Large language model-generated patterns for epidemiological modeling: a multi-benchmark evaluation framework

Infectious disease transmission is shaped by patterns of human interaction, which adapt as epidemic conditions change. Capturing these context-dependent behaviors remains a fundamental challenge for epidemic models. Here, we recast this challenge by using large language models (LLMs) to represent adaptive human behavior within mechanistic epidemic models. We operationalize this idea through Generative Adaptive Behavioral Layer for Epidemics (GABLE), which adapts LLMs to infer behavioral responses to epidemic and policy conditions and translates them into age-structured contact matrices coupled to a mechanistic epidemic model. Applied to COVID-19 in France, GABLE reproduced responses in population mixing and age-specific contact structures that remained epidemiologically informative. In short-term forecasting, LLM-generated contact matrices outperformed mobility-driven matrices derived from real-world mobility data, with the largest gains at longer horizons. GABLE also extends beyond forecasting to prospective policy evaluation by projecting behavioral and epidemic responses to candidate interventions before implementation. When supplied with subsequently implemented policies, GABLE reproduced epidemic trajectories and generated distinct responses to alternative policy timing and composition. By leveraging LLMs as a flexible behavioral layer, GABLE provides a framework for coupling context-sensitive behavioral generation with epidemic dynamics.

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.

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.