Non-selective distribution of infectious disease prevention may outperform risk-based targeting

Benjamin Steinegger, Iacopo Iacopini, Andreia Sofia Teixeira, Alberto Bracci, Pau Casanova-Ferrer, Alberto Antonioni and Eugenio Valdano ()
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Benjamin Steinegger: Universitat Rovira i Virgili
Iacopo Iacopini: Central European University
Andreia Sofia Teixeira: LASIGE, Departamento de Informática, Faculdade de Ciências, Universidade de Lisboa
Alberto Bracci: University of London
Pau Casanova-Ferrer: Grupo Interdisciplinar de Sistemas Complejos (GISC), Department of Mathematics, Carlos III University of Madrid
Alberto Antonioni: Grupo Interdisciplinar de Sistemas Complejos (GISC), Department of Mathematics, Carlos III University of Madrid
Eugenio Valdano: Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique

Nature Communications, 2022, vol. 13, issue 1, 1-9

Abstract: Abstract Epidemic control often requires optimal distribution of available vaccines and prophylactic tools, to protect from infection those susceptible. Well-established theory recommends prioritizing those at the highest risk of exposure. But the risk is hard to estimate, especially for diseases involving stigma and marginalization. We address this conundrum by proving that one should target those at high risk only if the infection-averting efficacy of prevention is above a critical value, which we derive analytically. We apply this to the distribution of pre-exposure prophylaxis (PrEP) of the Human Immunodeficiency Virus (HIV) among men-having-sex-with-men (MSM), a population particularly vulnerable to HIV. PrEP is effective in averting infections, but its global scale-up has been slow, showing the need to revisit distribution strategies, currently risk-based. Using data from MSM communities in 58 countries, we find that non-selective PrEP distribution often outperforms risk-based, showing that a logistically simpler strategy is also more effective. Our theory may help design more feasible and successful prevention.

Date: 2022
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DOI: 10.1038/s41467-022-30639-3

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