Epidemiological modeling of SARS-CoV-2 in white-tailed deer (Odocoileus virginianus) reveals conditions for introduction and widespread transmission.

Emerging infectious diseases with zoonotic potential often have complex socioecological dynamics and limited ecological data, requiring integration of epidemiological modeling with surveillance. Although our understanding of SARS-CoV-2 has advanced considerably since its detection in late 2019, the factors influencing its introduction and transmission in wildlife hosts, particularly white-tailed deer (Odocoileus virginianus), remain poorly understood. We use a Susceptible-Infected-Recovered-Susceptible epidemiological model to investigate the spillover risk and transmission dynamics of SARS-CoV-2 in wild and captive white-tailed deer populations across various simulated scenarios. We found that captive scenarios pose a higher risk of SARS-CoV-2 introduction from humans into deer herds and subsequent transmission among deer, compared to wild herds. However, even in wild herds, the transmission risk is often substantial enough to sustain infections. Furthermore, we demonstrate that the strength of introduction from humans influences outbreak characteristics only to a certain extent. Transmission among deer was frequently sufficient for widespread outbreaks in deer populations, regardless of the initial level of introduction. We also explore the potential for fence line interactions between captive and wild deer to elevate outbreak metrics in wild herds that have the lowest risk of introduction and sustained transmission. Our results indicate that SARS-CoV-2 could be introduced and maintained in deer herds across a range of circumstances based on testing a range of introduction and transmission risks in various captive and wild scenarios. Our approach and findings will aid One Health strategies that mitigate persistent SARS-CoV-2 outbreaks in white-tailed deer populations and potential spillback to humans.

Strategic testing approaches for targeted disease monitoring can be used to inform pandemic decision-making.

More than 1.6 million Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) tests were administered daily in the United States at the peak of the epidemic, with a significant focus on individual treatment. Here, we show that objective-driven, strategic sampling designs and analyses can maximize information gain at the population level, which is necessary to increase situational awareness and predict, prepare for, and respond to a pandemic, while also continuing to inform individual treatment. By focusing on specific objectives such as individual treatment or disease prediction and control (e.g., via the collection of population-level statistics to inform lockdown measures or vaccine rollout) and drawing from the literature on capture-recapture methods to deal with nonrandom sampling and testing errors, we illustrate how public health objectives can be achieved even with limited test availability when testing programs are designed a priori to meet those objectives.

Reframing wildlife disease management problems with decision analysis.

Contemporary wildlife disease management is complex because managers need to respond to a wide range of stakeholders, multiple uncertainties, and difficult trade-offs that characterize the interconnected challenges of today. Despite general acknowledgment of these complexities, managing wildlife disease tends to be framed as a scientific problem, in which the major challenge is lack of knowledge. The complex and multifactorial process of decision-making is collapsed into a scientific endeavor to reduce uncertainty. As a result, contemporary decision-making may be oversimplified, rely on simple heuristics, and fail to account for the broader legal, social, and economic context in which the decisions are made. Concurrently, scientific research on wildlife disease may be distant from this decision context, resulting in information that may not be directly relevant to the pertinent management questions. We propose reframing wildlife disease management challenges as decision problems and addressing them with decision analytical tools to divide the complex problems into more cognitively manageable elements. In particular, structured decision-making has the potential to improve the quality, rigor, and transparency of decisions about wildlife disease in a variety of systems. Examples of management of severe acute respiratory syndrome coronavirus 2, white-nose syndrome, avian influenza, and chytridiomycosis illustrate the most common impediments to decision-making, including competing objectives, risks, prediction uncertainty, and limited resources.

