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. 2022 Jul 24;10(8):1174. doi: 10.3390/vaccines10081174

An Optimal Control Model to Understand the Potential Impact of the New Vaccine and Transmission-Blocking Drugs for Malaria: A Case Study in Papua and West Papua, Indonesia

Bevina D Handari 1, Rossi A Ramadhani 1, Chidozie W Chukwu 2, Sarbaz H A Khoshnaw 3, Dipo Aldila 1,*
Editors: Khalid Hattaf, Bapi Pahar, Giuseppe La Torre
PMCID: PMC9331692  PMID: 35893823

Abstract

Malaria is one of the major causes of a high death rate due to infectious diseases every year. Despite attempts to eradicate the disease, results have not been very successful. New vaccines and other treatments are being constantly developed to seek optimal ways to prevent malaria outbreaks. In this article, we formulate and analyze an optimal control model of malaria incorporating the new pre-erythrocytic vaccine and transmission-blocking treatment. Sufficient conditions to guarantee local stability of the malaria-free equilibrium were derived based on the controlled reproduction number condition. Using the non-linear least square fitting method, we fitted the incidence data from the province of Papua and West Papua in Indonesia to estimate the model parameter values. The optimal control characterization and optimality conditions were derived by applying the Pontryagin Maximum Principle, and numerical simulations were also presented. Simulation results show that both the pre-erythrocytic vaccine and transmission-blocking treatment significantly reduce the spread of malaria. Accordingly, a high doses of pre-erythrocytic vaccine is needed if the number of infected individuals is relatively small, while transmission blocking is required if the number of infected individuals is relatively large. These results suggest that a large-scale implementation of both strategies is vital as the world continues with the effort to eradicate malaria, especially in endemic regions across the globe.

Keywords: malaria, vaccine, treatment, controlled reproduction number, optimal control

1. Introduction

The primary cause of any infectious disease is the spread of pathogens such as bacteria, viruses, parasites, or fungus. Some of these diseases can spread from person to person, either through direct or indirect contact. A disease that spreads in the human population with an intermediate vector is called a vector-borne disease. According to the world health organization (WHO) [1], vector-borne infection contributes to over 17% of total infectious disease cases worldwide, with an estimated 700,000 deaths annually. Malaria is a vector-borne disease that threatens millions of people every year. Most of the cases come from Africa, southeast Asia, the eastern Mediterranean, and West Pacific [2]. Globally, there were over 600,000 deaths reported out of over 240 million detected cases in 2020. In Indonesia, over 74% of all detected cases are from the provinces of Papua and West Papua [3].

Malaria spreads through the bite of female Anopheles mosquitoes from previously infected individuals with Plasmodium (P). The five types of Plasmodium that cause malaria are P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi [4]. Globally, among all these types of Plasmodium, P. falciparum is primarily commonly found in African countries, while P.vivax exists in other parts of the world (that is, outside Africa) [5]. Several forms of intervention to control the spread of malaria have been introduced for many years worldwide. Most forms of intervention aim to control the population of mosquitoes in the field, such as with the use of fumigation, larvacide, or insecticide-treated bed nets [6]. Other than vector control, malaria prevention also focuses on developing a new vaccine to prevent new infections in the human population. Based on the life cycle of Plasmodium in the human body, the malaria vaccine is divided into three types, namely pre-erythrocytic vaccine, blood-stage vaccine, and transmission-blocking vaccine [7]. The pre-erythrocytic vaccine was designed to eliminate sporozoites immediately after mosquitoes inject Plasmodium into the human body. It will also block the Plasmodium from going to the human liver. According to the WHO report [5], RTS, S/AS01 is one type of pre-erythrocytic vaccine that is recommended by WHO to kill P. falciparum in children population. The blood-stage vaccine is introduced to target the asexual stage of Plasmodium (merozoites) in human red blood cells. On the other hand, the transmission-blocking vaccine is given such that further infection can be avoided [8]. Other than the transmission-blocking vaccine, a type of transmission-blocking drug has been used to eliminate the sexual stages of Plasmodium in human or mosquito bodies.

