{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T06:14:31Z","timestamp":1774332871989,"version":"3.50.1"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005224","name":"National Center for Immunization and Respiratory Diseases","doi-asserted-by":"publisher","award":["6 U01 IP00113801-01"],"award-info":[{"award-number":["6 U01 IP00113801-01"]}],"id":[{"id":"10.13039\/100005224","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"<jats:p>Mathematical models have come to play a key role in global pandemic preparedness and outbreak response: helping to plan for disease burden, hospital capacity, and inform nonpharmaceutical interventions. Such models have played a pivotal role in the COVID-19 pandemic, with transmission models\u2014and, by consequence, modelers\u2014guiding global, national, and local responses to SARS-CoV-2. However, these models have largely not accounted for the social and structural factors, which lead to socioeconomic, racial, and geographic health disparities. In this piece, we raise and attempt to clarify several questions relating to this important gap in the research and practice of infectious disease modeling: Why do epidemiologic models of emerging infections typically ignore known structural drivers of disparate health outcomes? What have been the consequences of a framework focused primarily on aggregate outcomes on infection equity? What should be done to develop a more holistic approach to modeling-based decision-making during pandemics? In this review, we evaluate potential historical and political explanations for the exclusion of drivers of disparity in infectious disease models for emerging infections, which have often been characterized as \u201cequal opportunity infectors\u201d despite ample evidence to the contrary. We look to examples from other disease systems (HIV, STIs) and successes in including social inequity in models of acute infection transmission as a blueprint for how social connections, environmental, and structural factors can be integrated into a coherent, rigorous, and interpretable modeling framework. We conclude by outlining principles to guide modeling of emerging infections in ways that represent the causes of inequity in infection as central rather than peripheral mechanisms.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1009795","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T18:32:14Z","timestamp":1644431534000},"page":"e1009795","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":43,"title":["There are no equal opportunity infectors: Epidemiological modelers must rethink our approach to inequality in infection risk"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0708-2008","authenticated-orcid":true,"given":"Jon","family":"Zelner","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3155-6058","authenticated-orcid":true,"given":"Nina B.","family":"Masters","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7324-8195","authenticated-orcid":true,"given":"Ramya","family":"Naraharisetti","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2610-2625","authenticated-orcid":true,"given":"Sanyu A.","family":"Mojola","sequence":"additional","affiliation":[]},{"given":"Merlin","family":"Chowkwanyun","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3546-5935","authenticated-orcid":true,"given":"Ryan","family":"Malosh","sequence":"additional","affiliation":[]}],"member":"340","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"pcbi.1009795.ref001","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1126\/science.367.6485.1414-b","article-title":"With COVID-19, modeling takes on life and death importance","volume":"367","author":"M Enserink","year":"2020","journal-title":"Science"},{"key":"pcbi.1009795.ref002","doi-asserted-by":"crossref","first-page":"113554","DOI":"10.1016\/j.socscimed.2020.113554","article-title":"Socioeconomic inequalities in the spread of coronavirus-19 in the United States: A examination of the emergence of social inequalities","volume":"268","author":"SAP Clouston","year":"2021","journal-title":"Soc Sci Med"},{"key":"pcbi.1009795.ref003","first-page":"72","article-title":"Racial disparities in COVID-19 mortality are driven by unequal infection risks","author":"J Zelner","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pcbi.1009795.ref004","doi-asserted-by":"crossref","first-page":"100845","DOI":"10.1016\/j.ssmph.2021.100845","article-title":"Overcrowding and COVID-19 mortality across U.S. counties: Are disparities growing over time?","volume":"15","author":"C Kamis","year":"2021","journal-title":"SSM Popul Health"},{"key":"pcbi.1009795.ref005","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10109-020-00344-0","article-title":"Detecting space\u2013time clusters of COVID-19 in Brazil: mortality, inequality, socioeconomic vulnerability, and the relative risk of the disease in Brazilian municipalities","volume":"23","author":"MR Martines","year":"2021","journal-title":"J Geogr Syst"},{"key":"pcbi.1009795.ref006","doi-asserted-by":"crossref","first-page":"e005521","DOI":"10.1136\/bmjgh-2021-005521","article-title":"Exploring