Replanteamiento del manejo de problemas por enfermedades de fauna mediante el análisis de decisiones Resumen El manejo actual de las enfermedades de la fauna es complejo debido a que los gestores necesitan responder a una amplia gama de actores, varias incertidumbres y compensaciones difíciles que caracterizan los retos interconectados del día de hoy. A pesar de que en general se reconocen estas complejidades, el manejo de las enfermedades tiende a plantearse como un problema científico en el que el principal obstáculo es la falta de conocimiento. El proceso complejo y multifactorial de la toma decisiones está colapsado dentro de un esfuerzo científico para reducir la incertidumbre. Como resultado de esto, las decisiones contemporáneas pueden estar simplificadas en exceso, depender de métodos heurísticos simples y no considerar el contexto legal, social y económico más amplio en el que se toman las decisiones. De manera paralela, las investigaciones científicas sobre las enfermedades de la fauna pueden estar lejos de este contexto de decisiones, lo que deriva en información que puede no ser directamente relevante para las preguntas pertinentes de manejo. Proponemos replantear los obstáculos para el manejo de enfermedades de fauna como problemas de decisión y abordarlos con herramientas analíticas de decisión para dividir los problemas complejos en elementos más manejables de manera cognitiva. En particular, las decisiones estructuradas tienen el potencial de mejorar la calidad, el rigor y la transparencia de las decisiones sobre las enfermedades de la fauna en una variedad de sistemas. Ejemplos como el manejo del coronavirus del síndrome de respiración agudo tipo 2, el síndrome de nariz blanca, la influenza aviar y la quitridiomicosis ilustran los impedimentos más comunes para la toma de decisiones, incluyendo los objetivos en competencia, riesgos, incertidumbre en las predicciones y recursos limitados.

Qualitative value of information provides a transparent and repeatable method for identifying critical uncertainty.

Conservation decisions are often made in the face of uncertainty because the urgency to act can preclude delaying management while uncertainty is resolved. In this context, adaptive management is attractive, allowing simultaneous management and learning. An adaptive program design requires the identification of critical uncertainties that impede the choice of management action. Quantitative evaluation of critical uncertainty, using the expected value of information, may require more resources than are available in the early stages of conservation planning. Here, we demonstrate the use of a qualitative index to the value of information (QVoI) to prioritize which sources of uncertainty to reduce regarding the use of prescribed fire to benefit Eastern Black Rails (Laterallus jamaicensis jamaicensis), Yellow Rails (Coterminous noveboracensis), and Mottled Ducks (Anas fulvigula; hereafter, focal species) in high marshes of the U.S. Gulf of Mexico. Prescribed fire has been used as a management tool in Gulf of Mexico high marshes throughout the last 30+ years; however, effects of periodic burning on the focal species and the optimal conditions for burning marshes to improve habitat remain unknown. We followed a structured decision-making framework to develop conceptual models, which we then used to identify sources of uncertainty and articulate alternative hypotheses about prescribed fire in high marshes. We used QVoI to evaluate the sources of uncertainty based on their Magnitude, Relevance for decision-making, and Reducibility. We found that hypotheses related to the optimal fire return interval and season were the highest priorities for study, whereas hypotheses related to predation rates and interactions among management techniques were lowest. These results suggest that learning about the optimal fire frequency and season to benefit the focal species might produce the greatest management benefit. In this case study, we demonstrate that QVoI can help managers decide where to apply limited resources to learn which specific actions will result in a higher likelihood of achieving the desired management objectives. Further, we summarize the strengths and limitations of QVoI and outline recommendations for its future use for prioritizing research to reduce uncertainty about system dynamics and the effects of management actions.

Synergistic interventions to control COVID-19: Mass testing and isolation mitigates reliance on distancing.

Stay-at-home orders and shutdowns of non-essential businesses are powerful, but socially costly, tools to control the pandemic spread of SARS-CoV-2. Mass testing strategies, which rely on widely administered frequent and rapid diagnostics to identify and isolate infected individuals, could be a potentially less disruptive management strategy, particularly where vaccine access is limited. In this paper, we assess the extent to which mass testing and isolation strategies can reduce reliance on socially costly non-pharmaceutical interventions, such as distancing and shutdowns. We develop a multi-compartmental model of SARS-CoV-2 transmission incorporating both preventative non-pharmaceutical interventions (NPIs) and testing and isolation to evaluate their combined effect on public health outcomes. Our model is designed to be a policy-guiding tool that captures important realities of the testing system, including constraints on test administration and non-random testing allocation. We show how strategic changes in the characteristics of the testing system, including test administration, test delays, and test sensitivity, can reduce reliance on preventative NPIs without compromising public health outcomes in the future. The lowest NPI levels are possible only when many tests are administered and test delays are short, given limited immunity in the population. Reducing reliance on NPIs is highly dependent on the ability of a testing program to identify and isolate unreported, asymptomatic infections. Changes in NPIs, including the intensity of lockdowns and stay at home orders, should be coordinated with increases in testing to ensure epidemic control; otherwise small additional lifting of these NPIs can lead to dramatic increases in infections, hospitalizations and deaths. Importantly, our results can be used to guide ramp-up of testing capacity in outbreak settings, allow for the flexible design of combined interventions based on social context, and inform future cost-benefit analyses to identify efficient pandemic management strategies.

