The failure of \(R_{0}\) (Q642420)

Summary: The basic reproductive ratio, \(R_0\), is one of the fundamental concepts in mathematical biology. It is a threshold parameter, intended to quantify the spread of disease by estimating the average number of secondary infections in a wholly susceptible population, giving an indication of the invasion strength of an epidemic: if \(R_0 < 1\), the disease dies out, whereas if \(R_0 > 1\), the disease persists. \(R_0\) has been widely used as a measure of disease strength to estimate the effectiveness of control measures and to form the backbone of disease-management policy. However, in almost every aspect that matters, \(R_0\) is flawed. Diseases can persist with \(R_0 < 1\), while diseases with \(R_0 > 1\) can die out. We show that the same model of malaria gives many different values of \(R_0\), depending on the method used, with the sole common property that they have a threshold at 1. We also survey estimated values of \(R_0\) for a variety of diseases, and examine some of the alternatives that have been proposed. If \(R_0\) is to be used, it must be accompanied by caveats about the method of calculation, underlying model assumptions and evidence that it is actually a threshold. Otherwise, the concept is meaningless.