LESSON PLAN
Name: Stacy Garza
Title of lesson: Infectious Disease Prevention: Grant Proposal
Date of lesson: End of Week 5
Length of lesson: One Class Period

Description of the class:
Name of course: Biology
Grade level: 9th-11th
Honors or regular: Honors/Regulars
Source of the lesson:
NIH Curriculum Supplement Series Grades 9-12
Emerging and Re-emerging Infectious Disease: Making Hard Dicisions

TEKS addressed:
§112.43. Biology.
(3) Scientific processes. The student uses critical thinking and scientific problem solving to make informed decisions. The student is expected to:
(C) evaluate the impact of research on scientific thought, society, and the environment;
(12) Science concepts. The student knows that interdependence and interactions occur within an ecosystem. The student is expected to:
(D) identify and illustrate that long-term survival of species is dependent on a resource base that may be limited; and

I. Overview
• Infectious diseases have a devastating impact nationally and globally, but a variety of strategies can alleviate suffering due to these diseases. Because resources are limited, allocating funds among projects that address different diseases raises complex ethical questions. Understanding the relevant biological principles can help in making these difficult decisions.
o Students explore several Internet-based resources to evaluate proposals to combat AIDS, VRSA, and measles and recommend one proposal to support.
II. Performance or learner outcomes
Students will be able to:
• Understand that proposals to combat infectious diseases can be evaluated using several criteria,
• be able to provide a rationale for accepting or rejecting proposals based on the magnitude of the situation and their likely effectiveness,
• Understand that different people will define and weigh criteria differently as they evaluate questions about allocating funds for specific purposes, and
• Understand that it is possible for people to hold quite different positions on a controversial topic and still participate in a reasoned discussion about it.

II. Resources, materials and supplies needed:Web site: Data base links for activities and Video Clips
http://science.education.nih.gov/supplements/nih1/diseases/default.htm
Go to Web Portion of Student Activities
Click on Making Hard Decisions
Matrices found at:
http://science.education.nih.gov/supplements/nih1/diseases/guide/pdfs/ACT5M.PDF

• Master 5.1, Proposal Criteria Matrix (make 1 copy per student)
• Master 5.2, Proposal Summary Matrix (make 1 copy per student)
• Master 5.3, Reflection Questions (make 1 transparency)
• Emerging and Re-emerging Infectious Diseases Web site (1 per team)
Note to teachers: If you do not have enough computers equipped with Internet access to conduct this activity, you can use the print-based alternative.

Prerequisite Knowledge: Students should be familiar with problems in controlling infectious diseases, such as the evolution of drug resistance and the challenge of administering vaccines to a significant proportion of the population.


Five-E Organization
Teacher Does Probing Questions Student Does
Engage:
1. Introduce the activity by saying something like, “We’ve been studying infectious diseases and the reasons why ‘new’ diseases are emerging and ‘old’ ones are re-emerging. What are some of those reasons? What steps can we take to avoid disease emergence and re-emergence? How can research contribute to better ways to control infectious diseases?”

Entertain some answers, then explain that in this activity, students will consider proposals to fight three different diseases, investigate each of these diseases, and recommend one proposal to fund. Indicate that their recommendations will be based on two criteria, “magnitude” and “effectiveness,” which will be described in the activity. Their recomendations also must include reasons for funding one proposal but not the other two.
In the first video segment (see Step 3), the representative of the funding agency explains that students’ recommendations are to be based on the criteria of magnitude and effectiveness, and gives examples of the questions that students must answer to determine the magnitude of each situation and how effective the proposed plan is likely to be. Those and additional questions related to magnitude and effectiveness also appear on Master 5.1, Proposal Criteria Matrix.
You may want to indicate to students that there are valid reasons for recommending each proposal. Explain that this activity is like “real life” in that we frequently have to make difficult choices among several “good” options (or among several “bad” options).
Magnitude of the problem and effectiveness of the proposed approach are two criteria that are typically applied in making decisions about a plan to address a societal problem. With regard to infectious disease, magnitude refers to the current burden of illness, as well as the potential for this burden to increase in the future. Effectiveness refers to how well the proposal will alleviate the serious consequences of the disease.
A third criterion—means—often is used to make decisions about plans to address societal problems. Means refers to how well we can accomplish the actions described in the plan. For example, proposing that we spend money to distribute a “cure” for AIDS is not realistic because no cure is available at this time. In this activity, students consider means as part of their evaluation of the second criterion, effectiveness. That is, if a team judges a proposed project to have high “effectiveness,” the team believes there are means available to accomplish it.
Most funding agencies have an established review process and evaluation criteria for proposals submitted to them. NIH uses a peer review system, that is, external scientists familiar with the health issues, techniques, and research models in the proposals review and make recommendations about the scientific merit of the proposals. NIH specifies five major criteria for evaluation of proposals: significance (similar to the criterion of “magnitude” in the activity), approach (similar to “effectiveness”), innovation, experience of the principal investigator(s), and institutional support for the project.

