Trends in the Mechanistic and Dynamic Modeling of Infectious Diseases

Advancing adoptability and sustainability of digital prediction tools for climate-sensitive infectious disease prevention and control

Few forecasting models have been translated into digital prediction tools for prevention and control of climate-sensitive infectious diseases. We propose a 3-U (useful, usable, and used) research framework for advancing the adoptability and sustainability of these tools. We make recommendations for 1) developing a tool with a high level of accuracy and sufficient lead time to permit effective proactive interventions (useful); 2) conducting a needs assessment to ensure that a tool meets the needs of end-users (usable); and 3) demonstrating the efficacy and cost-effectiveness of a tool to secure its adoption into routine surveillance and response systems (used).

Modeling zoonotic and vector-borne viruses

The 2013-2016 Ebola virus disease epidemic and the coronavirus disease 2019 pandemic galvanized tremendous growth in models for emerging zoonotic and vector-borne viruses. Therefore, we have reviewed the main goals and methods of models to guide scientists and decision-makers. The elements of models for emerging viruses vary across spectrums: from understanding the past to forecasting the future, using data across space and time, and using statistical versus mechanistic methods. Hybrid/ensemble models and artificial intelligence offer new opportunities for modeling. Despite this progress, challenges remain in translating models into actionable decisions, particularly in areas at highest risk for viral disease outbreaks. To address this issue, we must identify gaps in models for specific viruses, strengthen validation, and involve policymakers in model development.

Mathematical models and analysis tools for risk assessment of unnatural epidemics: a scoping review

Predicting, issuing early warnings, and assessing risks associated with unnatural epidemics (UEs) present significant challenges. These tasks also represent key areas of focus within the field of prevention and control research for UEs. A scoping review was conducted using databases such as PubMed, Web of Science, Scopus, and Embase, from inception to 31 December 2023. Sixty-six studies met the inclusion criteria. Two types of models (data-driven and mechanistic-based models) and a class of analysis tools for risk assessment of UEs were identified. The validation part of models involved calibration, improvement, and comparison. Three surveillance systems (event-based, indicator-based, and hybrid) were reported for monitoring UEs. In the current study, mathematical models and analysis tools suggest a distinction between natural epidemics and UEs in selecting model parameters and warning thresholds. Future research should consider combining a mechanistic-based model with a data-driven model and learning to pursue time-varying, high-precision risk assessment capabilities.

Comparing the transmission of carbapenemase-producing and extended-spectrum beta-lactamase-producing Escherichia coli between broiler chickens

The emergence of carbapenemase-producing Enterobacteriaceae (CPE) is a threat to public health, because of their resistance to clinically important carbapenem antibiotics. The emergence of CPE in meat-producing animals is particularly worrying because consumption of meat contaminated with resistant bacteria comparable to CPE, such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, contributed to colonization in humans worldwide. Currently, no data on the transmission of CPE in livestock is available. We performed a transmission experiment to quantify the transmission of CPE between broilers to fill this knowledge gap and to compare the transmission rates of CPE and other antibiotic-resistant E. coli. A total of 180 Ross 308 broiler chickens were distributed over 12 pens on the day of hatch (day 0). On day 5, half of the 10 remaining chickens in each pen were orally inoculated with 5·102 colony-forming units of CPE, ESBL, or chloramphenicol-resistant E. coli (catA1). To evaluate the effect of antibiotic treatment, amoxicillin was given twice daily in drinking water in 6 of the 12 pens from days 2-6. Cloacal swabs of all animals were taken to determine the number of infectious broilers. We used a Bayesian hierarchical model to quantify the transmission of the E. coli strains. E. coli can survive in the environment and serve as a reservoir. Therefore, the susceptible-infectious transmission model was adapted to account for the transmission of resistant bacteria from the environment. In addition, the caecal microbiome was analyzed on day 5 and at the end of the experiment on day 14 to assess the relationship between the caecal microbiome and the transmission rates. The transmission rates of CPE were 52 - 68 per cent lower compared to ESBL and catA1, but it is not clear if these differences were caused by differences between the resistance genes or by other differences between the E. coli strains. Differences between the groups in transmission rates and microbiome diversity did not correspond to each other, indicating that differences in transmission rates were probably not caused by major differences in the community structure in the caecal microbiome. Amoxicillin treatment from day 2-6 increased the transmission rate more than three-fold in all inoculums. It also increased alpha-diversity compared to untreated animals on day 5, but not on day 14, suggesting only a temporary effect. Future research could incorporate more complex transmission models with different species of resistant bacteria into the Bayesian hierarchical model.