Mathematical models have been used for many years to understand the mechanisms of malaria transmission, since such model approaches can be used to give a visual interpretation of any possible intervention that can be implemented in the field to control malaria transmission. These approaches provide a scientific background before a final decision from the government should be taken. From the early work by Ross [9] in 1911, many mathematical models were introduced by authors to help a better understanding of malaria transmission. Macdonald in 1957 [10] used his model to estimate the infection and recovery rates of malaria. He found that reducing the number of mosquitoes in an endemic area is an inefficient malaria control strategy. In the early 1980s–1990s, Anderson and May [11] and Aron and May [12] constructed their malaria model based on the assumption that immunity to malaria is independent of the duration of exposure. Okosun et al., in [13], concluded from their mathematical model that a combination between insecticides and transmission-blocking treatment is the most cost-effective interventions to control malaria. An optimal vaccination and bed net mathematical model have been introduced by Prosper et al. in [14]. Their analytical result reveals that increasing the case detection strategy may reduce the chance of backward bifurcation phenomena in their model. An analysis of the potential impact of pre-erythrocytic vaccine from clinical data was discussed by the author in [15]. Similar to Prosper et al. in [14], Woldegerima et al. in [16] also found a possible backward bifurcation from their model on the impact of transmission-blocking drugs. Their model projects an approximately 82% death rate is reduced by 2035 if 35% of the population in Sub-Saharan Africa receives a transmission-blocking drug with an efficacy of 95%. Kuddus and Rahman in [17] analyze the dynamics of malaria using incidence data in Bangladesh from 2001 to 2014. They found that as infection rate has the greatest impact on the basic reproduction number compared to other model parameters, it is important to reduce this infection rate, such as using insecticide-treated bed nets, spraying insecticides, clearing stagnant water, etc. In a more recent mathematical model, authors include more recent facts on malaria transmission such as the effect of vector-bias [18], asymptotic carriers [19], age-structured [20], competitive strains [21], seasonal factor [22,23], and coinfection of malaria with COVID-19 [24]. Furthermore, intervention models also have been widely introduced by authors, such as the use of fumigation [25], insecticide-treated bed nets [26], and vaccines with waning immunity [27], or transmission-blocking vaccines [28].

The authors in [29] concluded that a better understanding of Plasmodium development in the pre-erythrocytic stage could lead to the discovery of new antigenic targets for enhanced immunization strategies. These findings may aid in the development of new malaria immunization techniques that are more successful and useful. In 2015, GlaxoSmithKline’s (GSK’s) RTS, S/AS01 pre-erythrocytic vaccine received a positive scientific response on the quality of this vaccine in combating malaria transmission [30]. Based on the above description, we consider it essential to see the potential impact of the pre-erythrocytic vaccine (RTS, S/AS01) and transmission-blocking drug as a combination of control to reduce the spread of malaria using a mathematical model approach.

Our model divided the susceptible population based on a condition, whether they use a pre-erythrocytic vaccine or not. Furthermore, we also consider the possibility that the transmission-blocking drug cannot kill all Plasmodium in either the sexual or asexual stage in the human body. We used incidence data from Papua and West Papua to calibrate our model by determining the best-fit parameter on our model. Sensitivity analysis on the basic reproduction number and the numerical simulation on the dynamics of each compartment are also conducted to see the impact of pre-erythrocytic vaccine and transmission-blocking drugs in the malaria control strategy. An optimal control model is then analyzed to determine the best possible scenario for combining pre-erythrocytic vaccine and transmission-blocking drugs. The novelty of our model lies in the originality of the model, where we discuss the potential impact of the pre-erythrocytic vaccine. Furthermore, we also use incidence data from two provinces in Indonesia, namely Papua and West Papua, to calibrate our model parameters. These incidence data have never been used in any malaria mathematical model.

The organization of this paper is as follows. In Section 2, we construct our model based on our assumptions, and estimate the parameter values on our model by fitting the output of our model with incidence data in Papua and West Papua. Dynamical analysis regarded the positiveness of the solution of our model, the existence and stability of equilibrium points, and the controlled reproduction number discussed in Section 3. Sensitivity analysis is given in Section 4. Existence of optimal solution and the characterization of the optimal control problem are given in Section 5 and Section 6, respectively. Finally, some conclusions are given in Section 7.

2. The Model and Parameter Estimation Result

2.1. The Model

Based on the malaria status in the human and mosquitoes population, we divided the total human population (denoted by N) into eight compartments as follows:

  • 1.

    Susceptible without vaccine (S1) consists of a group of individuals susceptible to malaria who have not received a pre-erythrocytic vaccine yet.

  • 2.

    Susceptible with a vaccine (S2) consists of a group of individuals who are also susceptible to malaria but have already received a pre-erythrocytic vaccine.

  • 3.

    Exposed without vaccine (E1) consists of a group of newly infected individuals from S1 who have not yet gotten the pre-erythrocytic vaccine. We assume that individuals in this compartment are in the leaver stage. Hence, although these individuals do not show any symptoms yet, we assume that they can transmit Plasmodium to susceptible mosquitoes.

  • 4.

