• M Elizabeth Halloran, Kari Auranen, Sarah Baird, Nicole E Basta, Steven E Bellan, Ron Brookmeyer, Ben S Cooper, Victor DeGruttola, James P Hughes, Justin Lessler, Eric T Lofgren, Ira M Longini, Jukka-Pekka Onnela, Berk Özler, George R Seage, Thomas A Smith, Alessandro Vespignani, Emilia Vynnycky, and Marc Lipsitch.
• Vaccine and Infectious Disease Division, Fred Hutchinson Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA. betz@fhcrc.org.
• Bmc Med. 2017 Dec 29; 15 (1): 223223.

BackgroundInterventions in infectious diseases can have both direct effects on individuals who receive the intervention as well as indirect effects in the population. In addition, intervention combinations can have complex interactions at the population level, which are often difficult to adequately assess with standard study designs and analytical methods.DiscussionHerein, we urge the adoption of a new paradigm for the design and interpretation of intervention trials in infectious diseases, particularly with regard to emerging infectious diseases, one that more accurately reflects the dynamics of the transmission process. In an increasingly complex world, simulations can explicitly represent transmission dynamics, which are critical for proper trial design and interpretation. Certain ethical aspects of a trial can also be quantified using simulations. Further, after a trial has been conducted, simulations can be used to explore the possible explanations for the observed effects.ConclusionMuch is to be gained through a multidisciplinary approach that builds collaborations among experts in infectious disease dynamics, epidemiology, statistical science, economics, simulation methods, and the conduct of clinical trials.

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