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dc.contributor.authorJnawali, Kamal
dc.contributor.authorMorsky, Bryce
dc.contributor.authorBauch, Chris T. 20:30:33 (GMT) 20:30:33 (GMT)
dc.description.abstractBackground: The evolution of antiviral drug resistance during influenza pandemics has created widespread concern. Use of antiviral drugs is a main contributor to the evolution of drug-resistant strains. Moreover, there are recent examples of influenza viruses acquiring drug resistance seemingly without incurring a fitness penalty that reduces their transmission rate. This creates the possibility of strategic (game theoretical) interaction between jurisdictions making decisions about use of antiviral drug stockpiles. Methods: We developed and analyzed a 2-player 2-strategy game theoretical model. Each ‘player’ (an authority in a health jurisdiction) can choose to treat with antiviral drugs at a low rate or a high rate. High treatment rates are more likely to cause emergence of a drug-resistant strain, and once a drug-resistant strain has evolved, it can spread between the two jurisdictions. We determine the Nash equilibria of the game. Results: We show that there is a coordination game between the jurisdictions, where both players choosing a low treatment rate, or both choosing a high treatment rate, are the only stable outcomes. The socially optimal outcome occurs if both players cooperate by choosing a low treatment rate, thereby avoiding generating drug-resistant mutants. However, such cooperation may fail to materialize if the jurisdictions are closely connected through travel; if the drug-resistant mutant is tolerated (not seen as undesirable); or if the antiviral drug has partial efficacy against transmission of the drug-resistant strain. Conclusions: Inter-jurisdictional cooperation could be essential during a severe influenza pandemic, but we know little about how jurisdictions will interact in a scenario where highly pathogenic, drug-resistant mutant strains are able to transmit as effectively as non-resistant strains. Therefore, strategic multi-population interactions during influenza pandemics should be further studied.en
dc.description.sponsorshipCanadian Institutes of Health Researchen
dc.publisherPublic Library of Scienceen
dc.rightsAttribution 3.0 Unported*
dc.subjectantiviral drugsen
dc.subjectantiviral stockpilesen
dc.subjectdrug resistanceen
dc.subjectfitness penaltyen
dc.subjectgame theoryen
dc.subjectinfluenza epidemiologyen
dc.subjectinfluenza modelen
dc.titleStrategic Interactions in Antiviral Drug Use During an Influenza Pandemicen
dcterms.bibliographicCitationJnawali, K., Morsky, B., & Bauch, C. T. (2017). Strategic Interactions in Antiviral Drug Use During an Influenza Pandemic. PLoS Currents.
uws.contributor.affiliation1Faculty of Mathematicsen
uws.contributor.affiliation2Applied Mathematicsen

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