The Effect of Vaccination on the Competitive Advantage of Two Strains of an Infectious Disease.

We investigate the impact of differential vaccine effectiveness, waning immunity, and natural cross-immunity on the capacity for vaccine-induced strain replacement in two-strain models of infectious disease spread. We focus specifically on the case where the first strain is more transmissible but the second strain is more immune-resistant. We consider two cases on vaccine-induced immunity: (1) a monovalent model where the second strain has immune escape with respect to vaccination; and (2) a bivalent model where the vaccine remains equally effective against both strains. Our analysis reaffirms the capacity for vaccine-induced strain replacement under a variety of circumstances; surprisingly, however, we find that which strain is preferred depends sensitively on the degree of differential vaccine effectiveness. In general, the monovalent model favors the more immune-resistant strain at high vaccination levels while the bivalent model favors the more transmissible strain at high vaccination levels. To further investigate this phenomenon, we parametrize the bifurcation space between the monovalent and bivalent model.