Optimizing management of invasions in an uncertain world using dynamic spatial models.

Dispersal drives invasion dynamics of nonnative species and pathogens. Applying knowledge of dispersal to optimize the management of invasions can mean the difference between a failed and a successful control program and dramatically improve the return on investment of control efforts. A common approach to identifying optimal management solutions for invasions is to optimize dynamic spatial models that incorporate dispersal. Optimizing these spatial models can be very challenging because the interaction of time, space, and uncertainty rapidly amplifies the number of dimensions being considered. Addressing such problems requires advances in and the integration of techniques from multiple fields, including ecology, decision analysis, bioeconomics, natural resource management, and optimization. By synthesizing recent advances from these diverse fields, we provide a workflow for applying ecological theory to advance optimal management science and highlight priorities for optimizing the control of invasions. One of the striking gaps we identify is the extremely limited consideration of dispersal uncertainty in optimal management frameworks, even though dispersal estimates are highly uncertain and greatly influence invasion outcomes. In addition, optimization frameworks rarely consider multiple types of uncertainty (we describe five major types) and their interrelationships. Thus, feedbacks from management or other sources that could magnify uncertainty in dispersal are rarely considered. Incorporating uncertainty is crucial for improving transparency in decision risks and identifying optimal management strategies. We discuss gaps and solutions to the challenges of optimization using dynamic spatial models to increase the practical application of these important tools and improve the consistency and robustness of management recommendations for invasions.

An introduction to decision science for conservation.

Biodiversity conservation decisions are difficult, especially when they involve differing values, complex multidimensional objectives, scarce resources, urgency, and considerable uncertainty. Decision science embodies a theory about how to make difficult decisions and an extensive array of frameworks and tools that make that theory practical. We sought to improve conceptual clarity and practical application of decision science to help decision makers apply decision science to conservation problems. We addressed barriers to the uptake of decision science, including a lack of training and awareness of decision science; confusion over common terminology and which tools and frameworks to apply; and the mistaken impression that applying decision science must be time consuming, expensive, and complex. To aid in navigating the extensive and disparate decision science literature, we clarify meaning of common terms: decision science, decision theory, decision analysis, structured decision-making, and decision-support tools. Applying decision science does not have to be complex or time consuming; rather, it begins with knowing how to think through the components of a decision utilizing decision analysis (i.e., define the problem, elicit objectives, develop alternatives, estimate consequences, and perform trade-offs). This is best achieved by applying a rapid-prototyping approach. At each step, decision-support tools can provide additional insight and clarity, whereas decision-support frameworks (e.g., priority threat management and systematic conservation planning) can aid navigation of multiple steps of a decision analysis for particular contexts. We summarize key decision-support frameworks and tools and describe to which step of a decision analysis, and to which contexts, each is most useful to apply. Our introduction to decision science will aid in contextualizing current approaches and new developments, and help decision makers begin to apply decision science to conservation problems.