Impact of vaccination and non-pharmacological interventions on COVID-19: a review of simulation modeling studies in Asia

Introduction

Epidemiological modeling is widely used to offer insights into the COVID-19 pandemic situation in Asia. We reviewed published computational (mathematical/simulation) models conducted in Asia that assessed impacts of pharmacological and non-pharmacological interventions against COVID-19 and their implications for vaccination strategy.

Methods

A search of the PubMed database for peer-reviewed, published, and accessible articles in English was performed up to November 2022 to capture studies in Asian populations based on computational modeling of outcomes in the COVID-19 pandemic. Extracted data included model type (mechanistic compartmental/agent-based, statistical, both), intervention type (pharmacological, non-pharmacological), and procedures for parameterizing age. Findings are summarized with descriptive statistics and discussed in terms of the evolving COVID-19 situation.

Results

The literature search identified 378 results, of which 59 met criteria for data extraction. China, Japan, and South Korea accounted for approximately half of studies, with fewer from South and South-East Asia. Mechanistic models were most common, either compartmental (61.0%), agent-based (1.7%), or combination (18.6%) models. Statistical modeling was applied less frequently (11.9%). Pharmacological interventions were examined in 59.3% of studies, and most considered vaccination, except one study of an antiviral treatment. Non-pharmacological interventions were also considered in 84.7% of studies. Infection, hospitalization, and mortality were outcomes in 91.5%, 30.5%, and 30.5% of studies, respectively. Approximately a third of studies accounted for age, including 10 that also examined mortality. Four of these studies emphasized benefits in terms of mortality from prioritizing older adults for vaccination under conditions of a limited supply; however, one study noted potential benefits to infection rates from early vaccination of younger adults. Few studies (5.1%) considered the impact of vaccination among children.

Conclusion

Early in the COVID-19 pandemic, non-pharmacological interventions helped to mitigate the health burden of COVID-19; however, modeling indicates that high population coverage of effective vaccines will complement and reduce reliance on such interventions. Thus, increasing and maintaining immunity levels in populations through regular booster shots, particularly among at-risk and vulnerable groups, including older adults, might help to protect public health. Future modeling efforts should consider new vaccines and alternative therapies alongside an evolving virus in populations with varied vaccination histories.

A domain-knowledge modeling of hospital-acquired infection risk in Healthcare personnel from retrospective observational data: A case study for COVID-19

INTRODUCTION

Hospital-acquired infections of communicable viral diseases (CVDs) have been posing a tremendous challenge to healthcare workers globally. Healthcare personnel (HCP) is facing a consistent risk of viral infections, and subsequently higher rates of morbidity and mortality.

MATERIALS AND METHODS

We proposed a domain-knowledge-driven infection risk model to quantify the individual HCP and the population-level risks. For individual-level risk estimation, a time-variant infection risk model is proposed to capture the transmission dynamics of CVDs. At the population-level, the infection risk is estimated using a Bayesian network model constructed from three feature sets, including individual-level factors, engineering control factors, and administrative control factors. For model validation, we investigated the case study of the Coronavirus disease, in which the individual-level and population-level infection risk models were applied. The data were collected from various sources such as COVID-19 transmission databases, health surveys/questionaries from medical centers, U.S. Department of Labor databases, and cross-sectional studies.

RESULTS

Regarding the individual-level risk model, the variance-based sensitivity analysis indicated that the uncertainty in the estimated risk was attributed to two variables: the number of close contacts and the viral transmission probability. Next, the disease transmission probability was computed using a multivariate logistic regression applied for a cross-sectional HCP data in the UK, with the 10-fold cross-validation accuracy of 78.23%. Combined with the previous result, we further validated the individual infection risk model by considering six occupations in the U.S. Department of Labor O*Net database. The occupation-specific risk evaluation suggested that the registered nurses, medical assistants, and respiratory therapists were the highest-risk occupations. For the population-level risk model validation, the infection risk in Texas and California was estimated, in which the infection risk in Texas was lower than that in California. This can be explained by California's higher patient load for each HCP per day and lower personal protective equipment (PPE) sufficiency level.

