'Imperfect but useful': pandemic response in the Global South can benefit from greater use of mathematical modelling

How mathematical modelling can inform outbreak response vaccination

Mathematical models are established tools to assist in outbreak response. They help characterise complex patterns in disease spread, simulate control options to assist public health authorities in decision-making, and longer-term operational and financial planning. In the context of vaccine-preventable diseases (VPDs), vaccines are one of the most-cost effective outbreak response interventions, with the potential to avert significant morbidity and mortality through timely delivery. Models can contribute to the design of vaccine response by investigating the importance of timeliness, identifying high-risk areas, prioritising the use of limited vaccine supply, highlighting surveillance gaps and reporting, and determining the short- and long-term benefits. In this review, we examine how models have been used to inform vaccine response for 10 VPDs, and provide additional insights into the challenges of outbreak response modelling, such as data gaps, key vaccine-specific considerations, and communication between modellers and stakeholders. We illustrate that while models are key to policy-oriented outbreak vaccine response, they can only be as good as the surveillance data that inform them.

Innovating tuberculosis prevention to achieve universal health coverage in the Philippines

To contribute to tuberculosis (TB) elimination, TB preventive treatment (TPT) should integrate innovative approaches including tele-contact investigation (TCI), mathematical modelling, and participatory governance. Aligning with the World Health Organisation's primary health care framework, supply is provided by the provincial health system, demand is cultivated by the community, while governance is represented by the governor, who oversees the health leadership structure, local policies, and allocation of resources. A healthy dynamic between these three components is required to achieve universal health coverage (UHC). Because of their potential to integrate health systems and engage communities, primary health care principles underpin an effective approach to TB prevention. First, the provincial health system should connect with the community through TCI to transform the status quo of passive service delivery. Second, community participation should strengthen the linkage between the health system and governance, which ensures that community action plans are aligned with provincial TPT targets. Third, governance should leverage mathematical modelling to allocate resources to those with greatest need. Central to this is a reliable TB information system that should validate a robust mathematical model to measure cost-effectiveness of the intervention. Collectively, this holistic approach to TB prevention could provide a proof-of-concept that investing in primary health care is the key to UHC.

Looking back to move forward: A travel rule underlined by the current pandemic

Learning from the past - is easier said than done. In this narrative, "travel" refers to the forward movement of the society at large on the path of health and development. It is suggested that looking back and learning from the lived experiences of the past outbreaks could help generating public health insights and incorporating them in planning for a better future. In the process, a country may choose to revisit what took place in the recent past during the COVID-19 pandemic within its boundary and beyond. However, unfolding of events in the past, which is not as immediate as COVID neither too far as the flu pandemic of 1918, also has lessons to offer. Recognizably, a few alarms, that rang in the recent past and cried for mass attention towards beefed up public health preparedness, were missed. It is therefore necessary now to critically examine the past-efforts to eradicate, eliminate or control diseases such as small pox, polio, HIV, tuberculosis, leprosy, measles or malaria. Results of such evaluation could inform the future courses of actions around disease elimination science and health (DESH) and help develop better nations.