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1. Impact of waning immunity against SARS-CoV-2 severity exacerbated by vaccine hesitancy

   https://doi.org/10.1371/journal.pcbi.1012211  

   Saad-Roy, Chadi M; Morris, Sinead E; Boots, Mike; Baker, Rachel E; Lewis, Bryan L; Farrar, Jeremy; Marathe, Madhav V; Graham, Andrea L; Levin, Simon A; Wagner, Caroline E; et al (August 2024, PLOS Computational Biology)

   Wallqvist, Anders (Ed.)

   The SARS-CoV-2 pandemic has generated a considerable number of infections and associated morbidity and mortality across the world. Recovery from these infections, combined with the onset of large-scale vaccination, have led to rapidly-changing population-level immunological landscapes. In turn, these complexities have highlighted a number of important unknowns related to the breadth and strength of immunity following recovery or vaccination. Using simple mathematical models, we investigate the medium-term impacts of waning immunity against severe disease on immuno-epidemiological dynamics. We find that uncertainties in the duration of severity-blocking immunity (imparted by either infection or vaccination) can lead to a large range of medium-term population-level outcomes (i.e. infection characteristics and immune landscapes). Furthermore, we show that epidemiological dynamics are sensitive to the strength and duration of underlying host immune responses; this implies that determining infection levels from hospitalizations requires accurate estimates of these immune parameters. More durable vaccines both reduce these uncertainties and alleviate the burden of SARS-CoV-2 in pessimistic outcomes. However, heterogeneity in vaccine uptake drastically changes immune landscapes toward larger fractions of individuals with waned severity-blocking immunity. In particular, if hesitancy is substantial, more robust vaccines have almost no effects on population-level immuno-epidemiology, even if vaccination rates are compensatorily high among vaccine-adopters. This pessimistic scenario for vaccination heterogeneity arises because those few individuals that are vaccine-adopters are so readily re-vaccinated that the duration of vaccinal immunity has no appreciable consequences on their immune status. Furthermore, we find that this effect is heightened if vaccine-hesitants have increased transmissibility (e.g. due to riskier behavior). Overall, our results illustrate the necessity to characterize both transmission-blocking and severity-blocking immune time scales. Our findings also underline the importance of developing robust next-generation vaccines with equitable mass vaccine deployment. 

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2. COVID-19 Seroprevalence in Canada Modelling Waning and Boosting COVID-19 Immunity in Canada a Canadian Immunization Research Network Study

   https://doi.org/10.3390/vaccines10010017  

   Dick, David W.; Childs, Lauren; Feng, Zhilan; Li, Jing; Röst, Gergely; Buckeridge, David L.; Ogden, Nick H.; Heffernan, Jane M. (January 2022, Vaccines)

   COVID-19 seroprevalence changes over time, with infection, vaccination, and waning immunity. Seroprevalence estimates are needed to determine when increased COVID-19 vaccination coverage is needed, and when booster doses should be considered, to reduce the spread and disease severity of COVID-19 infection. We use an age-structured model including infection, vaccination and waning immunity to estimate the distribution of immunity to COVID-19 in the Canadian population. This is the first mathematical model to do so. We estimate that 60–80% of the Canadian population has some immunity to COVID-19 by late Summer 2021, depending on specific characteristics of the vaccine and the waning rate of immunity. Models results indicate that increased vaccination uptake in age groups 12–29, and booster doses in age group 50+ are needed to reduce the severity COVID-19 Fall 2021 resurgence. 