CONCLUSION

The accurate estimation of infection risk at both individual level and population levels using our domain-knowledge-driven infection risk model will significantly enhance the PPE allocation, safety plans for HCP, and hospital staffing strategies.

Mechanistic models of Rift Valley fever virus transmission: A systematic review

Rift Valley fever (RVF) is a zoonotic arbovirosis which has been reported across Africa including the northernmost edge, South West Indian Ocean islands, and the Arabian Peninsula. The virus is responsible for high abortion rates and mortality in young ruminants, with economic impacts in affected countries. To date, RVF epidemiological mechanisms are not fully understood, due to the multiplicity of implicated vertebrate hosts, vectors, and ecosystems. In this context, mathematical models are useful tools to develop our understanding of complex systems, and mechanistic models are particularly suited to data-scarce settings. Here, we performed a systematic review of mechanistic models studying RVF, to explore their diversity and their contribution to the understanding of this disease epidemiology. Researching Pubmed and Scopus databases (October 2021), we eventually selected 48 papers, presenting overall 49 different models with numerical application to RVF. We categorized models as theoretical, applied, or grey, depending on whether they represented a specific geographical context or not, and whether they relied on an extensive use of data. We discussed their contributions to the understanding of RVF epidemiology, and highlighted that theoretical and applied models are used differently yet meet common objectives. Through the examination of model features, we identified research questions left unexplored across scales, such as the role of animal mobility, as well as the relative contributions of host and vector species to transmission. Importantly, we noted a substantial lack of justification when choosing a functional form for the force of infection. Overall, we showed a great diversity in RVF models, leading to important progress in our comprehension of epidemiological mechanisms. To go further, data gaps must be filled, and modelers need to improve their code accessibility.

Planning as Inference in Epidemiological Dynamics Models

In this work we demonstrate how to automate parts of the infectious disease-control policy-making process via performing inference in existing epidemiological models. The kind of inference tasks undertaken include computing the posterior distribution over controllable, via direct policy-making choices, simulation model parameters that give rise to acceptable disease progression outcomes. Among other things, we illustrate the use of a probabilistic programming language that automates inference in existing simulators. Neither the full capabilities of this tool for automating inference nor its utility for planning is widely disseminated at the current time. Timely gains in understanding about how such simulation-based models and inference automation tools applied in support of policy-making could lead to less economically damaging policy prescriptions, particularly during the current COVID-19 pandemic.

[Epidemiologic evidence on the role of hospitality venues in the transmission of COVID-19: A rapid review of the literature]

OBJECTIVE

To review the scientific epidemiologic evidence on the role of hospitality venues in the incidence or mortality from COVID-19.

METHOD

We included studies conducted in any population, describing either the impact of the closure or reopening of hospitality venues, or exposure to these venues, on the incidence or mortality from COVID-19. We used a snowball sampling approach with backward and forward citation search along with co-citations.

RESULTS

We found 20 articles examining the role of hospitality venues in the epidemiology of COVID-19. Modeling studies showed that interventions reducing social contacts in indoor venues can reduce COVID-19 transmission. Studies using statistical models showed similar results, including that the closure of hospitality venues is amongst the most effective measures in reducing incidence or mortality. Case studies highlighted the role of hospitality venues in generating super-spreading events, along with the importance of airflow and ventilation inside these venues.

CONCLUSIONS

We found consistent results across studies showing that the closure of hospitality venues is amongst the most effective measures to reduce the impact of COVID-19. We also found support for measures limiting capacity and improving ventilation to consider during the re-opening of these venues.

A comparison of modelling the spatio-temporal pattern of disease: a case study of schistosomiasis japonica in Anhui Province, China

The construction of spatio-temporal models can be either descriptive or dynamic. In this study we aim to evaluate the differences in model fitting between a descriptive model and a dynamic model of the transmission for intestinal schistosomiasis caused by Schistosoma japonicum in Guichi, Anhui Province, China. The parasitological data at the village level from 1991 to 2014 were obtained by cross-sectional surveys. We used the fixed rank kriging (FRK) model, a descriptive model, and the integro-differential equation (IDE) model, a dynamic model, to explore the space-time changes of schistosomiasis japonica. In both models, the average daily precipitation and the normalized difference vegetation index are significantly positively associated with schistosomiasis japonica prevalence, while the distance to water bodies, the hours of daylight and the land surface temperature at daytime were significantly negatively associated. The overall root mean square prediction error of the IDE and FRK models was 0.0035 and 0.0054, respectively, and the correlation reflected by Pearson's correlation coefficient between the predicted and observed values for the IDE model (0.71; p<0.01) was larger than that for the FRK model (0.53; p=0.02). The IDE model fits better in capturing the geographic variation of schistosomiasis japonica. Dynamic spatio-temporal models have the advantage of quantifying the process of disease transmission and may provide more accurate predictions.

