{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T13:54:06Z","timestamp":1778162046213,"version":"3.51.4"},"reference-count":62,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2011,8,16]],"date-time":"2011-08-16T00:00:00Z","timestamp":1313452800000},"content-version":"vor","delay-in-days":227,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004489","name":"Mitacs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004489","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Computational and Mathematical Methods in Medicine"],"published-print":{"date-parts":[[2011,1]]},"abstract":"<jats:p>The basic reproductive ratio, <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>, is one of the fundamental concepts in mathematical\nbiology. It is a threshold parameter, intended to quantify the spread\nof disease by estimating the average number of secondary infections in a wholly\nsusceptible population, giving an indication of the invasion strength of an epidemic: if\n<jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub> &lt; 1, the disease dies out, whereas if <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub> &gt; 1, the disease persists. <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>\n has\nbeen widely used as a measure of disease strength to estimate the effectiveness\nof control measures and to form the backbone of disease\u2010management policy. \nHowever, in almost every aspect that matters, <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>\n is flawed. Diseases can persist\nwith <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub> &lt; 1, while diseases with <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub> &gt; 1\n can die out. We show that the same\nmodel of malaria gives many different values of <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>, depending on the method\nused, with the sole common property that they have a threshold at 1. We also\nsurvey estimated values of <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>\n for a variety of diseases, and examine some of the alternatives that\nhave been proposed. If <jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>\n is to be used, it must be accompanied by caveats\nabout the method of calculation, underlying model assumptions and evidence\nthat it is actually a threshold. Otherwise, the concept is meaningless.<\/jats:p>","DOI":"10.1155\/2011\/527610","type":"journal-article","created":{"date-parts":[[2011,9,21]],"date-time":"2011-09-21T08:47:03Z","timestamp":1316594823000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":165,"title":["The Failure of <i>R<\/i><sub>0<\/sub>"],"prefix":"10.1155","volume":"2011","author":[{"given":"Jing","family":"Li","sequence":"first","affiliation":[]},{"given":"Daniel","family":"Blakeley","sequence":"additional","affiliation":[]},{"given":"Robert J.","family":"Smith?","sequence":"additional","affiliation":[]}],"member":"311","published-online":{"date-parts":[[2011,8,16]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/j.1467-9574.1996.tb01482.x","article-title":"The concept of R\n                  0\n in epidemic theory","volume":"50","author":"Heesterbeek J. A. 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