“Fighting infectious diseases requires money as well as knowledge. There is a limit, however, to the money that is available for this purpose. How do people decide where to invest money in fighting infectious diseases?” Reasons for disease emergence and re-emergence developed in the previous activities include environmental changes, indiscriminate use of antibiotics, and failure to vaccinate populations. Steps that can be taken to avoid disease emergence and re-emergence include carefully considering the impact of development in wilderness areas and being alert to the possibility of pathogens having access to a new and/or larger host population, avoiding unnecessary uses of antibiotics, and increasing efforts to enforce vaccination. Research can help us develop better ways to recognize and understand new pathogens, create new or improved antimicrobial drugs to prevent or treat infection, develop new vaccines to protect individuals and the population, and discover new ways to prevent transmission of infection.

Explore:
Organize students into their teams and direct them to watch the video segments Introducing the Proposals and Proposal 1, Proposal 2, and Proposal 3 on the Web site, then to proceed directly into their research using the databases on the Web site. Tell the teams that they have 30 minutes to complete their work.Distribute Master 5.1, Proposal Criteria Matrix, and Master 5.2, Proposal Summary Matrix, as students begin their work and tell them that at the end of the 30 minutes, each team should be prepared to announce its recommendation and explain its rationale to the class.
Ask each team to identify a spokesperson to tell the class which proposal the team recommends and the reason it selected that proposal. As the teams report their decisions, tally the number recommending each proposal.
Invite students to look at the results of the tally and ask them if they can explain the differences, considering that each team worked with the same information.
Display a transparency made from Master 5.3, Reflection Questions, and ask each team to work together to list as many responses to each question as they can. Conclude the activity by asking each team to give one of its answers and list it on the transparency.

Ask what each group of applicants proposes to do (AIDS applicants: produce and distribute drugs to HIV-positive individuals; measles applicants: produce and distribute vaccine to susceptible people around the world; VRSA applicants: develop new drug therapies against Staphylococcus aureus).

If all teams recommended the same proposal, tell them that other evaluators may well have recommended different proposals. Give them some possible rationales for those recommendations and ask them what explanation they can give for the different choices.
Question 1 How did understanding the biology of infectious diseases help you make your decision?

Question 2 What else did you consider in making your decisions?
Students should understand that making policy decisions about spending money to combat infectious diseases is complex and there is typically no one “right” decision. Students also should recognize that understanding the biology underlying such diseases can help inform the decisions that ultimately are made.
Students may respond with comments such as, “We thought that, even if the plan had problems, AIDS is so terrible that we should support any plan that could possibly help,” or “We thought that the measles plan had a pretty sure chance of working, whereas the others weren’t as likely to be effective.” Encourage this kind of discussion and point out that some teams gave more weight to the “magnitude” criterion and others gave more weight to the “effectiveness” criterion.

Students may indicate that understanding how natural selection leads to the evolution of antibiotic-resistant bacteria helped them evaluate the likelihood of the emergence of VRSA, or that understanding herd immunity helped them assess the effectiveness of a vaccination program to eliminate measles.
Students may say that they felt it was important to consider the number of people affected by the disease, or the impact the disease would have on the families of the victims (for example, “AIDS orphans”) or on the countries where the victims live (for example, the loss of productivity due to illness and death of AIDS victims in their prime working years).

Explain:
Basic research has contributed to the public health management of all three of these diseases. Research on the measles virus in the 1950s and 1960s led to the development of a vaccine to prevent the disease. Research into HIV replication revealed vulnerable points in its infectious cycle, leading to the proteases now used to increase both the quality and the length of life for those who are HIV-positive. Research demonstrating that antimicrobial-resistance genes can be passed from one bacterial species to another alerted health officials to the need for increased surveillance for resistant pathogens and reinforced the need to use antimicrobials prudently and to conduct research to develop new, more effective drugs. How were the pathways of contraction related to the magnitude of the disease?
Who was the target audience of the proposal and how did this affect your decision?
What main criteria did all groups find most important?
Were any of these duplicated categories?Now that you have done the research and shared your findings with other groups what disease would you choose?
If you were to make a master list of criteria for grant accepting what would be on the list and why?
Students will answer the questions through discussion. Have this occur as a class deliberation between the teams and maybe run it like a debate. If you want to drag it out, save it for a full day and make it a well run debate where the class votes for a winner.

Extend / Elaborate:
HOMEWORK:
Give students copies of the matrices and have them take them home. They need to look up their disease and construct a matrix plus fill it out. Prepare a 2-minute presentation for why their virus should be chosen for a grant and practice presenting it to their parents.
Think about the criteria expected of the diseases used in class when creating the matrix. Students will present the presentations to an audience as part of their final project.

Evaluate:
Have students write a paper on how the effectiveness of the plan and magnitude of the disease can dictate the action taken. How does the balance of funding, time needed for result, audience being affected, and over all acceptance of action play a role in how the disease is controlled?