    Exposed with vaccine (E2) consists of a group of newly infected individuals from S2. Although these individuals have already gotten vaccinated, the description is still the same with E1.

  • 5.

    Infected (I) consists of a group of individuals who have already gotten infected by malaria and show their symptoms.

  • 6.

    Infected individuals undergo transmission-blocking treatment (T), defined as a group of individuals who already get infected, show symptoms, but get a transmission-blocking treatment. We assume that this treatment can kill the sexual Plasmodium (gametocytes).

  • 7.

    Recovered but carrier (R1) consists of individuals who recovered from malaria (do not show symptoms anymore) and have a temporal immunity but still have asexual Plasmodium inside their bodies. Hence, this group of individuals can still transmit Plasmodium to the mosquito.

  • 8.

    Fully recovered (R2) consists of a group of individuals who recovered from malaria and succeeded in the transmission-blocking treatment process. Hence, unlike in R1, individuals in R2 lack sexual and asexual Plasmodium in their blood. Therefore, R2 compartment does not transmit malaria anymore.

On the other hand, we only divide the mosquitoes population (denoted by M) into two compartments, namely the susceptible and infected mosquitoes, denoted by V and W, respectively.

We use the following assumptions to construct the model:

  • 1.

    The rate of new individuals only came from newborns with a constant rate of Πh. We ignore migration from our model.

  • 2.

    Vertical transmission is neglected [31].

  • 3.

    The infected individuals in E1,E2,I,T, and R1 are capable to transmit Plasmodium to mosquitoes with a constant rate βv.

  • 4.

    The pre-erythrocytic vaccine is given to S1 individuals with a constant rate u1 to give temporal protection from mosquito bites that can lead to malaria infection. Hence, we assume that the transmission rate of S2 is less than S1 (βh2<βh1).

  • 5.

    The pre-erythrocytic vaccine is not for a lifetime. Hence, after a period of α1, individuals in S2 will return to S1.

  • 6.

    The transmission-blocking treatment is given to individuals in I with a constant rate u2 to cure malaria and wipe out sexual and asexual Plasmodium from their blood.

  • 7.

    The transmission-blocking treatment is not always successful in curing infected individuals.

  • 8.

    The description of all parameters is given in Table 1 and assumed to be nonnegative.

Table 1.

The parameters of malaria model in (1). Some parameter values are taken from parameter estimation results in Section 2.2 and the rest are from assumptions.

Symbols Biological Definitions Papua West Papua Sources
Πh Natural birth rate of humans 3,435,43071.5×12 981,82271.5×12 [32,33,34]
Πv Natural birth rate of mosquitos 2×3,435,4302130 2×981,8222130 [32,33,35]
b The average number of mosquitoes bite per unit time 9.07523 5.94285 estimated
βh1¯ The successful transmission rate of susceptible humans per bite 0.89999 0.87753 estimated
βh2¯ The successful transmission rate of susceptible humans who receive pre-erythrocytic vaccine per bite 0.42299 0.41244 estimated
βh1=bβh1¯N Average infection rate to humans per unit time per mosquito 2.37749×106 5.31162×106 estimated
βh2=bβh2¯N Average infection rate to humans who receive pre-erythrocytic vaccine per unit time per mosquito 1.11742×106 2.49646×106 estimated
βv¯ Average of successful transmission rate of susceptible mosquitos per bite 0.00572 0.01054 estimated
βv=bβv¯N Average infection rate to mosquitos per unit time per human 1.51190×108 6.38376×108 estimated
κ Waning rate of temporal immunity from recovered carriers 0.33333 0.33333 estimated
ϑ Waning rate of temporal immunity from fully recovered class 0.05555 0.05555 estimated
u1 Vaccination rate with pre-erythrocytic vaccine 0.001 0.001 assumption
u2 Rate of treatment with transmission-blocking drugs 0.499999 0.499997 estimated
1ξ pre-erythrocytic vaccine efficacy level 0.53 0.53 [36]
α Waning rate of vaccine efficacy 16 16 [37]
δ1 Progression rate from exposed without vaccine class 6.08333 6.08333 estimated
δ2 Progression rate from exposed with vaccine class 2 2 [36,38]
γ1 Natural recovery rate of infected humans by immune response 0.19999 0.19999 estimated
γ21 Duration of treatment with transmission-blocking drugs 11.08631 11.08631 estimated
p Proportion of people in treatment who managed to get protection 0.59999 0.59964 estimated
q Proportion of people in treatment who fail to receive protection and then recover naturally 0.29999 0.29994 estimated
1pq Proportion of people in treatment who fail to receive protection and then return to the infected class 0.100000004 0.10040 estimated
ζe1 Correction factor for infection rate in mosquitoes by exposed humans 0.04999 0.04999 estimated
ζe2 Correction factor for infection rate in mosquitoes by exposed humans with vaccine 0.03999 0.03999 assumption
ζr Correction factor for infection rate in mosquitoes by recovered humans but carrier 0.06 0.06 estimated
ζt Correction factor for infection rate in mosquitoes by humans in treatment 0.08 0.08 estimated
μh Natural death rate of humans 171.5×12 171.5×12 [34]
μv Natural death rate of mosquitos 3021 3021 [35]

