Individually optimal choices can be collectively disastrous in COVID-19 disease control
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Abstract
Background
The word ‘pandemic’ conjures dystopian images of bodies stacked in the streets and societies on the brink of collapse. Despite this frightening picture, denialism and noncompliance with public health measures are common in the historical record, for example during the 1918 Influenza pandemic or the 2015 Ebola epidemic. The unique characteristics of SARS-CoV-2—its high basic reproduction number (R 0 ), time-limited natural immunity and considerable potential for asymptomatic spread—exacerbate the public health repercussions of noncompliance with interventions (such as vaccines and masks) to limit disease transmission. Our work explores the rationality and impact of noncompliance with measures aimed at limiting the spread of SARS-CoV-2.
Methods
In this work, we used game theory to explore when noncompliance confers a perceived benefit to individuals. We then used epidemiological modeling to predict the impact of noncompliance on control of SARS-CoV-2, demonstrating that the presence of a noncompliant subpopulation prevents suppression of disease spread.
Results
Our modeling demonstrates that noncompliance is a Nash equilibrium under a broad set of conditions and that the existence of a noncompliant population can result in extensive endemic disease in the long-term after a return to pre-pandemic social and economic activity. Endemic disease poses a threat for both compliant and noncompliant individuals; all community members are protected if complete suppression is achieved, which is only possible with a high degree of compliance. For interventions that are highly effective at preventing disease spread, however, the consequences of noncompliance are borne disproportionately by noncompliant individuals.
Conclusions
In sum, our work demonstrates the limits of free-market approaches to compliance with disease control measures during a pandemic. The act of noncompliance with disease intervention measures creates a negative externality, rendering suppression of SARS-CoV-2 spread ineffective. Our work underscores the importance of developing effective strategies for prophylaxis through public health measures aimed at complete suppression and the need to focus on compliance at a population level.
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SciScore for 10.1101/2020.11.29.20240440: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This behavior underscores the limitations of the laissez-faire, individualistic, approach to disease control during a pandemic. While the underpinnings of such a laissez-faire approach are often said to lie in the economic theory of utilitarianism (49), put forward by John Stuart Mill, such an approach actually violates the standard …
SciScore for 10.1101/2020.11.29.20240440: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This behavior underscores the limitations of the laissez-faire, individualistic, approach to disease control during a pandemic. While the underpinnings of such a laissez-faire approach are often said to lie in the economic theory of utilitarianism (49), put forward by John Stuart Mill, such an approach actually violates the standard originally laid out by Mill by which a person’s liberty may be restricted: “The only purpose for which power can rightfully be exercised over any member of a civilized community, against his will, is to prevent harm to others” (50). Given the ubiquity of the problem, some public policy solutions can be found that have close analogies to successful interventions in other spheres of human activity. First, public health messaging that seeks to alter the Nash equilibrium at an individual level are worth exploring. In individualistic societies, this may be accomplished by de-emphasizing altruism and focusing on the individual cost-benefit. One way this may be achieved is by emphasizing the long-term morbidity costs (such as cryptic heart, lung, brain and kidney damage) as have been documented to occur in even asymptomatic COVID-19 patients in an age-independent manner(51–53). An additional approach is to provide an accurate and current picture of the risk of contracting the disease. Second, public health policy that creates costs for noncompliers may serve to shift some of the externalities back on to the originator (as was the case with mask ordinance...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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