equity in health and poverty impacts of control measures for SARS-CoV-2 in six countries","volume":"6","author":"S Sweeney","year":"2021","journal-title":"BMJ Glob Health"},{"key":"pcbi.1009795.ref007","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1111\/hsc.13214","article-title":"Health inequality experienced by the socially disadvantaged populations during the outbreak of COVID-19 in Hong Kong: An interaction with social inequality.","volume":"29","author":"JY Siu","year":"2021","journal-title":"Health Soc Care Community"},{"key":"pcbi.1009795.ref008","first-page":"1","article-title":"A review and agenda for integrated disease models including social and behavioural factors.","author":"J Bedson","year":"2021","journal-title":"Nat Hum Behav"},{"key":"pcbi.1009795.ref009","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/s41586-021-03694-x","article-title":"Thinking clearly about social aspects of infectious disease transmission","volume":"595","author":"C Buckee","year":"2021","journal-title":"Nature"},{"key":"pcbi.1009795.ref010","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1126\/science.abb8021","article-title":"Aggregated mobility data could help fight COVID-19. Sills J, editor","volume":"368","author":"CO Buckee","year":"2020","journal-title":"Science"},{"key":"pcbi.1009795.ref011","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2105\/AJPH.2012.300743","article-title":"Fundamental Causes of Colorectal Cancer Mortality in the United States: Understanding the Importance of Socioeconomic Status in Creating Inequality in Mortality.","volume":"103","author":"N Saldana-Ruiz","year":"2013","journal-title":"Am J Public Health"},{"key":"pcbi.1009795.ref012","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1146\/annurev-soc-073014-112305","article-title":"Is Racism a Fundamental Cause of Inequalities in Health?","volume":"41","author":"JC Phelan","year":"2015","journal-title":"Annu Rev Sociol"},{"key":"pcbi.1009795.ref013","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/S0033-3549(04)50068-7","article-title":"Racial residential segregation: A fundamental cause of racial disparities in health","volume":"116","author":"DR Williams","year":"2001","journal-title":"Public Health Rep"},{"key":"pcbi.1009795.ref014","doi-asserted-by":"crossref","first-page":"813","DOI":"10.2105\/AJPH.2012.301069","article-title":"Stigma as a Fundamental Cause of Population Health Inequalities","volume":"103","author":"ML Hatzenbuehler","year":"2013","journal-title":"Am J Public Health"},{"key":"pcbi.1009795.ref015","doi-asserted-by":"crossref","first-page":"80","DOI":"10.2307\/2626958","article-title":"Social Conditions As Fundamental Causes of Disease","volume":"35","author":"BG Link","year":"1995","journal-title":"J Health Soc Behav."},{"key":"pcbi.1009795.ref016","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/aje\/kwu274","article-title":"Formalizing the Role of Agent-Based Modeling in Causal Inference and Epidemiology","volume":"181","author":"BDL Marshall","year":"2015","journal-title":"American Journal of Epidemiology"},{"key":"pcbi.1009795.ref017","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1002\/soej.12333","article-title":"Shackling the Identification Police?","volume":"85","author":"CJ Ruhm","year":"2019","journal-title":"Southern Economic Journal"},{"key":"pcbi.1009795.ref018","article-title":"Dynamical Modeling as a Tool for Inferring Causation","author":"SF Ackley","year":"2021","journal-title":"Am J Epidemiol"},{"key":"pcbi.1009795.ref019","doi-asserted-by":"crossref","first-page":"113741","DOI":"10.1016\/j.socscimed.2021.113741","article-title":"Reparations for Black American descendants of persons enslaved in the U.S. and their potential impact on SARS-CoV-2 transmission","volume":"276","author":"ET Richardson","year":"2021","journal-title":"Soc Sci Med"},{"key":"pcbi.1009795.ref020","doi-asserted-by":"crossref","first-page":"2478","DOI":"10.1001\/jama.2020.8051","article-title":"COVID-19 and Health Equity\u2014A New Kind of Herd Immunity","volume":"323","author":"DR Williams","year":"2020","journal-title":"JAMA"},{"key":"pcbi.1009795.ref021","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/0025-5564(88)90031-4","article-title":"Modeling and analyzing HIV transmission: the effect of contact patterns","volume":"92","author":"JA Jacquez","year":"1988","journal-title":"Math Biosci"},{"key":"pcbi.1009795.ref022","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/00002030-199705000-00012","article-title":"Concurrent partnerships and the spread of HIV","volume":"11","author":"M Morris","year":"1997","journal-title":"AIDS"},{"key":"pcbi.1009795.