Mechanistic modelling of COVID-19 and the impact of lockdowns on a short-time scale

BACKGROUND

To mitigate the spread of the COVID-19 coronavirus, some countries have adopted more stringent non-pharmaceutical interventions in contrast to those widely used. In addition to standard practices such as enforcing curfews, social distancing, and closure of non-essential service industries, other non-conventional policies also have been implemented, such as the total lockdown of fragmented regions, which are composed of sparsely and highly populated areas.

METHODS

In this paper, we model the movement of a host population using a mechanistic approach based on random walks, which are either diffusive or super-diffusive. Infections are realised through a contact process, whereby a susceptible host is infected if in close spatial proximity of the infectious host with an assigned transmission probability. Our focus is on a short-time scale (∼ 3 days), which is the average time lag time before an infected individual becomes infectious.

RESULTS

We find that the level of infection remains approximately constant with an increase in population diffusion, and also in the case of faster population dispersal (super-diffusion). Moreover, we demonstrate how the efficacy of imposing a lockdown depends heavily on how susceptible and infectious individuals are distributed over space.

CONCLUSION

Our results indicate that on a short-time scale, the type of movement behaviour does not play an important role in rising infection levels. Also, lock-down restrictions are ineffective if the population distribution is homogeneous. However, in the case of a heterogeneous population, lockdowns are effective if a large proportion of infectious carriers are distributed in sparsely populated sub-regions.

Spatial connectivity in mosquito-borne disease models: a systematic review of methods and assumptions

Spatial connectivity plays an important role in mosquito-borne disease transmission. Connectivity can arise for many reasons, including shared environments, vector ecology and human movement. This systematic review synthesizes the spatial methods used to model mosquito-borne diseases, their spatial connectivity assumptions and the data used to inform spatial model components. We identified 248 papers eligible for inclusion. Most used statistical models (84.2%), although mechanistic are increasingly used. We identified 17 spatial models which used one of four methods (spatial covariates, local regression, random effects/fields and movement matrices). Over 80% of studies assumed that connectivity was distance-based despite this approach ignoring distant connections and potentially oversimplifying the process of transmission. Studies were more likely to assume connectivity was driven by human movement if the disease was transmitted by an Aedes mosquito. Connectivity arising from human movement was more commonly assumed in studies using a mechanistic model, likely influenced by a lack of statistical models able to account for these connections. Although models have been increasing in complexity, it is important to select the most appropriate, parsimonious model available based on the research question, disease transmission process, the spatial scale and availability of data, and the way spatial connectivity is assumed to occur.

The between-farm transmission dynamics of porcine epidemic diarrhoea virus: A short-term forecast modelling comparison and the effectiveness of control strategies

A limited understanding of the transmission dynamics of swine disease is a significant obstacle to prevent and control disease spread. Therefore, understanding between-farm transmission dynamics is crucial to developing disease forecasting systems to predict outbreaks that would allow the swine industry to tailor control strategies. Our objective was to forecast weekly porcine epidemic diarrhoea virus (PEDV) outbreaks by generating maps to identify current and future PEDV high-risk areas, and simulating the impact of control measures. Three epidemiological transmission models were developed and compared: a novel epidemiological modelling framework was developed specifically to model disease spread in swine populations, PigSpread, and two models built on previously developed ecosystems, SimInf (a stochastic disease spread simulations) and PoPS (Pest or Pathogen Spread). The models were calibrated on true weekly PEDV outbreaks from three spatially related swine production companies. Prediction accuracy across models was compared using the receiver operating characteristic area under the curve (AUC). Model outputs had a general agreement with observed outbreaks throughout the study period. PoPS had an AUC of 0.80, followed by PigSpread with 0.71, and SimInf had the lowest at 0.59. Our analysis estimates that the combined strategies of herd closure, controlled exposure of gilts to live viruses (feedback) and on-farm biosecurity reinforcement reduced the number of outbreaks. On average, 76% to 89% reduction was seen in sow farms, while in gilt development units (GDU) was between 33% to 61% when deployed to sow and GDU farms located in probabilistic high-risk areas. Our multi-model forecasting approach can be used to prioritize surveillance and intervention strategies for PEDV and other diseases potentially leading to more resilient and healthier pig production systems.

