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Unfolding selection to infer individual risk heterogeneity for optimising disease forecasts and policy development

Mathematical models are increasing adopted for setting targets for disease prevention and control. As model-informed policies are implemented, however, the inaccuracies of some forecasts become apparent, for example overprediction of infection burdens and overestimation of intervention impacts. Here, we attribute these discrepancies to methodological limitations in capturing the heterogeneities of real-world systems. The mechanisms underpinning single factors for infection and their interactions determine individual propensities to acquire disease. These are potentially so numerous that to attain a full mechanistic description may be unfeasible. To contribute constructively to the development of health policies, model developers either leave factors out (reductionism) or adopt a broader but coarse description (holism). In our view, predictive capacity requires holistic descriptions of heterogeneity which are currently underutilised in infectious disease epidemiology but common in other disciplines.