"Early, rapid, aggressive": when strategic interactions between governments, opposition, and lobbies can hinder effective responses to epidemics.

Background: Two critical factors in the success of the response to a threatening epidemic outbreak are the degree of responsibility of the main political actors involved in the response and the population compliance to the proposed measures. The Behavioural epidemiology literature has focused on the latter factor but largely disregarded the former. The multiple failures in COVID-19 control and the lack of consensus that still surround the main response options (i.e., the elimination-suppression-mitigation trichotomy) highlight the importance of considering the political layer in preparedness activities. Methods: We integrate a simple transmission model into a game-theoretic framework for the interaction between the main political actors involved in the response, namely a government, its opposition and lobbies. The aim is to provide a conceptual framework allowing one to identify the political factors promoting a timely and effective response. Results: Low degrees of responsibility (i.e., prioritizing consensus over health protection) of political agents can delay or de-potentiate the response until when epidemic growth eventually overtakes the agents' payoffs, thereby forcing them to switch towards the higher degree of responsibility needed to promote an adequate response. When both the government and the opposition are only "partly" responsible, a stall in the response decision-making process likely arises, further delaying the response. Policy and epidemiological parameters amplifying the response delay are ranked by a sensitivity analysis. Conclusions: Promoting a high degree of responsibility of political actors and lobbies during emergency situations should be a key target of preparedness. Therefore, future pandemic plans should also include, beyond technical indications, ethical statements "guiding" political entities to cooperation.