A review of mechanistic models of viral dynamics in bat reservoirs for zoonotic disease

The emergence of SARS-CoV-2, a coronavirus with suspected bat origins, highlights a critical need for heightened understanding of the mechanisms by which bats maintain potentially zoonotic viruses at the population level and transmit these pathogens across species. We review mechanistic models, which test hypotheses of the transmission dynamics that underpin viral maintenance in bat systems. A search of the literature identified only twenty-five mechanistic models of bat-virus systems published to date, derived from twenty-three original studies. Most models focused on rabies and related lyssaviruses (eleven), followed by Ebola-like filoviruses (seven), Hendra and Nipah-like henipaviruses (five), and coronaviruses (two). The vast majority of studies has modelled bat virus transmission dynamics at the population level, though a few nested within-host models of viral pathogenesis in population-level frameworks, and one study focused on purely within-host dynamics. Population-level studies described bat virus systems from every continent but Antarctica, though most were concentrated in North America and Africa; indeed, only one simulation model with no associated data was derived from an Asian bat-virus system. In fact, of the twenty-five models identified, only ten population-level models were fitted to data - emphasizing an overall dearth of empirically derived epidemiological inference in bat virus systems. Within the data fitted subset, the vast majority of models were fitted to serological data only, highlighting extensive uncertainty in our understanding of the transmission status of a wild bat. Here, we discuss similarities and differences in the approach and findings of previously published bat virus models and make recommendations for improvement in future work.

Pairwise likelihood estimation of latent autoregressive count models

Latent autoregressive models are useful time series models for the analysis of infectious disease data. Evaluation of the likelihood function of latent autoregressive models is intractable and its approximation through simulation-based methods appears as a standard practice. Although simulation methods may make the inferential problem feasible, they are often computationally intensive and the quality of the numerical approximation may be difficult to assess. We consider instead a weighted pairwise likelihood approach and explore several computational and methodological aspects including estimation of robust standard errors and the role of numerical integration. The suggested approach is illustrated using monthly data on invasive meningococcal disease infection in Greece and Italy.

Choices and trade-offs in inference with infectious disease models

Inference using mathematical models of infectious disease dynamics can be an invaluable tool for the interpretation and analysis of epidemiological data. However, researchers wishing to use this tool are faced with a choice of models and model types, simulation methods, inference methods and software packages. Given the multitude of options, it can be challenging to decide on the best approach. Here, we delineate the choices and trade-offs involved in deciding on an approach for inference, and discuss aspects that might inform this decision. We provide examples of inference with a dataset of influenza cases using the R packages pomp and rbi.

Satellite Earth Observation Data in Epidemiological Modeling of Malaria, Dengue and West Nile Virus: A Scoping Review

Earth Observation (EO) data can be leveraged to estimate environmental variables that influence the transmission cycle of the pathogens that lead to mosquito-borne diseases (MBDs). The aim of this scoping review is to examine the state-of-the-art and identify knowledge gaps on the latest methods that used satellite EO data in their epidemiological models focusing on malaria, dengue and West Nile Virus (WNV). In total, 43 scientific papers met the inclusion criteria and were considered in this review. Researchers have examined a wide variety of methodologies ranging from statistical to machine learning algorithms. A number of studies used models and EO data that seemed promising and claimed to be easily replicated in different geographic contexts, enabling the realization of systems on regional and national scales. The need has emerged to leverage furthermore new powerful modeling approaches, like artificial intelligence and ensemble modeling and explore new and enhanced EO sensors towards the analysis of big satellite data, in order to develop accurate epidemiological models and contribute to the reduction of the burden of MBDs.

Dynamics of Zika virus outbreaks: an overview of mathematical modeling approaches

BACKGROUND

The Zika virus was first discovered in 1947. It was neglected until a major outbreak occurred on Yap Island, Micronesia, in 2007. Teratogenic effects resulting in microcephaly in newborn infants is the greatest public health threat. In 2016, the Zika virus epidemic was declared as a Public Health Emergency of International Concern (PHEIC). Consequently, mathematical models were constructed to explicitly elucidate related transmission dynamics.

