The Allee effect and elimination of neglected tropical diseases: a mathematical modelling study

Elimination and control programmes for neglected tropical diseases (NTDs) are underway around the world, yet they are generally informed by epidemiological modelling only to a rudimentary degree. Chief among the modelling-derived predictors of disease emergence or controllability is the basic reproduction number R0. The ecological systems of several of the NTDs include density-dependent processes - which alter the rate of e.g. parasite establishment or fecundity - that complicate the calculation of R0. Here we show how the forms of the density-dependent functions for a model of the NTD lymphatic filariasis affect the effective reproduction number Reff. We construct infection transmission models containing various density-dependent functions and show how they alter the shape of the Reff profile, affecting two important epidemiological outcome variables that relate to elimination and control programmes: the parasite transmission breakpoint (or extinction threshold) and the reproduction fitness, as measured by Reff. The current drive to control, eliminate or eradicate several parasitic infections would be substantially aided by the existence of ecological Allee effects. For these control programmes, the findings of this paper are encouraging, since a single positive density dependency (DD) can introduce a reasonable chance of achieving elimination; however, there are diminishing returns to additional positive DDs