Measured voluntary avoidance behaviour during the 2009 A/H1N1 epidemic

Jude Bayham, Nicolai Kuminoff, Quentin Gunn, Eli P. Fenichel

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Managing infectious disease is among the foremost challenges for public health policy. Interpersonal contacts play a critical role in infectious disease transmission, and recent advances in epidemiological theory suggest a central role for adaptive human behaviour with respect to changing contact patterns. However, theoretical studies cannot answer the following question: are individual responses to disease of sufficient magnitude to shape epidemiological dynamics and infectious disease risk? We provide empirical evidence that Americans voluntarily reduced their time spent in public places during the 2009 A/H1N1 swine flu, and that these behavioural shifts were of a magnitude capable of reducing the total number of cases. We simulate 10 years of epidemics (2003–2012) based on mixing patterns derived from individual time-use data to show that the mixing patterns in 2009 yield the lowest number of total infections relative to if the epidemic had occurred in any of the other nine years. The World Health Organization and other public health bodies have emphasized an important role for ‘distancing’ or nonpharmaceutical interventions. Our empirical results suggest that neglect for voluntary avoidance behaviour in epidemic models may overestimate the public health benefits of public social distancing policies.

Original languageEnglish (US)
Article number20150814
JournalProceedings of the Royal Society B: Biological Sciences
Issue number1818
StatePublished - Oct 28 2015


  • A/H1N1
  • Avoidance behaviour
  • Social distancing

ASJC Scopus subject areas

  • General Agricultural and Biological Sciences
  • General Environmental Science
  • General Immunology and Microbiology
  • General Biochemistry, Genetics and Molecular Biology


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