The construction of the model is based on the transmission diagram in Figure 1. All newborns in human and mosquito populations are assumed to be susceptible, with a rate of Πh and Πv, respectively. On the other hand, we assume that each compartment has a natural death rate of μh and μv for human and mosquito populations, respectively. According to [32,33], the total inhabitants in Papua and West papua are 3,453,430 and 981,822, respectively.

Figure 1.

Figure 1

Transmission diagram of model (1).

Our main purpose is to understand the potential impact of the pre-erythrocytic vaccine on reducing the possible transmission of malaria in the human population. This vaccine was designed to clean the sporozoite from the human body right after the mosquito injects the Plasmodium into the human body and block the sporozoites’ invasion of the human liver cell. Hence, we include the rate of this pre-erythrocytic with a constant rate of u1 to the susceptible population (S1). This vaccine is not for a lifetime [37]. Hence, after a certain period of time, individuals in S2 will return to S1. We denote this dropout rate with α. The transmission of malaria comes from the bite of infected mosquitoes to susceptible humans. We assume that the successful transmission rates of S1 and S2 are denoted by βh1¯ and βh2¯, respectively. Let b be the average number of mosquitoes bite per month, then bβh1¯ and bβh2¯ are the averages of possible success transmission in S1 and S2 each month due to the bite of one infected mosquitoes, respectively. We use a ratio-dependent function to model our infection term. Therefore, the number of total infections in S1 is given by bβh1¯WS1N. We assume that the total human population is constant. Therefore, bβh1¯N is constant, and we denote it by βh1. Therefore, we have that the total number of new infections in the human population from the S1 compartment is given by βh1S1W. Using the same approach, the number of new infections in S2 is given by βh2S2W. Exposed individuals without vaccine (E1) and with vaccine (E2) move to Infected class (I) due to progression rate δ1 and δ2, respectively. Note that due to the effect of pre-erythrocytic vaccine that can suppress invasion of sporozoites in hepatocytes [8], we have δ2<δ1. Without treatment, we assume that infected individual I can recover with a constant rate γ1.

Another essential factor that is considered in this article is the use of transmission-blocking treatment for infected individuals I. We assume that individuals in I get a treatment with a constant rate u2, which will transfer them into compartment T. This treatment is given in a duration of γ21. Hence, after a period of γ21, the result of this treatment should be evaluated. If the treatment successfully kills all sexual and asexual parasites, then they are transferred to the compartment of R2 with a rate of pγ2. If the treatment only partially succeeds where only sexual parasites could be eliminated but not the asexual parasites, these individuals will go to R1 with a rate of qγ2. Finally, if the treatment fails, then individuals in T go back to I with a rate of (1pq)γ2. We assume that individuals in R1 still could infect mosquitoes, but they are immune to the symptoms of malaria. Further, we also assume that they have a temporal immunity of κ1. On the other hand, individuals in R2 cannot transfer Plasmodium to mosquitoes and have a temporal immunity of ϑ1.

Unlike the human population, the modeling of the mosquito population is not as complex. It only involves newborn Πv, natural death rate μv, and infection. We assume that susceptible mosquitoes will get infected if they bite infected individuals in compartments E1,E2,I,T, and R1. Since the status of parasites in each mentioned compartment is in different stages, we assume the transmission rate for the mosquitoes are different based on their parasites status. Gametocytes are sexual forms of parasites produced by blood-stage merozoites. However, for P. vivax, gametocytes can be produced by liver stage merozoites [39]. Therefore, humans still in the pre-erythrocyte stage can also transmit susceptible mosquitoes. Exposed humans who received the pre-erythrocytic vaccine (E1) will have fewer parasites in the liver, so the likelihood of liver-stage merozoites producing gametocytes will be less than that of exposed unvaccinated humans (E2). In addition, according to [39], gametocytes can still be found in peripheral blood after several weeks of asexual parasite infection being cleared, so recovered humans (R1) can still transmit susceptible mosquitoes. Humans in treatment can transmit susceptible mosquitoes because humans in treatment (T) are people who are still infected or have not been fully treated. Hence, the transmission rate of E1,E2,R,T to susceptible mosquitoes are given by ζe2βv¯,ζe1βv¯,ζrβv¯, and ζtβv¯, respectively. Note that ζe1,ζe2,ζr, and ζt are the correction parameters due to parasites’ stage in human body, and satisfies the following inequality:

0<ζe2<ζe1<ζr<ζt<1.

