CONTAIN: CONtact Tracing, Infection and Transmission: An INterdisciplinary approach

The COVID-19 pandemic underlined the continuing threat from emerging novel zoonotic diseases, and the need for better national and global preparedness. Interpersonal contact, and contact tracing, has long been recognised as important in the transmission and control of communicable diseases. However, the notion of "contact" is frequently loosely defined, and we have limited information on the wide variety of interactions that may occur between individuals, particularly in lower-income settings where epidemic/pandemic threats most frequently emerge. As a result, there have been few in-depth assessments of the complex nature of daily interactions or variations across settings. There is also little consensus on interplay between biology (virology) and related cultural, environmental and psychological factors, or the way in which prior historical events help shape contact patterns. To understand this better we need innovative approaches that take a truly inter-disciplinary approach. We focus this interdisciplinary work in trying to better understand and model complex and changing human contacts in a specific high-risk setting - 'wet' and wild animal marketplaces. We reciprocally employ mathematical and geospatial modelling, epidemiology, social psychology, performance, cultural studies and historical perspectives to examine contact patterns across settings and identify likely shifts in both past behaviour and future disease outbreaks. We conduct this work in two distinct yet heterogeneous countries - Ghana and Thailand, distinguished by variations in their daily interactional patterns, population density and migration patterns, consumption of wild animals, and availability of both pharmaceutical and non-pharmaceutical barriers to spread. We first (WP1) conduct large general population surveys in the two countries on their use and activities in markets, with questions partly informed by historical evidence on the societal role of markets and their part in disease transmission and psychological research on risk perception and social interaction. We then (WP2) conduct an observational study in marketplaces noting interaction patterns between customers and traders using a novel interdisciplinary framework for risk analysis. We next employ performance methodologies to better understand the everyday, interpersonal practices of marketplaces by engaging market traders in a variety of role play interactions exploring contact patterns across environments and time, using measures of key disease-risk factors for each scripted interaction (including distance, interpersonal touch, and interaction with surfaces). We additionally interrogate traders daily routines and networks and extend an internationally tested pictogram used to assess proximity and trust. We next (WP3) build on the above to model potential transmission from the market to the wider community. Employing a Bayesian framework we estimate proportions of contact and employ agent-based modelling (ABM) of contagion processes in the markets. We use geospatial patterns of movement to inform novel, feasible and locally acceptable interventions that minimise risks of human-human disease transmission. With guidance from colleagues, cultural studies, psychology and history we use a sub-sample of our market traders to consecutively simulate scenarios of behavioural change and optimise our models, relating this to the attack rates of different pathogens and the trade-off of acceptability of action and risk, as informed by both trader responses and historical evidence on the efficacy of these over time. Finally (WP4) we bring these findings together in a series of dissemination activities in the UK, Ghana and Thailand, engaging with WHO country offices and Ministries of Health, as well as events (such as durbar in Ghana) with key stakeholders, and plan further interdisciplinary programmes of research.