Las decisiones sobre la conservación de la biodiversidad son difíciles de tomar, especialmente cuando involucran diferentes valores, objetivos multidimensionales complejos, recursos limitados, urgencia y una incertidumbre considerable. Las ciencias de la decisión incorporan una teoría sobre cómo tomar decisiones difíciles y una variedad extensa de marcos de trabajo y herramientas que transforman esa teoría en práctica. Buscamos mejorar la claridad conceptual y la aplicación práctica de las ciencias de la decisión para ayudar al órgano decisorio a aplicar estas ciencias a los problemas de conservación. Nos enfocamos en las barreras para la aceptación de las ciencias de la decisión, incluyendo la falta de capacitación y de conciencia por estas ciencias; la confusión por la terminología común y cuáles herramientas y marcos de trabajo aplicar; y la impresión errónea de que la aplicación de estas ciencias consume tiempo y debe ser costosa y compleja. Para asistir en la navegación de la literatura extensa y dispar de las ciencias de la decisión, aclaramos el significado de varios términos comunes: ciencias de la decisión, teoría de la decisión, análisis de decisiones, toma estructurada de decisiones y herramientas de apoyo para las decisiones. La aplicación de las ciencias de la decisión no tiene que ser compleja ni debe llevar mucho tiempo; de hecho, todo comienza con saber cómo pensar detenidamente en los componentes de una decisión mediante el análisis de decisiones (es decir, definir el problema, producir objetivos, desarrollar alternativas, estimar consecuencias y realizar compensaciones). Lo anterior se logra de mejor manera mediante la aplicación de una estrategia prototipos rápidos. En cada paso, las herramientas de apoyo para las decisiones pueden proporcionar visión y claridad adicionales, mientras que los marcos de apoyo para las decisiones (p.ej.: gestión de amenazas prioritarias y planeación sistemática de la conservación) pueden asistir en la navegación de los diferentes pasos de un análisis de decisiones para contextos particulares. Resumimos los marcos de trabajo y las herramientas más importantes de apoyo para las decisiones y describimos el paso, y el contexto, del análisis de decisiones para el que es más útil aplicarlos. Nuestra introducción a las ciencias de la decisión apoyará en la contextualización de las estrategias actuales y los nuevos desarrollos, y ayudarán al órgano decisorio a comenzar a aplicar estas ciencias en los problemas de conservación.

Vote-processing rules for combining control recommendations from multiple models.

Mathematical modelling is used during disease outbreaks to compare control interventions. Using multiple models, the best method to combine model recommendations is unclear. Existing methods weight model projections, then rank control interventions using the combined projections, presuming model outputs are directly comparable. However, the way each model represents the epidemiological system will vary. We apply electoral vote-processing rules to combine model-generated rankings of interventions. Combining rankings of interventions, instead of combining model projections, avoids assuming that projections are comparable as all comparisons of projections are made within each model. We investigate four rules: First-past-the-post, Alternative Vote (AV), Coombs Method and Borda Count. We investigate rule sensitivity by including models that favour only one action or including those that rank interventions randomly. We investigate two case studies: the 2014 Ebola outbreak in West Africa (37 compartmental models) and a hypothetical foot-and-mouth disease outbreak in UK (four individual-based models). The Coombs Method was least susceptible to adding models that favoured a single action, Borda Count and AV were most susceptible to adding models that ranked interventions randomly. Each rule chose the same intervention as when ranking interventions by mean projections, suggesting that combining rankings provides similar recommendations with fewer assumptions about model comparability. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Modeling of Future COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Rates and Nonpharmaceutical Intervention Scenarios - United States, April-September 2021.

After a period of rapidly declining U.S. COVID-19 incidence during January-March 2021, increases occurred in several jurisdictions (1,2) despite the rapid rollout of a large-scale vaccination program. This increase coincided with the spread of more transmissible variants of SARS-CoV-2, the virus that causes COVID-19, including B.1.1.7 (1,3) and relaxation of COVID-19 prevention strategies such as those for businesses, large-scale gatherings, and educational activities. To provide long-term projections of potential trends in COVID-19 cases, hospitalizations, and deaths, COVID-19 Scenario Modeling Hub teams used a multiple-model approach comprising six models to assess the potential course of COVID-19 in the United States across four scenarios with different vaccination coverage rates and effectiveness estimates and strength and implementation of nonpharmaceutical interventions (NPIs) (public health policies, such as physical distancing and masking) over a 6-month period (April-September 2021) using data available through March 27, 2021 (4). Among the four scenarios, an accelerated decline in NPI adherence (which encapsulates NPI mandates and population behavior) was shown to undermine vaccination-related gains over the subsequent 2-3 months and, in combination with increased transmissibility of new variants, could lead to surges in cases, hospitalizations, and deaths. A sharp decline in cases was projected by July 2021, with a faster decline in the high-vaccination scenarios. High vaccination rates and compliance with public health prevention measures are essential to control the COVID-19 pandemic and to prevent surges in hospitalizations and deaths in the coming months.

Demographic risk assessment for a harvested species threatened by climate change: polar bears in the Chukchi Sea.

