Appendix A – The Wargame

Background

In this wargame we are asking you to play the role of an advisor to the decisionmakers that are charged with responding to the bioincident described in the two scenarios. For those of you who occupy positions in which providing advice to decisionmakers is part of your day-to-day activities, please play the war game as yourself. For those who do not routinely interact with decisionmakers, please play the war game as if you have been contacted for your advice based on the particular skill set that you have developed and the work that you currently perform. The key in this wargame is to gather a large number of responses; the analysis will enable us to draw conclusions from the wargame inputs.

Game Play

You will read two brief scenarios, each with a specific array of reporting mechanisms that you would be able to task. Use the Excel spreadsheet to evaluate how useful the set of sensors/reporting mechanisms is to reacting to the incident. For the purposes of this evaluation, we also provide characteristics of the biological agent that would be unknown at the time of the incident. You can use these agent characteristics to help score the sensor set; e.g., a set would score fairly well if it can quickly, reliably and cheaply provide the agent’s traits. Remember that you are scoring the sensors in their entirety, i.e. as a “package deal.”

The essence of the wargame is for you to assess the bioincident and the sensor systems that are described and for you to determine how well the sensor set that is available to you, in the scenario under study, would support you advising a decision maker to take action. At this stage it is not important to discriminate between action that would be considered as “investigative” or as a full “response” – this will be evaluated in future iterations of the wargame.

Scenarios

We are asking that you consider two scenarios. In the first scenario the biological agent conforms to our current threat list and results in infections in humans that correspondingly conform to expected symptoms. Examples in this case would include anthrax, botulinum toxin, plague, etc. In the second scenario we are asking you to consider a biological agent that does not form part of our current threat list or behaves in an abnormal manner in humans. Examples here would include a bio-engineered strain of anthrax or plague, or an agent not on our current priority list but that could still be used in attacks on humans (examples might include Q-fever).

The reason for the inclusion of the second scenario is that some of the sensor systems that we are asking you to evaluate are limited in terms of detection capacity to a very small number of agents – specifically those that are a priority on the threat list. Their utility may be similarly limited. We are keeping most of the scenario parameters constant and have provided a simple outline to limit the amount of reading on the part of the respondents – this will mean that for some people the scenarios are somewhat unclear. In this case the scenarios will likely correspond to real life – in any bioincident we will have access to much less information than we would like to have before being asked to provide an opinion. In this wargame please use your best judgment based on the data provided.

In both scenarios the initial release occurred in a major metropolitan area of the United States. The incident occurred approximately four days prior to the time of the war game – i.e., the biological agent will have had time to incubate and it could be anticipated that those who have been exposed (and possibly their immediate contacts) will be exhibiting symptoms. The sensor systems or reporting systems will have been triggered and data will have been reported to various authorities. Specific information will still be unavailable or not yet confirmed by a federal agency.

Scenario #1 – “Known Biological Agent”

In this scenario the biological agent affects humans and has the following characteristics:

• Known agent – i.e. on threat lists and not genetically-modified.
• Infectious or contagious – mode of transmission not yet identified.
• Transmission rate (humans) ~60%.
• Symptoms/diagnosis conform to threat list data.
• Specific sensor technologies or tests will produce positive result.

Scenario #2 – “Unknown Biological Agent”

In this scenario the biological agent affects humans and has the following characteristics:

• Unknown agent – i.e. not on threat lists – newly emergent or modified agent.
• Infectious or contagious – mode of transmission not yet identified.
• Transmission rate (humans) ~60%.
• Symptoms do not conform to any known agent.
• Specific sensor technologies or tests will produce negative or ambiguous results.

Sensor Groups Under Review

In order to make the first iteration of the wargame statistically manageable and not too onerous for the respondents, we have grouped the sensor systems to create three sets of technologies that will be assessed for their contribution to a detection capability. For each of the groups we have included sensors that are currently considered candidates as detector systems following a biological release. The groups each have sensor systems with a range of characteristics with respect to sensitivity, specificity, cost, etc. In each group we have included at least one sensor system that is capable (when fully deployed) of providing data very quickly after release of the agent and at least one system that will provide more specific data on the characteristics of the agent (but not necessarily the exact identity) some time after the incident is established. The sensor groups are shown below:

Group A
Absenteeism rates from selected (normalized) populations.
OTC pharmacy sales (electronic data – commercial sites).
Medical claims reporting.

Group B
Doctors Office & ER reporting (electronic data – e.g. ICD-9).
Veterinary & agricultural reporting from sentinel populations.
Calls/web-enquiries to Nurse Helplines

Group C
Sensor reports from fixed sites.
Reports of prodromic symptoms for selected disease states.
Laboratory test results.

The wargame is designed to assess the value of the sensor groups to the respondent (not anyone else) when that person is functioning as a decision maker or as an advisor to a decision maker. In this case decision maker refers to a person’s ability to take “trigger” action or actions that will impact the emerging incident. We are asking that you provide your input on assessment of the sensor group characteristics for the groups that have been randomly assigned to you – the statistical plan will enable us to gather data on all of the sensor groups and combinations of sensor groups that will drive the outcome for the wargame.

Sensor Group Attributes and Scoring

We have selected a range of attributes that will be assessed for each of the sensor groups by our wargame. They include all of the key characteristics and will be assessed based on their use as “Attribution Statements” to which the respondents are asked to provide responses based on their “strength of belief” in the statements when they are applied to the sensor groups. The attributes that are being assessed are shown below:

Utility
Signal availability
Timeliness
Actionable

Trustworthiness
Sensitivity
Specificity
Reliability

Resource requirements
Cost
Sustainability
Mode of collection
Data source

Wargame Example Score Sheet (Response Group 1)

System-of-Systems 'wargame'
Score Sheet – Respondent Group Number 1

Notes:
Please read the attached notes before completing this survey.
You are being asked to complete the survey on the basis of random assignment to one of eight groups.
Your input is limited to the 'Survey Group' (or Groups) shown below

Scoring In each case the ‘scoring’ will be based on the following scale:

Your Responses:

Score Sheet

Respondent Group Number 1