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Review: Gaming Disease Response

ED McGrady and John Curry, Roll to Save: Gaming Disease Response (History of Wargaming Project, 2021). 143pp. USD$20 paperback, USD$7.92 Kindle.

The current COVID-19 pandemic has underscored the value of serious gaming for supporting health sector preparedness and government policy response. Indeed, in my own case, during the past year I have found myself designing games on pandemic-related food security issues, working with the Public Health Agency of Canada and Department of National Defence in red teaming Canada’s national vaccine roll-out plans (including a major national tabletop exercise), and I’m currently working with the READY Initiative on digital games-based training for epidemic disease preparedness and response in the humanitarian sector.

All of that is to say that I wish Roll to Save: Gaming Disease Response had been published a year ago, because it is a very useful resource indeed for anyone working in this area. Some of the chapters address general design issues, including the value of serious games; gaming at the strategic (policy), operational, and “tactical” levels of disease response; and important considerations in professional game design. Other chapters discuss particular game designs, addressing topics as wide-ranging as vaccination/prophylaxis; bioterrorism (anthrax, melioidosis); particular epidemic outbreak scenarios (ebola); mental health support; and pandemic recovery (COVID-X). It also contains brief chapters discussing some of the basics of infectious diseases, epidemiology, public health planning, outbreak investigation, and the importance of information, politics, and the media. My only disappointment was the bibliography, which lists some of the sources cited in the book but which doesn’t provide a wider reference to the substantial literature on medical and emergency preparedness gaming.

Above and beyond the very considerable value of this publication for those designing disease response games, it also stands as an excellent example of how serious gaming should be undertaken. McGrady not only has extensive experience in designing and implementing serious games on a wide range of national security and policy issues, but also has keen insight into what works in what context. He thus underscores the importance of designing a game around not only the topic, but equally the game objectives, available resources, participants, and client/sponsors.

Reflections from an infectious disease outbreak matrix game

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The latest issue of the open-access Journal of Globalization and Health 16 (2020) features an article by Julia Smith, Nathan Sears, Ben Taylor, and Madeline Johnson on “Serious games for serious crises: reflections from an infectious disease outbreak matrix game.” This is the same pandemic response game featured in a previous PAXsims report last year.

Background

While there is widespread recognition of global health failures when it comes to infectious disease outbreaks, there is little discussion on how policy-makers and global health organizations can learn to better prepare and respond. Serious games provide an underutilized tool to promote learning and innovation around global health crises. In order to explore the potential of Serious Games as a policy learning tool, Global Affairs Canada, in collaboration with the Department of National Defense and academic partners, developed and implemented a matrix game aimed at prompting critical reflection and gender-based analysis on infectious disease outbreak preparedness and response. This commentary, written by the core development team, reflects on the process and outcomes of the gaming exercise, which we believe will be of interest to others hoping to promote innovative thinking and learning around global health policy and crisis response, as well as the application of serious games more broadly.

Main body

Participants reported, through discussions and a post-game survey, that they felt the game was reflective of real-world decision-making and priority-setting challenges during a crisis. They reflected on the challenges that emerge around global health co-operation and outbreak preparedness, particularly noting the importance of learning to work with private actors. While participants only sporadically applied gender-based analysis or considered the social determinants of health during the game, post-game discussions led to reflection on the ways in which equity concerns are put aside during a crisis scenario and on why this happens, offering critical learning opportunities.

Conclusion

Matrix games provide opportunities for policy-makers and health professionals to experience the challenges of global health co-operation, test ideas and explore how biases, such as those around gender, influence policy-making and implementation. Due to their flexibility, adaptability and accessibility, serious games offer a potentially powerful learning tool for global health policy-makers and practitioners.

A post-game survey indicated that participants were generally impressed by the utility of matrix games in foreign policy planning and development in general, and for thinking about how Global Affairs Canada might respond to a global pandemic in particular.

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By playing the game, participants felt they better understood the issues and challenges involved, with regard to both global health and security issues and gender-based analysis.

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For another recent game on the value of matrix games in exploring pandemic preparedness, see our report on Gaming African Swine Fever.

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