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-018-6304-x","article-title":"Potential drivers of HIV acquisition in African-American women related to mass incarceration: An agent-based modelling study","volume":"18","author":"JW Adams","year":"2018","journal-title":"BMC Public Health"},{"key":"pcbi.1009795.ref024","doi-asserted-by":"crossref","first-page":"e1805","DOI":"10.1093\/cid\/ciaa1166","article-title":"Household Transmission of Severe Acute Respiratory Syndrome Coronavirus-2 in the United States","volume":"73","author":"NM Lewis","year":"2021","journal-title":"Clin Infect Dis"},{"key":"pcbi.1009795.ref025","doi-asserted-by":"crossref","first-page":"e2031756","DOI":"10.1001\/jamanetworkopen.2020.31756","article-title":"Household Transmission of SARS-CoV-2: A Systematic Review and Meta-analysis","volume":"3","author":"ZJ Madewell","year":"2020","journal-title":"JAMA Netw Open"},{"key":"pcbi.1009795.ref026","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1073\/pnas.1008895108","article-title":"Role of social networks in shaping disease transmission during a community outbreak of 2009 H1N1 pandemic influenza","volume":"108","author":"S Cauchemez","year":"2011","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pcbi.1009795.ref027","article-title":"Inequality in acute respiratory infection outcomes in the United States: A review of the literature and its implications for public health policy and practice","author":"E Moran","year":"2020","journal-title":"medRxiv"},{"key":"pcbi.1009795.ref028","doi-asserted-by":"crossref","first-page":"e1009149","DOI":"10.1371\/journal.pcbi.1009149","article-title":"Covasim: An agent-based model of COVID-19 dynamics and interventions","volume":"17","author":"CC Kerr","year":"2021","journal-title":"PLoS Comput Biol"},{"key":"pcbi.1009795.ref029","doi-asserted-by":"crossref","first-page":"4961","DOI":"10.1038\/s41467-020-18190-5","article-title":"The use of mobile phone data to inform analysis of COVID-19 pandemic epidemiology","volume":"11","author":"KH Grantz","year":"2020","journal-title":"Nat Commun"},{"key":"pcbi.1009795.ref030","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1038\/s41586-020-2923-3","article-title":"Mobility network models of COVID-19 explain inequities and inform reopening","volume":"589","author":"S Chang","year":"2021","journal-title":"Nature"},{"key":"pcbi.1009795.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.omega.2005.07.012","article-title":"Adventures in policy modeling! Operations research in the community and beyond.","volume":"36","author":"EH Kaplan","year":"2008","journal-title":"Omega"},{"key":"pcbi.1009795.ref032","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1098\/rstb.2010.0387","article-title":"How to make predictions about future infectious disease risks","volume":"366","author":"M. Woolhouse","year":"2011","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"pcbi.1009795.ref033","doi-asserted-by":"crossref","first-page":"e66601","DOI":"10.7554\/eLife.66601","article-title":"Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics","volume":"10","author":"KC Ma","year":"2021","journal-title":"eLife"},{"key":"pcbi.1009795.ref034","volume-title":"Class Counts: Comparative Studies in Class Analysis.","author":"Illustrated","year":"1996"},{"key":"pcbi.1009795.ref035","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1057\/sth.2015.17","article-title":"Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction.","volume":"13","author":"C Muntaner","year":"2015","journal-title":"Soc Theory Health"},{"key":"pcbi.1009795.ref036","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/EDE.0b013e3182109296","article-title":"Compound Treatments and Transportability of Causal Inference","volume":"22","author":"MA Hern\u00e1n","year":"2011","journal-title":"Epidemiology"},{"key":"pcbi.1009795.ref037","article-title":"SARS-CoV-2 reinfection associates with unstable housing and occurs in the presence of antibodies","author":"DJ Bean","year":"2021","journal-title":"Clin Infect Dis"},{"key":"pcbi.1009795.ref038","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2105\/AJPH.2015.302910","article-title":"High tuberculosis stran diversity among New York City public housing residents","volume":"106","author":"P Dawson","year":"2016","journal-title":"Am J Public Health"},{"key":"pcbi.1009795.ref039","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/19491247.2020.1756599","article-title":"Housing policy and the COVID-19 pandemic: the importance of housing research during this health emergency","volume":"20","author":"D Rogers","year":"2020","journal-title":"Int J Hous Policy"},{"key":"pcbi.1009795.ref040","first-page":"5","article-title":"Degree of Housing Instability Shows Independent \u201cDose-Response\u201d With Virologic Suppression Rates Among People Living With Human Immunodeficiency Virus","author":"A Clemenzi-Allen","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"pcbi.1009795.ref041","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1038\/nature04153","article-title":"Superspreading and the effect of individual variation on disease emergence","volume":"438","author":"JO Lloyd-Smith","year":"2005","journal-title":"Nature"},{"key":"pcbi.1009795.ref042","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1098\/rspb.1993.0011","article-title":"Chaos and Biological Complexity