Population heterogeneity in vaccine coverage impacts epidemic thresholds and bifurcation dynamics.

Population heterogeneity, especially in individuals' contact networks, plays an important role in transmission dynamics of infectious diseases. For vaccine-preventable diseases, outstanding issues like vaccine hesitancy and availability of vaccines further lead to nonuniform coverage among groups, not to mention the efficacy of vaccines and the mixing pattern varying from one group to another. As the ongoing COVID-19 pandemic transitions to endemicity, it is of interest and significance to understand the impact of aforementioned population heterogeneity on the emergence and persistence of epidemics. Here we analyze epidemic thresholds and characterize bifurcation dynamics by accounting for heterogeneity caused by group-dependent characteristics, including vaccination rate and efficacy as well as disease transmissibility. Our analysis shows that increases in the difference in vaccination coverage among groups can render multiple equilibria of disease burden to exist even if the overall basic reproductive ratio is below one (also known as backward bifurcation). The presence of other heterogeneity factors such as differences in vaccine efficacy, transmission, mixing pattern, and group size can each exhibit subtle impacts on bifurcation. We find that heterogeneity in vaccine efficacy can undermine the condition for backward bifurcations whereas homophily tends to aggravate disease endemicity. Our results have practical implications for improving public health efforts by addressing the role of population heterogeneity in the spread and control of diseases.