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Abstract The recurrence of epidemic waves has been a hallmark of infectious disease outbreaks. Repeated surges in infections pose significant challenges to public health systems, yet the mechanisms that drive these waves remain insufficiently understood. Most prior models attribute epidemic waves to exogenous factors, such as transmission seasonality, viral mutations, or implementation of public health interventions. We show that epidemic waves can emerge autonomously from the feedback loop between infection dynamics and human behavior. Our results are based on a behavioral framework in which individuals continuously adjust their level of risk mitigation subject to their perceived risk of infection, which depends on information availability and disease severity. We show that delayed behavioral responses alone can lead to the emergence of multiple epidemic waves. The magnitude and frequency of these waves depend on the interplay between behavioral factors (delay, severity, and sensitivity of responses) and disease factors (transmission and recovery rates). Notably, if the response is either too prompt or excessively delayed, multiple waves cannot emerge. Our results further align with previous observations that adaptive human behavior can produce nonmonotonic final epidemic sizes, shaped by the trade-offs between various biological and behavioral factors—namely, risk sensitivity, response stringency, and disease generation time. Interestingly, we found that the minimal final epidemic size occurs on regimes that exhibit a few damped oscillations. Altogether, our results emphasize the importance of integrating social and operational factors into infectious disease models, in order to capture the joint evolution of adaptive behavioral responses and epidemic dynamics.
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This content will become publicly available on October 3, 2026
Improving policy design and epidemic response using integrated models of economic choice and disease dynamics with behavioral feedback
Human behavior plays a crucial role in infectious disease transmission, yet traditional models often overlook or oversimplify this factor, limiting predictions of disease spread and the associated socioeconomic impacts. Here we introduce a feedback-informed epidemiological model that integrates human behavior with disease dynamics in a credible, tractable, and extendable manner. From economics, we incorporate a dynamic decision-making model where individuals assess the trade-off between disease risks and economic consequences, and then link this to a risk-stratified compartmental model of disease spread taken from epidemiology. In the unified framework, heterogeneous individuals make choices based on current and future payoffs, influencing their risk of infection and shaping population-level disease dynamics. As an example, we model disease-decision feedback during the early months of the COVID-19 pandemic, when the decision to participate in paid, in-person work was a major determinant of disease risk. Comparing the impacts of stylized policy options representing mandatory, incentivized/compensated, and voluntary work abstention, we find that accounting for disease-behavior feedback has a significant impact on the relative health and economic impacts of policies. Including two crucial dimensions of heterogeneity—health and economic vulnerability—the results highlight how inequities between risk groups can be exacerbated or alleviated by disease control measures. Importantly, we show that a policy of more stringent workplace testing can potentially slow virus spread and, surprisingly, increase labor supply since individuals otherwise inclined to remain at home to avoid infection perceive a safer workplace. In short, our framework permits the exploration of avenues whereby health and wealth need not always be at odds. This flexible and extendable modeling framework offers a powerful tool for understanding the interplay between human behavior and disease spread.
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- Award ID(s):
- 2229996
- PAR ID:
- 10652984
- Editor(s):
- Geard, Nicholas
- Publisher / Repository:
- PLOS
- Date Published:
- Journal Name:
- PLOS Computational Biology
- Volume:
- 21
- Issue:
- 10
- ISSN:
- 1553-7358
- Page Range / eLocation ID:
- e1013549
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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