Leaky or polarised immunity: Non-Markovian modelling highlights the impact of immune memory assumptions

Mathematical models tend to oversimplify the biological details of vaccine or infection-derived immunity effectiveness. Yet, epidemiological outcomes may diverge when assuming polarised immunity-individuals are either fully susceptible or completely immune-compared to leaky immunity-where all individuals are partially protected. We explore the differences between the two by taking advantage of a non-Markovian framework, which allows us to explicitly record the 'age' of the immunity and vary its effectiveness accordingly. A basic scenario reveals that leaky immunity leads to a shorter time between reinfections. A more data-driven scenario based on SARS-CoV-2 data finds that leaky immunity yields substantially more reinfections than polarised immunity and a higher number of infected individuals, yet with a lower probability of hospitalisation. Our findings emphasize the critical role of immune memory modelling assumptions, especially for long-term epidemiological dynamics and public health policies.