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Volume 37, 2021, 100507

Challenges in evaluating risks and policy options around endemic establishment or elimination of novel pathogens

C. Jessica E.Metcalfa,b, Soa Fy Andriamandimbyc, Rachel E. Bakera,d, Emma E. Glennone, Katie Hampsonf, T. Deirdre Hollingsworthg, Petra Klepach, Amy Wesolowskil

Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.


When a novel pathogen emerges there may be opportunities to eliminate transmission - locally or globally - whilst case numbers are low. However, the effort required to push a disease to elimination may come at a vast cost at a time when uncertainty is high. Models currently inform policy discussions on this question, but there are a number of open challenges, particularly given unknown aspects of the pathogen biology, the effectiveness and feasibility of interventions, and the intersecting political, economic, sociological and behavioural complexities for a novel pathogen. In this overview, we detail how models might identify directions for better leveraging or expanding the scope of data available on the pathogen trajectory, for bounding the theoretical context of emergence relative to prospects for elimination, and for framing the larger economic, behavioural and social context that will influence policy decisions and the pathogen’s outcome.

Keywords: Endemic, Epidemic, Mathematical model, Elimination, Emergence.

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