SURVEY METHODOLOGY

In this review article, two steps of journal article searching were performed. First, we attempted to identify mathematical models previously applied to the study of vector-borne diseases using the search terms "dynamics," "mathematical model," "modeling," and "vector-borne" together with the names of vector-borne diseases including chikungunya, dengue, malaria, West Nile, and Zika. Then the identified types of model were further investigated. Second, we narrowed down our survey to focus on only Zika virus research. The terms we searched for were "compartmental," "spatial," "metapopulation," "network," "individual-based," "agent-based" AND "Zika." All relevant studies were included regardless of the year of publication. We have collected research articles that were published before August 2017 based on our search criteria. In this publication survey, we explored the Google Scholar and PubMed databases.

RESULTS

We found five basic model architectures previously applied to vector-borne virus studies, particularly in Zika virus simulations. These include compartmental, spatial, metapopulation, network, and individual-based models. We found that Zika models carried out for early epidemics were mostly fit into compartmental structures and were less complicated compared to the more recent ones. Simple models are still commonly used for the timely assessment of epidemics. Nevertheless, due to the availability of large-scale real-world data and computational power, recently there has been growing interest in more complex modeling frameworks.

DISCUSSION

Mathematical models are employed to explore and predict how an infectious disease spreads in the real world, evaluate the disease importation risk, and assess the effectiveness of intervention strategies. As the trends in modeling of infectious diseases have been shifting towards data-driven approaches, simple and complex models should be exploited differently. Simple models can be produced in a timely fashion to provide an estimation of the possible impacts. In contrast, complex models integrating real-world data require more time to develop but are far more realistic. The preparation of complicated modeling frameworks prior to the outbreaks is recommended, including the case of future Zika epidemic preparation.

Evidence Synthesis for Stochastic Epidemic Models

In recent years, the role of epidemic models in informing public health policies has progressively grown. Models have become increasingly realistic and more complex, requiring the use of multiple data sources to estimate all quantities of interest. This review summarises the different types of stochastic epidemic models that use evidence synthesis and highlights current challenges.

An Integrated Framework for Process-Driven Model Construction in Disease Ecology and Animal Health

Process models that focus on explicitly representing biological mechanisms are increasingly important in disease ecology and animal health research. However, the large number of process modelling approaches makes it difficult to decide which is most appropriate for a given disease system and research question. Here, we discuss different motivations for using process models and present an integrated conceptual analysis that can be used to guide the construction of infectious disease process models and comparisons between them. Our presentation complements existing work by clarifying the major differences between modelling approaches and their relationship with the biological characteristics of the epidemiological system. We first discuss distinct motivations for using process models in epidemiological research, identifying the key steps in model design and use associated with each. We then present a conceptual framework for guiding model construction and comparison, organised according to key aspects of epidemiological systems. Specifically, we discuss the number and type of disease states, whether to focus on individual hosts (e.g., cows) or groups of hosts (e.g., herds or farms), how space or host connectivity affect disease transmission, whether demographic and epidemiological processes are periodic or can occur at any time, and the extent to which stochasticity is important. We use foot-and-mouth disease and bovine tuberculosis in cattle to illustrate our discussion and support explanations of cases in which different models are used to address similar problems. The framework should help those constructing models to structure their approach to modelling decisions and facilitate comparisons between models in the literature.

Ensemble modelling and structured decision-making to support Emergency Disease Management

Epidemiological models in animal health are commonly used as decision-support tools to understand the impact of various control actions on infection spread in susceptible populations. Different models contain different assumptions and parameterizations, and policy decisions might be improved by considering outputs from multiple models. However, a transparent decision-support framework to integrate outputs from multiple models is nascent in epidemiology. Ensemble modelling and structured decision-making integrate the outputs of multiple models, compare policy actions and support policy decision-making. We briefly review the epidemiological application of ensemble modelling and structured decision-making and illustrate the potential of these methods using foot and mouth disease (FMD) models. In case study one, we apply structured decision-making to compare five possible control actions across three FMD models and show which control actions and outbreak costs are robustly supported and which are impacted by model uncertainty. In case study two, we develop a methodology for weighting the outputs of different models and show how different weighting schemes may impact the choice of control action. Using these case studies, we broadly illustrate the potential of ensemble modelling and structured decision-making in epidemiology to provide better information for decision-making and outline necessary development of these methods for their further application.