Climate change threatens global biodiversity. Many species vulnerable to climate change are important to humans for nutritional, cultural, and economic reasons. Polar bears Ursus maritimus are threatened by sea-ice loss and represent a subsistence resource for Indigenous people. We applied a novel population modeling-management framework that is based on species life history and accounts for habitat loss to evaluate subsistence harvest for the Chukchi Sea (CS) polar bear subpopulation. Harvest strategies followed a state-dependent approach under which new data were used to update the harvest on a predetermined management interval. We found that a harvest strategy with a starting total harvest rate of 2.7% (˜85 bears/yr at current abundance), a 2:1 male-to-female ratio, and a 10-yr management interval would likely maintain subpopulation abundance above maximum net productivity level for the next 35 yr (approximately three polar bear generations), our primary criterion for sustainability. Plausible bounds on starting total harvest rate were 1.7-3.9%, where the range reflects uncertainty due to sampling variation, environmental variation, model selection, and differing levels of risk tolerance. The risk of undesired demographic outcomes (e.g., overharvest) was positively related to harvest rate, management interval, and projected declines in environmental carrying capacity; and negatively related to precision in population data. Results reflect several lines of evidence that the CS subpopulation has been productive in recent years, although it is uncertain how long this will last as sea-ice loss continues. Our methods provide a template for balancing trade-offs among protection, use, research investment, and other factors. Demographic risk assessment and state-dependent management will become increasingly important for harvested species, like polar bears, that exhibit spatiotemporal variation in their response to climate change.

A framework for allocating conservation resources among multiple threats and actions.

Land managers decide how to allocate resources among multiple threats that can be addressed through multiple possible actions. Additionally, these actions vary in feasibility, effectiveness, and cost. We sought to provide a way to optimize resource allocation to address multiple threats when multiple management options are available, including mutually exclusive options. Formulating the decision as a combinatorial optimization problem, our framework takes as inputs the expected impact and cost of each threat for each action (including do nothing) and for each overall budget identifies the optimal action to take for each threat. We compared the optimal solution to an easy to calculate greedy algorithm approximation and a variety of plausible ranking schemes. We applied the framework to management of multiple introduced plant species in Australian alpine areas. We developed a model of invasion to predict the expected impact in 50 years for each species-action combination that accounted for each species' current invasion state (absent, localized, widespread); arrival probability; spread rate; impact, if present, of each species; and management effectiveness of each species-action combination. We found that the recommended action for a threat changed with budget; there was no single optimal management action for each species; and considering more than one candidate action can substantially increase the management plan's overall efficiency. The approximate solution (solution ranked by marginal cost-effectiveness) performed well when the budget matched the cost of the prioritized actions, indicating that this approach would be effective if the budget was set as part of the prioritization process. The ranking schemes varied in performance, and achieving a close to optimal solution was not guaranteed. Global sensitivity analysis revealed a threat's expected impact and, to a lesser extent, management effectiveness were the most influential parameters, emphasizing the need to focus research and monitoring efforts on their quantification.

Un Marco de Referencia para Asignar Recursos para la Conservación entre Múltiples Amenazas y Acciones Resumen Los administradores de tierras deciden cómo asignar recursos entre múltiples amenazas que pueden abordarse por medio de múltiples acciones. Adicionalmente, estas acciones varían en viabilidad, efectividad y costo. Buscamos proporcionar una manera para optimizar la asignación de recursos para abordar varias amenazas cuando están disponibles muchas opciones de manejo, incluyendo opciones mutuamente excluyentes. Con una formulación de la decisión como un problema combinatorio de optimización, nuestro marco de referencia toma como entradas el impacto esperado y el costo de cada amenaza para cada acción (incluyendo hacer nada) y para cada presupuesto generalizado identifica la acción óptima a realizar ante cada amenaza. Comparamos la solución óptima con una aproximación de un algoritmo avaricioso fácil de calcular y una variedad de esquemas plausibles de clasificación. Aplicamos el marco de trabajo al manejo de múltiples especies de plantas introducidas en las áreas alpinas de Australia. Desarrollamos un modelo de invasión para predecir el impacto esperado en 50 años para cada combinación de especie-acción que consideró el estado actual de invasión para cada especie (ausente, localizada, ampliamente distribuida), la probabilidad de invasión, la tasa de esparcimiento, el impacto, cuando abundante, de cada especie y la efectividad de manejo de cada combinación especie-acción. Descubrimos que la acción recomendada para una amenaza cambia con el presupuesto, que no existe una acción única de manejo óptimo para cada especie y que considerar más de una acción candidata puede incrementar sustancialmente la eficiencia general del plan de manejo. La solución aproximada (solución clasificada por rentabilidad) tuvo un buen desempeño cuando el presupuesto fue igual al costo de las acciones prioritarias, lo que indica que esta estrategia sería efectiva si el presupuesto está fijado como parte del proceso de priorización. Los esquemas de clasificación variaron en cuanto a desempeño, y lograr una solución cercana a lo óptimo no estuvo garantizado. El análisis de sensibilidad global reveló que el impacto esperado de una amenaza y, a menor grado, la efectividad del manejo no fueron los parámetros con mayor influencia, lo que enfatiza la necesidad de enfocar la investigación y los esfuerzos de monitoreo en la cuantificación del impacto esperado y la efectividad del manejo.

