From West Africa to Westeros: how mathematical modelling can help save lives

Game of Thrones winning formula. Credit: LSHTM

How can Queen Cersei ensure the survival of the Seven Kingdoms?

Perhaps not the opening line you might expect to read on the website of a leading global health institution…but bear with us!

In our day job as public health researchers, we work with a variety tools: agent-based simulations, statistical models, and geospatial information systems to name a few.  We also work on very different diseases such as Ebola, Dengue and influenza. We analyse factors like how people move around for work or how climate factors drive mosquito populations, and try to answer questions for decision makers about the value of various interventions like vaccination campaigns.

We all came to the London School of Hygiene & Tropical Medicine from very different backgrounds, but we all share a passion for improving global health. We’re also part-time major Game of Thrones (GoT) fans.

In the lead up to the new season theories flew around the office more wildly than a conspiracy of ravens. How to settle these competing predictions?  Why, with the same skills we use for the rest of our work of course.

We decided to make a simple model of a battle against the Army of the Dead, considering the decisions confronting the leaders of living Westeros. We used the same tools we might to represent the dynamics of the immune system or swarms of mosquitoes, instead applied to warfare, ending up with something that might be found behind the scenes of a video game. We then carefully ‘reviewed the literature’ for the numbers to plug into that model, and played out our three scenarios.

Finally, we indulged in a bit of fan-fiction, writing ourselves into the universe and trying to get our results to the one most likely to determine the fate of Westeros: Queen Cersei, first of her name. (Die hard fans keep scrolling at the end of this piece).

So, apart from settling office wagers, why did we do this?

First, it was fun! A unique opportunity to bring two of our passions together.

Second, public health research, like GoT, is intrinsically political. It involves decisions about using resources for the best population outcomes, not necessarily the best results for particular individuals.   We thought our fun example might be an effective way to highlight this and the role we play at LSHTM in that decision process, to the public.

Third, LSHTM and GoT have a strong connection. Kit Harrington’s character is currently battling the Army of the Dead, but back in 1854 another John Snow was battling a different kind of plague – a cholera outbreak in Soho. 

Dr Snow’s work traced the outbreak to a public water hand pump and determined that cholera was spread through contaminated water. His investigation is considered groundbreaking and still informs the way scientists research and treat epidemics across the world.

Like the ‘King in the North’, Dr Snow was also mocked by figures of authority, but is now regarded as the father of modern epidemiology, the cornerstone of life-saving work conducted by public health research institutions such as LSHTM.

While light-hearted, this piece of work is a tribute to Dr Snow, and a reminder that collaboration in public health is key to tackling some of the world greatest challenges.

In the meantime, we eagerly await to see if Queen Cersei heeds our advice by teaming up with Jon Snow to save the Seven Kingdoms.

To Qyburn, Hand of the Queen:
We write in trust that the chains of reason still bind, and that despite our past disputes, you will be swayed by our findings. The Wall no longer stands intact; an army of ancient magic roves Southward while a meager force rushes to assemble against it. Your interest in the restricted histories and their dark secrets has doubtless granted insight into coming conflict; indeed, we are told you have personally witnessed the character of our enemy.

We, too, have scoured these records for data, and obtained reports from sources throughout Westeros. We understand the Queen has contracted with the Golden Company of Essos, and even now marshalls that force to our shores. When they arrive, we expect them to be armed with the finest weaponry, novel artillery, developed at your direction, as well as the accumulated Wildfire stores that now rival those of the Mad King. What we are uncertain of is how the Queen intends to employ such forces.

We foresee three options: that they will garrison in the South, awaiting the outcome of the Battle for the North; or that the Queen will deploy them to the North either to help or to harry the forces of the so-called King in the North, Jon Snow. While no masters of tactics, we have made rough estimates of the outcomes of each scenario, tracking the ultimate fate of the Night King’s unholy forces. If the Golden Company stations in the South, likely in the historical chokepoint in the Neck, they will face a victorious Targaryen army or an even stronger horde of the dead.

While they might hold off the weakened force of the living, they will be crushed by the Night King’s host. Alternatively, if they skirmish with the Northerners before the Night King arrives, both living armies will be slaughtered only to be enslaved to that terrible purpose. The only certain outcome in our favor is for the Golden Company to come to the aid against the Night King, elsewise the Seven Kingdoms, or at least what remains of them, will suffer a fate worse than old Valyria - mindless thralldom under a King who affords the dead no peace.

We appeal to your unimpeachable reason: convince the Queen to stay her wrath until the Night King is defeated.

Yours, in the sight of the Seven, Archmaester Ebrose, on behalf of The Conclave The Citadel, Oldtown



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