An Infectious Disease Spread Simulation Based on Large Language Model Decision Making

Human behaviour during epidemics affects infectious disease dynamics, but quantifying this remains deeply challenging. Here we introduce the Epi-LLM framework: a novel integration of agent-based modelling, real-life epigames, and large language models (LLMs) in which a synthetic society of agents reasons and adapts dynamically over an outbreak contact network. Comparing synthetic agent behaviour against a no-intervention SEIR baseline and human participant data from the AUIB epigame study, we find that LLM agents across four different architectures reduced peak active infections, with quarantine compliance peaking at 58-65% on day six of the 15-day simulation. A binomial generalised linear model showed that perceived health severity was the strongest predictor of quarantine behaviour ($β= 0.33, p = 0.002$), yielding a pseudo-$R^2$ of 0.055, comparable to the 0.072 observed in the human trial. LLM architecture is a key determinant of epidemic dynamics: low-variance architectures offer greater internal validity for testing behavioural rules, while high-variance models may better represent real-world decision-making. Geographic labels alone do not induce culturally differentiated behaviour; explicit attitudinal parameterisation is required. This proof-of-principle work lays the groundwork for deploying the Epi-LLM framework as a scalable, risk-free simulation environment for pandemic preparedness research.

Agent-based modeling (ABM) has the capability to model millions of individuals and their interactions, which is useful for policy making. However, ABMs have traditionally relied on static prior, which prevents the models from adapting to real-time changes. Our research provides a novel approach to addressing this information gap. Large language models (LLMs) offer new opportunities to predict human decision-making. Here, we introduce a scalable Hybrid Agent-based and Language-driven Epidemic (HALE) modeling framework that leverages LLMs to predict human decision-making in an ABM simulation. As a proof-of-concept, we use HALE to simulate COVID-19 and its effects in Salt Lake County, UT.

Epidemiological models often rely on survey data to represent how individuals make health-related decisions, such as whether to vaccinate or adopt protective behaviors. However, repeated large-scale surveys are costly, time-consuming, and limited in the range of scenarios they can capture. In this work, we investigate whether large language models (LLMs) can generate synthetic survey responses that reproduce patterns observed in real populations. Using longitudinal data from the FluPaths surveys, we first identify groups associated with broadly positive or negative attitudes toward vaccination through clustering analysis. We then evaluate several LLMs using a cluster-informed prompting approach to generate synthetic survey responses across multiple epidemic waves. Across models, the synthetic data generally reproduce the distributions of demographic characteristics, vaccination-related beliefs, risk perceptions, and health behaviors observed in the survey data. However, they are less successful at capturing how these factors vary together within respondents. Some models reproduce group-level vaccination trends more reliably than others, although performance varies across waves. We also trained a classifier to distinguish real from synthetic records and found that the generated responses remained identifiable as synthetic. Overall, our findings suggest that LLM-generated survey data may provide a useful tool for exploratory data augmentation and we hope that it could support agent-based epidemic modeling approaches. However, the generated data should not be treated as a substitute for human survey data without further methodological improvements and validation.