Therefore, the total of new infection in mosquitoes population is given by

βvζe1E1+ζe2E2+I+ζrR+ζtTV,

where βv=bβv¯N. From all mentioned parameters above, we must understand that some parameters, especially in the mosquito population, might depend on time or other factors such as weather. For example, mosquitoes are more active when the temperature is low, which means that mosquitoes will be more active in biting humans when the temperature is relatively low [40]. Based on this explanation, all parameter values in our model as in Table 1 are average values.

In many mathematical models for disease control, an optimal control approach is commonly used by many authors to understand the behavior of each intervention as a time-dependent variable under a specific budget limitation problem [41,42,43]. Our proposed model has two different forms of intervention: the pre-erythrocytic vaccine and transmission-blocking treatment, denoted by u1 and u2, respectively. In this article, these two forms of intervention will be treated as a time-dependent variable to pursue the best strategy to suppress the spread of malaria. Hence, we have u1=u1(t) and u2=u2(t).

Based on assumptions above, we describe the dynamics of malaria under the effect of pre-erythrocytic vaccine and transmission-blocking treatment by the following system of ordinary differential equations:

dS1dt=Πh+κR1+ϑR2+αS2βh1S1W(u1(t)+μh)S1,dS2dt=u1(t)S1βh2S2W(α+μh)S2,dE1dt=βh1S1W(δ1+μh)E1,dE2dt=βh2S2W(δ2+μh)E2,dIdt=δ1E1+δ2E2+(1pq)γ2T(u2(t)+γ1+μh)IdTdt=u2(t)Ipγ2Tqγ2T(1pq)γ2TμhT,dR1dt=γ1I+qγ2T(κ+μh)R1,dR2dt=pγ2T(ϑ+μh)R2,dVdt=Πvβv(ζe1E1+ζe2E2+I+ζtT+ζrR1)VμvV,dWdt=βv(ζe1E1+ζe2E2+I+ζtT+ζrR1)VμvW, (1)

with positive initial conditions, and time measured in months. Next, we deduce the related cost which needed to be minimized in the context of malaria control strategy.

  • 1.
    Cost to implement pre-erythtocytic vaccine. The total cost to implement the pre-erythrocytic vaccine is given by
    0tfω1u12dt,
    where ω1 is the weight parameter for pre-erythrocytic parameter and tf is the final time of simulation. The unit of ω1 is 1month2. In this article, we consider the non-linearity term on this cost term as authors in [18,26].
  • 2.
    Cost to implement transmission-blocking treatment. Similar to u1, we also use a quadratic term for u2. Hence, the total cost of transmission blocking is given by
    0tfω2u22dt,
    where ω2 is the weight parameter for transmission blocking. The unit of ω2 is 1month2.
  • 3.
    Cost related to the high number of infected individuals. Except the cost related to the implementation of pre-erythrocytic and transmission-blocking, the cost for malaria control strategy also comes from the cost related to the high number of infected individuals who were not treated (I and R1). This cost is given by
    0tfω3I+ω4R1dt,
    where ω3 and ω4 are the weight parameters for I and R1, respectively. ω3I and ω4R1 respectively denote the cost associated with the high number of infected individuals, such as for maintaining health campaigns or any other related cost which comes as a consequence of the high number of infected individuals. The unit of ω3 and ω4 is 1individual.

Based on the above explanation, the cost function for our model is given by:

J=0tfω1u12+ω2u22+ω3I+ω4R1dt. (2)

There are no exact values of ωi for i=1,2,3,4. Choosing the values of ωi should balance the value of each components on J, since the range of u1 and u2 are very small compared to I and R1. Hence, we have to choose ωi so that no component dominates other components in the cost function. For example, in order to balance between ω1u12 and ω3I, then ω1 and ω3 should satisfy ω1ω3Iu12. To simulate our optimal control problem, it is important that we use parameter values which can present the situation of malaria dynamics in Papua and West papua. Hence, it is important that we estimate our parameter values based on the incidence data in these areas.

