Hedged allocation of committed measles doses clears more US schools of transmission risk
- 1Cornell Universiity
Abstract
US measles elimination is in question, and the protective doses are already committed; which schools receive them first is unresolved. Of 36,031 US schools, 12,196 hold enough susceptible children to sustain transmission once a case arrives. One 77,292-dose budget would clear 2,497 of them under a lightly hedged rule against 1,511 under the lowest-coverage-first rule now in use, leaving 112,733 fewer children where a chain can persist at no additional dose. The gain comes from finishing schools near the herd-immunity threshold rather than starting schools far below it. Allocation theorys point-optimal form of that rule assumes every school is equally likely to see a case; pre-outbreak records from a 2025-26 South Carolina outbreak show exposed schools over-represented 5.0-fold in susceptible headcount, unlike enrollment. Under non-uniform risk, whose strength one outbreak cannot identify, that optimum is the least robust of seven rules, while the hedge holds roughly 90% of attainable benefit.
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BibTeX
@misc{alexander2026hedged,
title = {{Hedged allocation of committed measles doses clears more US schools of transmission risk}},
author = {L. W. Alexander and A. Pandey and N. Hupert and E. A. Serman and L. Rennert and A. I. Bento},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.20.26360961},
url = {https://www.medrxiv.org/content/10.64898/2026.08.20.26360961v2},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Hedged allocation of committed measles doses clears more US schools of transmission risk
AU - L. W. Alexander
AU - A. Pandey
AU - N. Hupert
AU - E. A. Serman
AU - L. Rennert
AU - A. I. Bento
PY - 2026
DA - 2026/08/20
PB - medRxiv
DO - 10.64898/2026.08.20.26360961
UR - https://www.medrxiv.org/content/10.64898/2026.08.20.26360961v2
AB - US measles elimination is in question, and the protective doses are already committed; which schools receive them first is unresolved. Of 36,031 US schools, 12,196 hold enough susceptible children to sustain transmission once a case arrives. One 77,292-dose budget would clear 2,497 of them under a lightly hedged rule against 1,511 under the lowest-coverage-first rule now in use, leaving 112,733 fewer children where a chain can persist at no additional dose. The gain comes from finishing schools near the herd-immunity threshold rather than starting schools far below it. Allocation theorys point-optimal form of that rule assumes every school is equally likely to see a case; pre-outbreak records from a 2025-26 South Carolina outbreak show exposed schools over-represented 5.0-fold in susceptible headcount, unlike enrollment. Under non-uniform risk, whose strength one outbreak cannot identify, that optimum is the least robust of seven rules, while the hedge holds roughly 90% of attainable benefit.
ER -