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3. Mathematical analysis of simple behavioral epidemic models

   https://doi.org/10.1016/j.mbs.2024.109250  

   LeJeune, Leah; Ghaffarzadegan, Navid; Childs, Lauren M; Saucedo, Omar (September 2024, Mathematical Biosciences)

   COVID-19 highlighted the importance of considering human behavior change when modeling disease dynamics. This led to developing various models that incorporate human behavior. Our objective is to contribute to an in-depth, mathematical examination of such models. Here, we consider a simple deterministic compartmental model with endogenous incorporation of human behavior (i.e., behavioral feedback) through transmission in a classic Susceptible–Exposed–Infectious–Recovered (SEIR) structure. Despite its simplicity, the SEIR structure with behavior (SEIRb) was shown to perform well in forecasting, especially compared to more complicated models. We contrast this model with an SEIR model that excludes endogenous incorporation of behavior. Both models assume permanent immunity to COVID-19, so we also consider a modification of the models which include waning immunity (SEIRS and SEIRSb). We perform equilibria, sensitivity, and identifiability analyses on all models and examine the fidelity of the models to replicate COVID-19 data across the United States. Endogenous incorporation of behavior significantly improves a model’s ability to produce realistic outbreaks. While the two endogenous models are similar with respect to identifiability and sensitivity, the SEIRSb model, with the more accurate assumption of the waning immunity, strengthens the initial SEIRb model by allowing for the existence of an endemic equilibrium, a realistic feature of COVID-19 dynamics. When fitting the model to data, we further consider the addition of simple seasonality affecting disease transmission to highlight the explanatory power of the models. 

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4. Protective microbiomes can limit the evolution of host pathogen defense

   https://doi.org/10.1002/evl3.140  

   Metcalf, C. Jessica E.; Koskella, Britt (October 2019, Evolution Letters)

   Abstract The evolution of host immunity occurs in the context of the microbiome, but little theory exists to predict how resistance against pathogens might be influenced by the need to tolerate and regulate commensal microbiota. We present a general model to explore the optimal investment in host immunity under conditions in which the host can, versus cannot easily distinguish among commensal versus pathogenic bacteria, and when commensal microbiota can, versus cannot protect the host against the impacts of pathogen infection. We find that a loss of immune vigilance associated with innate immunity over evolutionary time can occur due to the challenge of discriminating between pathogenic and other microbe species. Further, we find the greater the protective effect of microbiome species, acting either directly or via competition with a pathogen, or the higher the costs of immunity, the more likely the loss of immune vigilance is. Conversely, this effect can be reversed when pathogens increase host mortality. Generally, the magnitude of costs of immunity required to allow evolution of decreased immune vigilance are predicted to be lowest when microbiome and pathogen species most resemble each other (in terms of host recognition), and when immune effects on the pathogen are weak. Our model framework makes explicit the core trade-offs likely to shape the evolution of immunity in the context of microbiome/pathogen discrimination. We discuss how this informs interpretation of patterns and process in natural systems, including vulnerability to pathogen emergence. 

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5. Analysis of the potential efficacy and timing of COVID-19 vaccine on morbidity and mortality

   Haghpanah, F; Lin, G; Levin, SA; Klein, E. (January 2021, EClinicalMedicine)

   null (Ed.)

   Background: COVID-19 vaccines have been approved and made available. While questions of vaccine allocation strategies have received significant attention, important questions remain regarding the potential impact of the vaccine given uncertainties regarding efficacy against transmission, availability, timing, and durability. Methods: We adapted a susceptible-exposed-infectious-recovered (SEIR) model to examine the potential impact on hospitalization and mortality assuming increasing rates of vaccine efficacy, coverage, and administration. We also evaluated the uncertainty of the vaccine to prevent infectiousness as well as the impact on outcomes based on the timing of distribution and the potential effects of waning immunity. Findings: Increased vaccine efficacy against disease reduces hospitalizations and deaths from COVID-19; however, the relative benefit of transmission blocking varied depending on the timing of vaccine distribution. Early in an outbreak, a vaccine that reduces transmission will be relatively more effective than one introduced later in the outbreak. In addition, earlier and accelerated implementation of a less effective vaccine is more impactful than later implementation of a more effective vaccine. These findings are magnified when considering the durability of the vaccine. Vaccination in the spring will be less impactful when immunity is less durable. Interpretation: Policy choices regarding non-pharmaceutical interventions, such as social distancing and face mask use, will need to remain in place longer if the vaccine is less effective at reducing transmission or distributed slower. In addition, the stage of the local outbreak greatly impacts the overall effectiveness of the vaccine in a region and should be considered when allocating vaccines. 

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