How does within‐host dynamics affect population‐level dynamics? Insights from an immuno‐epidemiological model of malaria

Malaria is one of the most common mosquito‐borne diseases widespread in the tropical and subtropical regions. Few models coupling the within‐host malaria dynamics with the between‐host mosquito‐human dynamics have been developed. In this paper, by adopting the nested approach, a malaria transmission model with immune response of the host is formulated. Applying age‐structured partial differential equations for the between‐host dynamics, we describe the asymptomatic and symptomatic infectious host population for malaria transmission. The basic reproduction numbers for the within‐host model and for the coupled system are derived, respectively. The existence and stability of the equilibria of the coupled model are analyzed. We show numerically that the within‐host model can exhibit complex dynamical behavior, possibly even chaos. In contrast, equilibria in the immuno‐epidemiological model are globally stable and their stabilities are determined by the reproduction number. Increasing the activation rate of the within‐host immune response “dampens” the sensitivity of the population level reproduction number and prevalence to the increase of the within‐host reproduction of the pathogen. From public health perspective this means that treatment in a population with higher immunity has less impact on the population‐level reproduction number and prevalence than in a population with less immunity.