Epidemiological, evolutionary, and economic determinants of eradication tails, Journal of Theoretical Biology, http://dx.doi.org/10. 1016/j.jtbi.2016.03.019 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Highlightsx We provide a model-based analysis of eradication tails.x For the first time, we quantitatively study the trade-off between infectivity and mobility.x Eradication tails depend on how the extinction threshold is approached.x Pathogen evolution counteracts eradication measures.x The cost structure of eradication measures strongly shapes eradication tails.
AbstractInfectious diseases still generate huge socio-economic costs and many people would like to see them gone entirely. While success stories like with smallpox and rinderpest give hope that this may be possible, many other eradication attempts have failed. Eradication requires huge and costly efforts, which can only be sustained if sufficient progress can be reported.While initial successes are usually easily obtained, progress often becomes harder as the disease becomes rare (during the "endgame"). Often a long "eradication tail" of slowly decreasing incidence level frustrates eradication efforts, as it becomes unclear whether progress towards eradication is still made and how much more needs to be invested to push the disease beyond the extinction threshold. Realistic disease dynamics are complex, generally involving dynamics on several temporal and spatial scales, and evolutionary responses to interventions. Models that account for these complexities can serve to understand the eradication tails of diseases as they are pushed to extinction; that is, they allow predicting how hard or costly eradication will be, and may even inform in which manner progress has to be assessed during the endgame. Here, we outline a general procedure by analyzing the eradication tail of a generic SIS disease, taking into account two major ingredients of realistic complexity; namely, a spatially-structured host population where contacts within groups are much more likely than contacts between groups, and virulence evolution, with a trade-off linking local infectivity and host mobility among groups.Disentangling the epidemiological, evolutionary, and economic determinants of the eradication tail, we show that different tails result depending both on parameters and on how the extinction threshold is approached. Specifically, we find that pathogen evolution generally extends the eradication tail. Finally, we show how the cost structure of eradication measures shapes eradication tails in a major way.