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. 2018 Jun;34(1-2):78-120.
doi: 10.1002/sdr.1589.

Using integrated modeling to support the global eradication of vaccine-preventable diseases

Radboud J Duintjer Tebbens  1 , Kimberly M Thompson  1
Affiliations

Using integrated modeling to support the global eradication of vaccine-preventable diseases

Radboud J Duintjer Tebbens et al. Syst Dyn Rev. 2018 Jun.

Abstract

The long-term management of global disease eradication initiatives involves numerous inherently dynamic processes, health and economic trade-offs, significant uncertainty and variability, rare events with big consequences, complex and inter-related decisions, and a requirement for cooperation among a large number of stakeholders. Over the course of more than 16 years of collaborative modeling efforts to support the Global Polio Eradication Initiative, we developed increasingly complex integrated system dynamics models that combined numerous analytical approaches, including differential equation-based modeling, risk and decision analysis, discrete-event and individual-based simulation, probabilistic uncertainty and sensitivity analysis, health economics, and optimization. We discuss the central role of systems thinking and system dynamics in the overall effort and the value of integrating different modeling approaches to appropriately address the trade-offs involved in some of the policy questions. We discuss practical challenges of integrating different analytical tools and we provide our perspective on the future of integrated modeling.

Keywords: decision analysis; health economics; integrated modeling; polio eradication; systems thinking.

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Figures

Figure 1:
Figure 1:
Diagram of main global model structure with analytical tools for each component indicated in red italics and following an asterisk. Abbreviations: cVDPV, circulating vaccine-derived poliovirus; DEB, differential equation-based; IPV, inactivated poliovirus vaccine; iVDPV, immunodeficiency-associated vaccine-derived poliovirus; OPV, oral poliovirus vaccine; oSIA, outbreak response supplemental immunization activity; pSIA, preventive supplemental immunization activity; RI, routine immunization; VAPP, vaccine-associated paralytic poliomyelitis; WPV, wild poliovirus
Figure 2:
Figure 2:
Causal loop diagram related to iVDPV behavior Abbreviations: iVDPV, immunodeficiency-associated vaccine-derived poliovirus; OPV, oral poliovirus vaccine; PID, primary immunodeficiency
Figure 3:
Figure 3:
Four realizations of the discrete-event simulation model, showing the monthly number of active long-term iVDPV excretors
Figure 4:
Figure 4:
Integration of DES model within the global model Abbreviations and notation: DES, discrete event simulation; IPV, inactivated poliovirus vaccine; iVDPV, immunodeficiency-associated vaccine-derived poliovirus; OPV, oral poliovirus vaccine; PID, primary immunodeficiency; PITT, population immunity to transmission; R0, basic reproduction number; s, subpopulation; t, time
Figure 5:
Figure 5:
Integrated global model results for 5 realizations for serotype 2 showing contacts of iVDPV excretors with a general population (generated by the DES model), resulting effective infections and potential OPV outbreak response (generated by the global model), and potential new iVDPV infections caused by post-cessation OPV use (generated by the global model using PID patients generated by the DES model). Runs 1–4 represent a quasi-random selection (i.e., the first 4 global model realizations), run 5 represents a selected, non-representative and rare realization in which an outbreak caused by a new iVDPV excretor ultimately triggered an OPV restart. Abbreviations and notation: DES, discrete event simulation; iVDPV, immunodeficiency-associated vaccine-derived poliovirus; OPV, oral poliovirus vaccine; PID, primary immunodeficiency
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