Anticipating future learning affects current control decisions: A comparison between passive and active adaptive management in an epidemiological setting.

Infectious disease epidemics present a difficult task for policymakers, requiring the implementation of control strategies under significant time constraints and uncertainty. Mathematical models can be used to predict the outcome of control interventions, providing useful information to policymakers in the event of such an epidemic. However, these models suffer in the early stages of an outbreak from a lack of accurate, relevant information regarding the dynamics and spread of the disease and the efficacy of control. As such, recommendations provided by these models are often incorporated in an ad hoc fashion, as and when more reliable information becomes available. In this work, we show that such trial-and-error-type approaches to management, which do not formally take into account the resolution of uncertainty and how control actions affect this, can lead to sub-optimal management outcomes. We compare three approaches to managing a theoretical epidemic: a non-adaptive management (AM) approach that does not use real-time outbreak information to adapt control, a passive AM approach that incorporates real-time information if and when it becomes available, and an active AM approach that explicitly incorporates the future resolution of uncertainty through gathering real-time information into its initial recommendations. The structured framework of active AM encourages the specification of quantifiable objectives, models of system behaviour and possible control and monitoring actions, followed by an iterative learning and control phase that is able to employ complex control optimisations and resolve system uncertainty. The result is a management framework that is able to provide dynamic, long-term projections to help policymakers meet the objectives of management. We investigate in detail the effect of different methods of incorporating up-to-date outbreak information. We find that, even in a highly simplified system, the method of incorporating new data can lead to different results that may influence initial policy decisions, with an active AM approach to management providing better information that can lead to more desirable outcomes from an epidemic.

Essential information: Uncertainty and optimal control of Ebola outbreaks.

Early resolution of uncertainty during an epidemic outbreak can lead to rapid and efficient decision making, provided that the uncertainty affects prioritization of actions. The wide range in caseload projections for the 2014 Ebola outbreak caused great concern and debate about the utility of models. By coding and running 37 published Ebola models with five candidate interventions, we found that, despite this large variation in caseload projection, the ranking of management options was relatively consistent. Reducing funeral transmission and reducing community transmission were generally ranked as the two best options. Value of information (VoI) analyses show that caseloads could be reduced by 11% by resolving all model-specific uncertainties, with information about model structure accounting for 82% of this reduction and uncertainty about caseload only accounting for 12%. Our study shows that the uncertainty that is of most interest epidemiologically may not be the same as the uncertainty that is most relevant for management. If the goal is to improve management outcomes, then the focus of study should be to identify and resolve those uncertainties that most hinder the choice of an optimal intervention. Our study further shows that simplifying multiple alternative models into a smaller number of relevant groups (here, with shared structure) could streamline the decision-making process and may allow for a better integration of epidemiological modeling and decision making for policy.

Concurrent assessment of epidemiological and operational uncertainties for optimal outbreak control: Ebola as a case study.

