developing the capability for integrated epidemiological and macro-economic modelling to aid epidemic preparedness and response.

Epidemics threaten human and animal health. However, they can also have devastating consequences on the economy of nations. This occurs through a variety of mechanisms, including mandated or voluntary behaviour change that reduce the risk of transmission and protect health systems but which also result in changes in consumption patterns; interruption of trade and restriction of labour or capital allocation. Standard health economic evaluations fail to capture most of these effects, as they concentrate on the direct costs and benefits of epidemics or control interventions only. This can lead to inefficient decision-making; leading to under-investment in epidemic prevention measures, and distorted and disjointed analyses during epidemics, from an inability to appropriately weigh the full benefits and costs of a given course of action. This inability to perform integrated analyses can be very problematic as decision-makers are forced to weigh separate pieces of evidence (on the health and economic side) that were typically produced by separate groups working with different assumptions and aiming to optimise different objective functions. The health of the country and its economy are intimately entwined, but these separated analyses lead to potentially false trade-offs being assumed. The problems faced by governments during crises are compounded by the need to make rapid decisions whilst managing the enormous uncertainty around epidemiological and economic consequences of those choices. There is therefore a need to have tools available to policy-makers that they can integrate macro-economic and epidemiological analyses in a shared framework. The lack of these integrated analyses became very apparent during the COVID-19 pandemic resulting in debates about the cost-benefit trade-offs of many interventions, such as travel restrictions, closure of schools, lockdowns, etc, that are still unresolved. We propose to address these problems to aid epidemic preparedness and response, through a number of activities. The ultimate aim is to develop an ecosystem of integrated epidemiological and macro-economic models and to develop a network of individuals and institutions capable of conducting these analyses at pace, as well as policy-makers capable of interacting with and utilising these tools. The work in this preparatory phase will follow three strands: Construction of an interdisciplinary network of researchers across academia, policy-makers, government agencies and other sectors; Engagement with policy-makers to ensure that models are being developed to answer the right questions, are able to provide answers in a time-frame and format that makes them useful, and have the confidence of policy-makers; Building on an initial scoping review of models used during the COVID-19 pandemic, categorisation of the models used for joint epidemiological and macro-economic analyses; assessment of their capabilities for addressing different policy options; as well as their data and computational needs. It is envisaged that these activities will create an interdisciplinary network that is responsive to demands from policy-makers and capable of driving this field forward. This should help ensure that future responses to epidemics are more effective by providing more rounded guidance on how to respond to epidemics in real-time and helping to ensure better preparedness by guiding investments now.