2.2. Parameter Estimation

In this section, we discuss the incidence data that we use to estimate our parameters and the numerical scheme that has been used. The incidence data for malaria are taken from two provinces in Indonesia that have the highest number of malaria incidence every year, namely Papua and West Papua [44]. According to [32,33], the total number of inhabitants in Papua and West Papua was 3,435,430 and 981,822 in 2020, respectively. In both areas, the majority of malaria cases are caused by Plasmodium falciparum, and Plasmodium vivax, both of which cause routine health problems and morbidity in these areas [45].

The incidence data used in this article is the monthly new cases in both provinces, from January to December 2020. The data was collected by personal request from the Directorate of Prevention and Control of Vector and Zoonotic Infectious Diseases, Ministry of Health of the Republic of Indonesia. The data can be seen in Figure 2.

Figure 2.

Figure 2

Estimation result on fitting the accumulated cases in Papua with c(t) in Equation (3). The best-fit initial conditions for S1, E1, I, T, R1, R2, V,W are 3,435,430, 2000, 2000, 2000, 1000, 21, 6,870,860, 3000, respectively.

In our model, we do not have a compartment that describes the monthly cases of malaria. Hence, we need to adapt our model to accommodate this. Hence, we transform the monthly cases in both provinces into the accumulated case. Next, we create a new compartment from our model, which describes the accumulated cases. From the transmission diagram given in Figure 1, the total detected cases are coming from the compartment T. Hence, the newly detected cases come from the intervention of transmission-blocking from I to T with a rate of u2. Hence, the dynamic of the monthly cases is given by

dcdt=u2I. (3)

Solving the above differential equation will give us the accumulated cases of malaria incidence. Our task is to minimize the Euclidean distance between c(t) from our numerical results with the incidence data, using the best-fit parameter of our model. This task can be formulated as follows.

minX0tfc(t)simulationc(t)data2dt, (4)

where X is the set of best-fit parameters and initial conditions, while tf is the final time of available data. However, because the use of pre-erythrocytic vaccines had not been implemented in Papua and West Papua in 2020, parameter estimation is performed when the parameters u1,α,βh2,δ2, and ζe2 are zero and the S2 and E2 compartments are zero. The corresponding best-fit parameters are κ,ϑ,βh1¯,b,δ1,p,q,u2,γ1,γ2,βv¯,ζe1,ζt,ζr, and all initial conditions of the system (1) (except S2(0) and E2(0)) and (3). We used a nonlinear optimization toolbox in MATLAB to conduct this parameter estimation, called fmincon function. To run the simulation, we need to give an estimation of an interval in which our parameter values must exist. Hence, we use the lower and upper bound of our parameter values, calculated as shown in Table 2. We estimate our parameter values for incidence data in Papua and West Papua, and the result is given in Table 1, while the fitted cumulated cases are in Figure 2 and Figure 3. This finding indicates that malaria incidence will increase in Papua Province, which tends to the malaria-endemic equilibrium point. Meanwhile, malaria incidence in West Papua Province tends to the malaria-free equilibrium point. From our modeling analyses/results, we can deduce the following:

  • 1.

    Papua is more malaria-endemic than West Papua given the non-controlled basic reproduction number (R0|Papua=1.75 and R0|WestPapua=1.53). See the formula of non-controlled basic reproduction number (R0) in (12).

  • 2.

    Based on the value of p and q, we conclude that individuals in Papua have a slightly bigger chance of reaching the malaria elimination target if there is a continuous implementation of treatment efforts compared to West Papua.

  • 3.

    The infection rates from mosquitoes to humans (βh1, and βh2) in West Papua is higher than in Papua. Hence, it is important to develop a media campaign that targets reducing the contact between humans and mosquitoes in West Papua than in Papua. Such campaigns may include the use of bed nets or mosquito repellent.

Table 2.

Lower and upper bound of parameters that will be estimated.

Parameters Interval Values Sources
Πh 3,435,43071.5×12 or 981,82271.5×12 [32,33,34]
Πv 2×3,435,430×3021 or 2×981,822×3021 [32,33,35]
b 3.012,17.4 [27]
βh1¯ 0.03,0.9 [16,27]
βh2¯ 0.47×0.03,0.47×0.9 [16,27,36]
βh1=bβh1¯N 2.63×108,4.22×106 or 9.20×108,1.47×105 [27,32,33]
βh2=bβh2¯N 1.23×108,1.98×106 or 4.32×108,6.94×106 [27,32,33,36]
βv¯ 0.00572,0.09 [27]
βv=bβv¯N 5.01×109,4.55×107 or 1.75×108,1.59×106 [27,32,33]
κ 112,13 [38]
ϑ 118,13 [38]
u1 0,1 varied
u2 0,1 varied
1ξ 0.53 [36]
α 14×12,14 [37]
δ1 2.02778,6.08334 [38]
δ2 0.9530566,2.8591698 [36,38]
γ1 112,15 [46]
γ2 0.7242071429,1.086310714 [47]
p 0,1 varied
q 0,1 varied
1pq 0,1 varied
ζe1 0.00001,1 [16]
ζe2 0,1 varied
ζr 0.005,1 [16]
ζt 0.02,1 [16]
μh 171.5×12 [34]
μv 3021 [35]

Figure 3.