Determining how best to manage an infectious disease outbreak may be hindered by both epidemiological uncertainty (i.e. about epidemiological processes) and operational uncertainty (i.e. about the effectiveness of candidate interventions). However, these two uncertainties are rarely addressed concurrently in epidemic studies. We present an approach to simultaneously address both sources of uncertainty, to elucidate which source most impedes decision-making. In the case of the 2014 West African Ebola outbreak, epidemiological uncertainty is represented by a large ensemble of published models. Operational uncertainty about three classes of interventions is assessed for a wide range of potential intervention effectiveness. We ranked each intervention by caseload reduction in each model, initially assuming an unlimited budget as a counterfactual. We then assessed the influence of three candidate cost functions relating intervention effectiveness and cost for different budget levels. The improvement in management outcomes to be gained by resolving uncertainty is generally high in this study; appropriate information gain could reduce expected caseload by more than 50%. The ranking of interventions is jointly determined by the underlying epidemiological process, the effectiveness of the interventions and the size of the budget. An epidemiologically effective intervention might not be optimal if its costs outweigh its epidemiological benefit. Under higher-budget conditions, resolution of epidemiological uncertainty is most valuable. When budgets are tight, however, operational and epidemiological uncertainty are equally important. Overall, our study demonstrates that significant reductions in caseload could result from a careful examination of both epidemiological and operational uncertainties within the same modelling structure. This approach can be applied to decision-making for the management of other diseases for which multiple models and multiple interventions are available.

Real-time decision-making during emergency disease outbreaks.

In the event of a new infectious disease outbreak, mathematical and simulation models are commonly used to inform policy by evaluating which control strategies will minimize the impact of the epidemic. In the early stages of such outbreaks, substantial parameter uncertainty may limit the ability of models to provide accurate predictions, and policymakers do not have the luxury of waiting for data to alleviate this state of uncertainty. For policymakers, however, it is the selection of the optimal control intervention in the face of uncertainty, rather than accuracy of model predictions, that is the measure of success that counts. We simulate the process of real-time decision-making by fitting an epidemic model to observed, spatially-explicit, infection data at weekly intervals throughout two historical outbreaks of foot-and-mouth disease, UK in 2001 and Miyazaki, Japan in 2010, and compare forward simulations of the impact of switching to an alternative control intervention at the time point in question. These are compared to policy recommendations generated in hindsight using data from the entire outbreak, thereby comparing the best we could have done at the time with the best we could have done in retrospect. Our results show that the control policy that would have been chosen using all the data is also identified from an early stage in an outbreak using only the available data, despite high variability in projections of epidemic size. Critically, we find that it is an improved understanding of the locations of infected farms, rather than improved estimates of transmission parameters, that drives improved prediction of the relative performance of control interventions. However, the ability to estimate undetected infectious premises is a function of uncertainty in the transmission parameters. Here, we demonstrate the need for both real-time model fitting and generating projections to evaluate alternative control interventions throughout an outbreak. Our results highlight the use of using models at outbreak onset to inform policy and the importance of state-dependent interventions that adapt in response to additional information throughout an outbreak.

Quantifying the Value of Perfect Information in Emergency Vaccination Campaigns.

Foot-and-mouth disease outbreaks in non-endemic countries can lead to large economic costs and livestock losses but the use of vaccination has been contentious, partly due to uncertainty about emergency FMD vaccination. Value of information methods can be applied to disease outbreak problems such as FMD in order to investigate the performance improvement from resolving uncertainties. Here we calculate the expected value of resolving uncertainty about vaccine efficacy, time delay to immunity after vaccination and daily vaccination capacity for a hypothetical FMD outbreak in the UK. If it were possible to resolve all uncertainty prior to the introduction of control, we could expect savings of £55 million in outbreak cost, 221,900 livestock culled and 4.3 days of outbreak duration. All vaccination strategies were found to be preferable to a culling only strategy. However, the optimal vaccination radius was found to be highly dependent upon vaccination capacity for all management objectives. We calculate that by resolving the uncertainty surrounding vaccination capacity we would expect to return over 85% of the above savings, regardless of management objective. It may be possible to resolve uncertainty about daily vaccination capacity before an outbreak, and this would enable decision makers to select the optimal control action via careful contingency planning.

Implicit decision framing as an unrecognized source of confusion in endangered species classification.

