Quantifying and Realizing the Benefits of Targeting for Pandemic Response

Problem definition To respond to pandemics such as COVID-19, policy makers have relied on interventions that target specific population groups or activities. Since targeting is operationally challenging and contentious, rigorously quantifying its benefits and designing practically implementable policies that achieve some of these benefits is critical for effective and equitable pandemic control. Methodology/results We propose a flexible modeling framework that allows computing optimized interventions that target two dimensions of heterogeneity: age groups and the specific activities that individuals normally engage in. We showcase a complete implementation focused on the Île-de-France region of France, based on commonly available public data. We use this case study to quantify the potential benefits of targeting in an idealized setting where dual targeting is implementable. We find that dual-targeted policies can improve both health and economic outcomes, while maintaining higher activity levels for most age groups (and importantly, for those most confined). We fit decision trees that explain the decisions and the gains afforded by dual targeting. Gains are generated by leveraging complementarities, imposing less confinement on group-activity pairs with high marginal economic value prorated by social contacts. We also derive additional practical insights for identifying settings where gains are high. Because dual targeting can face significant implementation challenges, we introduce two practical proposals inspired by real-world interventions — based on curfews and recommendations — that achieve a significant portion of the benefits without explicitly discriminating based on age. Implications Our framework suggests that significant benefits could be generated by targeting confinements based on activities and age groups, and that some of these benefits can be materialized through realistic interventions that avoid contentious age targeting. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No external funding was received. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All relevant ethical guidelines have been followed. No necessary IRB/ethics committee approvals, to the best of our knowledge. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The time-use survey data was obtained after special request from the French National Archive of Data from Official Statistics (ADISP). All other data referred to in the manuscript are public and URL references to the datasets are included in the manuscript.