A simple vaccination model with multiple endemic states.

A simple two-dimensional SIS model with vaccination exhibits a backward bifurcation for some parameter values. A two-population version of the model leads to the consideration of vaccination policies in paired border towns. The results of our mathematical analysis indicate that a vaccination campaign φ meant to reduce a disease's reproduction number R(φ) below one may fail to control the disease. If the aim is to prevent an epidemic outbreak, a large initial number of infective persons can cause a high endemicity level to arise rather suddenly even if the vaccine-reduced reproduction number is below threshold. If the aim is to eradicate an already established disease, bringing the vaccine-reduced reproduction number below one may not be sufficient to do so. The complete bifurcation analysis of the model in terms of the vaccine-reduced reproduction number is given, and some extensions are considered.