Legal classification of species requires scientific and values-based components, and how those components interact depends on how people frame the decision. Is classification a negotiation of trade-offs, a decision on how to allocate conservation efforts, or simply a comparison of the biological status of a species to a legal standard? The answers to problem-framing questions such as these influence decision making in species classifications. In our experience, however, decision makers, staff biologists, and stakeholders often have differing perspectives of the decision problem and assume different framings. In addition to differences between individuals, in some cases it appears individuals themselves are unclear about the decision process, which contributes to regulatory paralysis, litigation, and a loss of trust by agency staff and the public. We present 5 framings: putting species in the right bin, doing right by the species over time, saving the most species on a limited budget, weighing extinction risk against other objectives, and strategic classification to advance conservation. These framings are inspired by elements observed in current classification practices. Putting species in the right bin entails comparing a scientific status assessment with policy thresholds and accounting for potential misclassification costs. Doing right by the species adds a time dimension to the classification decision, and saving the most species on a limited budget classifies a suite of species simultaneously. Weighing extinction risk against other objectives would weigh ecological or socioeconomic concerns in classification decisions, and strategic classification to advance conservation would make negotiation a component of classification. We view these framings as a means to generate thought, discussion, and movement toward selection and application of explicit classification framings. Being explicit about the decision framing could lead decision makers toward more efficient and defensible decisions, reduce internal confusion and external conflict, and support better collaboration between scientists and policy makers.

Adaptive management and the value of information: learning via intervention in epidemiology.

Optimal intervention for disease outbreaks is often impeded by severe scientific uncertainty. Adaptive management (AM), long-used in natural resource management, is a structured decision-making approach to solving dynamic problems that accounts for the value of resolving uncertainty via real-time evaluation of alternative models. We propose an AM approach to design and evaluate intervention strategies in epidemiology, using real-time surveillance to resolve model uncertainty as management proceeds, with foot-and-mouth disease (FMD) culling and measles vaccination as case studies. We use simulations of alternative intervention strategies under competing models to quantify the effect of model uncertainty on decision making, in terms of the value of information, and quantify the benefit of adaptive versus static intervention strategies. Culling decisions during the 2001 UK FMD outbreak were contentious due to uncertainty about the spatial scale of transmission. The expected benefit of resolving this uncertainty prior to a new outbreak on a UK-like landscape would be £45-£60 million relative to the strategy that minimizes livestock losses averaged over alternate transmission models. AM during the outbreak would be expected to recover up to £20.1 million of this expected benefit. AM would also recommend a more conservative initial approach (culling of infected premises and dangerous contact farms) than would a fixed strategy (which would additionally require culling of contiguous premises). For optimal targeting of measles vaccination, based on an outbreak in Malawi in 2010, AM allows better distribution of resources across the affected region; its utility depends on uncertainty about both the at-risk population and logistical capacity. When daily vaccination rates are highly constrained, the optimal initial strategy is to conduct a small, quick campaign; a reduction in expected burden of approximately 10,000 cases could result if campaign targets can be updated on the basis of the true susceptible population. Formal incorporation of a policy to update future management actions in response to information gained in the course of an outbreak can change the optimal initial response and result in significant cost savings. AM provides a framework for using multiple models to facilitate public-health decision making and an objective basis for updating management actions in response to improved scientific understanding.

Two-step adaptive management for choosing between two management actions.

Adaptive management is widely advocated to improve environmental management. Derivations of optimal strategies for adaptive management, however, tend to be case specific and time consuming. In contrast, managers might seek relatively simple guidance, such as insight into when a new potential management action should be considered, and how much effort should be expended on trialing such an action. We constructed a two-time-step scenario where a manager is choosing between two possible management actions. The manager has a total budget that can be split between a learning phase and an implementation phase. We use this scenario to investigate when and how much a manager should invest in learning about the management actions available. The optimal investment in learning can be understood intuitively by accounting for the expected value of sample information, the benefits that accrue during learning, the direct costs of learning, and the opportunity costs of learning. We find that the optimal proportion of the budget to spend on learning is characterized by several critical thresholds that mark a jump from spending a large proportion of the budget on learning to spending nothing. For example, as sampling variance increases, it is optimal to spend a larger proportion of the budget on learning, up to a point: if the sampling variance passes a critical threshold, it is no longer beneficial to invest in learning. Similar thresholds are observed as a function of the total budget and the difference in the expected performance of the two actions. We illustrate how this model can be applied using a case study of choosing between alternative rearing diets for hihi, an endangered New Zealand passerine. Although the model presented is a simplified scenario, we believe it is relevant to many management situations. Managers often have relatively short time horizons for management, and might be reluctant to consider further investment in learning and monitoring beyond collecting data from a single time period.