Figure 3

Estimation result of fitting the accumulated cases in West Papua with c(t) in Equation (3). The best-fit initial conditions for S1, E1, I, T, R1, R2, V, W are 974,300, 400, 400, 51, 21, 125, 1,789,099, 202, respectively.

3. Dynamical Analysis of the Model

3.1. Preliminary Results on the Positiveness and Boundedness of the Solution

The malaria model in system (1) involves human and mosquito populations. Hence, it is necessary to guarantee that all associated variables are positive with nonnegative parameters and initial conditions.

Theorem 1.

Let the initial conditions of all variables in system (1) be nonnegative as follows:

S1(0)>0,S2(0)0,E1(0)0,E2(0)0,I(0)0,T(0)0,R1(0)0,T2(0)0,V(0)>0,W(0)0. (5)

Then the solution set

Ω=S1(t),S2(t),E1(t),E2(t),I(t),T(t),R1(t),R2(t),V(t),W(t)

is nonnegative for all t0.

Proof. 

Let βh1S1W+(u1+μh)S1=G(t). Since the initial conditions of R1,R2, and S2 are nonnegative, then the first equation in system (1) satisfies:

dS1(t)dt=ΠhG(t)S1(t)+κR1+ϑR2+αS2ΠhG(t)S1(t).

Hence, we have:

dS1(t)dt+G(t)S1(t)Πh.

Choosing the integrating factor as exp0tG(τ)dτ. gives us:

dS1(t)dtexp0tG(τ)dτ+G(t)S1(t)exp0tG(τ)dτΠhexp0tG(τ)dτddtS1(t)exp0tG(τ)dτΠhexp0tG(τ)dτ.

Integrating both sides yields

S1(t)exp0tG(τ)dτS1(0)Πh0texp0τG(u)dudt. (6)

Therefore,

S1(t)S1(0)exp0τG(u)du+Πh0texp0τG(u)dudtexp0τG(u)du0. (7)

Therefore, we can see that if S1(0)>0, then we have that S1(t)0 for all t>0. A similar approach can be used to show that S2(t),E11(t),E2(t),I(t),R1(t),R2(t),V(t), and W(t) are nonnegative for all t0. This completes the proof. □

It can be shown that our model in system (1) is well-defined biologically in the feasible region below.

Ω=(X(t),Y(t))R+8×R+2|0N(t)Πhμh,0V(t)+W(t)Πvμv, (8)

where X(t)={S1(t),S2(t),E1(t),E2(t),I(t),T(t),R1(t),R2(t)} and Y(t)={V(t),W(t)}.

3.2. The Malaria-Free Equilibrium and the Controlled Reproduction Number

The first equilibrium point of malaria model in (1) is the malaria-free equilibrium, which is denoted by E*, and given by

E*=(S10,S20,E10,E20,I0,T0,R10,R20,V0,W0)=(α+μh)Πhμh(α+μh+u1),u1Πhμh(α+μh+u1),0,0,0,0,0,0,Πvμv,0. (9)

It can be seen that E* presents a condition where all infections have disappeared from both populations. In this condition, we also can see that the ratio of susceptible human beings with and without pre-erythrocytic vaccine is given by

S10S20=(α+μh)Πhμh(α+μh+u1)u1Πhμh(α+μh+u1)=(α+μh)Πhu1Πh=α+μhu1. (10)

The purpose is, of course, to reduce this ratio, which is equivalent to increasing the number of individuals in S2. It can be seen that this ratio is only affected by three parameters, namely μh,α, and u1. Of these three parameters, only the latter two are controllable. Therefore, we can see that reducing this ratio can be done by increasing the rate of vaccination, and the vaccine’s duration could be prolonged. Hence, the higher the quality of the vaccine (i.e., its duration), the better.

