways of encountering their continuously changing, uncertain nature. When a new, emerging infection appears, or when vaccination coverage fails to provide population-wide protection, the preventive and protective measures against risks need to be re-assessed and developed further. Computer-based modelling techniques provide a set of tools for encountering public health risks. What kinds of model-based predictions are utilised in public health decision-making processes and on what basis do we rely on these predictions? These questions are addressed through a notion of modelled encounters with public health risks. The main focus is on two modes of predictive encounters with public health risks. First, by analysing the case of Haemophilus influenzae type b bacterial circulation and the effectiveness of vaccination interventions to reduce it, I will introduce the notion of explanation-based predictions. These predictions are capable of addressing short-term developments in the transmission of Hib by explaining its epidemiological mechanisms. Secondly, I will study scenario-building predictions that anticipate the course of a pandemic influenza outbreak. Through these cases, the nature of model-based prediction is discussed as modelled encounters with public health risks. These encounters provide an evidence-base for public health decision-making processes. The study builds on a long-term ethnographic research project on mathematical modelling of infectious diseases with a research group from the National Institute for Health and Welfare, Helsinki (the Hib case). The data on the pandemic influenza preparedness planning is gathered from scientific publications and from policy documents of a national and international level.

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