in Measles Dynamics","volume":"251","author":"BM Bolker","year":"1993","journal-title":"Proc Biol Sci"},{"key":"pcbi.1009795.ref043","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1126\/science.1090727","article-title":"Unifying the epidemiological and evolutionary dynamics of pathogens","volume":"303","author":"BT Grenfell","year":"2004","journal-title":"Science"},{"key":"pcbi.1009795.ref044","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.annepidem.2020.09.002","article-title":"Estimation of COVID-19 basic reproduction ratio in a large urban jail in the United States","volume":"53","author":"LB Puglisi","year":"2021","journal-title":"Ann Epidemiol"},{"key":"pcbi.1009795.ref045","doi-asserted-by":"crossref","first-page":"e042898","DOI":"10.1136\/bmjopen-2020-042898","article-title":"Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis","volume":"11","author":"GSP Malloy","year":"2021","journal-title":"BMJ Open"},{"key":"pcbi.1009795.ref046","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1038\/s41467-021-22521-5","article-title":"The effect of eviction moratoria on the transmission of SARS-CoV-2","volume":"12","author":"A Nande","year":"2021","journal-title":"Nat Commun"},{"key":"pcbi.1009795.ref047","article-title":"Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality","author":"KM Leifheit","year":"2021","journal-title":"Am J Epidemiol"},{"key":"pcbi.1009795.ref048","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/scientificamerican0555-31","article-title":"Second Thoughts on the Germ Theory","volume":"192","author":"RJ Dubos","year":"1955","journal-title":"Sci Am"},{"key":"pcbi.1009795.ref049","author":"R Dubos","year":"1959"},{"key":"pcbi.1009795.ref050","author":"SK Roberts","year":"2009"},{"key":"pcbi.1009795.ref051","author":"S. Johnson","year":"2007"},{"key":"pcbi.1009795.ref052","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.socscimed.2010.11.006","article-title":"Fishing in dangerous waters: Ecology, gender and economy in HIV risk","volume":"72","author":"SA Mojola","year":"2011","journal-title":"Soc Sci Med."},{"key":"pcbi.1009795.ref053","first-page":"22","article-title":"Contextual drivers of HIV risk among young African women","author":"SA Mojola","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"pcbi.1009795.ref054","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1186\/s12936-015-1010-y","article-title":"Social inequalities in malaria knowledge, prevention and prevalence among children under 5 years old and women aged 15\u201349 in Madagascar.","volume":"14","author":"SAP Clouston","year":"2015","journal-title":"Malar J"},{"key":"pcbi.1009795.ref055","doi-asserted-by":"crossref","first-page":"159","DOI":"10.4269\/ajtmh.14-0595","article-title":"Assessing drivers of full adoption of test and treat policy for malaria in Senegal","volume":"93","author":"C Faust","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"pcbi.1009795.ref056","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/S0277-9536(00)00016-2","article-title":"Residential segregation and the epidemiology of infectious diseases","volume":"51","author":"D. Acevedo-Garcia","year":"2000","journal-title":"Soc Sci Med"},{"key":"pcbi.1009795.ref057","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1007\/s13524-016-0495-5","article-title":"A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality","volume":"53","author":"SAP Clouston","year":"2016","journal-title":"Demography"},{"key":"pcbi.1009795.ref058","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1525\/maq.2003.17.4.423","article-title":"Syndemics and public health: reconceptualizing disease in bio-social context.","volume":"17","author":"M Singer","year":"2003","journal-title":"Med Anthropol Q"},{"key":"pcbi.1009795.ref059","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"M Singer","year":"2017","journal-title":"Lancet"},{"key":"pcbi.1009795.ref060","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1056\/NEJMp2012910","article-title":"Racial Health Disparities and Covid-19\u2014Caution and Context","volume":"383","author":"M Chowkwanyun","year":"2020","journal-title":"N Engl J Med"},{"key":"pcbi.1009795.ref061","doi-asserted-by":"crossref","first-page":"16732","DOI":"10.1073\/pnas.2006520117","article-title":"The challenges of modeling and forecasting the spread of COVID-19","volume":"117","author":"AL Bertozzi","year":"2020","journal-title":"Proc Natl Acad Sci U S A"}],"container-title":["PLOS Computational Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1009795","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T18:33:13Z","timestamp":1644431593000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1009795"}},"subtitle":[],"editor":[{"given":"Jason A.","family":"Papin","sequence":"first","affiliation":[]}],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":61,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pcbi.1009795","relation":{},"ISSN":["1553-7358"],"issn-type":[{"value":"1553-7358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,9]]}}}