We will now calculate the basic and controlled reproduction number of our model, which is denoted by R0 and RC, respectively. The basic reproduction number defines the expected average number of secondary malaria cases caused by a single malaria-infected case during its infection period in a completely susceptible population. This threshold holds a vital role in many malaria models [48]. From its definition, R0 helps us to understand the qualitative behavior of our model and whether the disease may persist or exist. Mostly, they found that malaria will disappear from the population if R0<1, and exist if R0>1. In several cases, mainly when backward bifurcation phenomena occur in their model [18,49,50,51], it is still possible to find malaria even though RC is already less than one.

When no control intervention is given to our model, then system (1) reduced into:

dS1dt=Πh+κR1βh1S1WμhS1, (11a)
dE1dt=βh1S1W(δ1+μh)E1, (11b)
dIdt=δ1E1(γ1+μh)I, (11c)
dR1dt=γ1I(κ+μh)R1, (11d)
dVdt=Πvβv(ζe1E1+I+ζrR1)VμvV, (11e)
dWdt=βv(ζe1E1+I+ζrR1)VμvW. (11f)

To find the basic reproduction number of the basic model (Section 3.2), we use the well known next-generation matrix approach [52]. The respected basic reproduction number for the basic model (11) is given as follows.

R0=Πhβh1μhμv×βvζe1πvμvδ1+μh+βvπvδ1μvδ1+μhγ1+μh+βvζrΠvδ1γ1μvδ1+μhγ1+μhκ+μh. (12)

With a similar approach, we can calculate the controlled reproduction number of our malaria problem. Implementing the next-generation matrix method into system (1), the controlled reproduction number is given by:

RC=fa+gb+hc+id+je, (13)

where

fa=Πvμv·βvζe1μvR0vE1·Πhμh·α+μhα+μh+u1·βh1δ1+μhR0h1E1, (14a)
gb=Πvμv·βvζe2μvR0vE2·Πhμh·u1α+μh+u1·βh2δ2+μhR0h2E2, (14b)
hc=Πvμv·βvμvR0vI·ΠhμhKR0hI, (14c)
id=Πvμv·βvζtμvR0vT·Πhμhα+μhα+μh+u1·βh1δ1+μh·δ1u2L+u1α+μh+u1·βh2δ2+μh·δ2u2LR0hT, (14d)
je=Πvμv·βvζrμvR0vR1·ΠhμhMR0hR1, (14e)

and

K=α+μhα+μh+u1·βh1δ1+μh·δ1γ2+μhL+u1α+μh+u1·βh2δ2+μh·δ2γ2+μhL,M=α+μhα+μh+u1·βh1δ1+μh·δ1κ+μh·u2γ2q+γ2γ1+μhγ1L+u1α+μh+u1·βh2δ2+μh·δ2κ+μh·u2γ2q+γ2γ1+μhγ1L,L=pγ2u2+qγ2u2+γ1γ2+γ1μh+γ2μh+μh2+μhu2.

As we can see from the expression on (13), R0 is the combination of many paths of infection on our model. The explanation is given as follows.

  • 1.

    R0vE1 shows the path of transmission for a new case in mosquito due to a bite from susceptible mosquitoes to an exposed human in compartment E1.

  • 2.

    R0h1E1 shows the transmission path which gives a new infection in humans without pre-erythrocytic vaccine (E1) due to a bite from infected mosquitoes.

  • 3.

    R0vE2 presents the transmission path for a new infection in the mosquito population after they bite exposed humans in E2.

  • 4.

    R0h2E2 presents the transmission path for a new infection in vaccinated human E2 due to a bite from infected mosquitoes.

  • 5.

    R0vI shows a transmission for a new infection in the mosquitoes population after biting an infected individual in I.

  • 6.

    R0hI presents a transmission path for a new cases in I due to progression of E1 and E2.

  • 7.

    R0vT presents a transmission path for a new case in the mosquitoes population after biting an infected individual who is undergoing treatment (T).

  • 8.

    R0hT presents a transmission path for a new case in treated human population (T) due to the treatment rate from I.

  • 9.

    R0vR1 presents a transmission path for a new case in the mosquito population after biting individuals in R1.

  • 10.

    R0hR1 presents a transmission path for new cases in the compartment of humans who partially succeed in conducting transmission-blocking treatment.

3.3. The Malaria-Endemic Equilibrium

The malaria-endemic equilibrium point of system (1) indicates the condition when malaria persists in the human and mosquito populations. The malaria-endemic equilibrium of system (1) will be determined when the number of infected individuals is not equal to zero. However, due to the complexity of the model, we can not explicitly show the form of the endemic equilibrium point as a function of other parameters. Hence, we write our endemic equilibrium point as a function of dependent variables I and W. The idea is as follows. We set the right hand side of system (1) equal to zero, and solve them backwardly with respect to each variables until we only have I and W left. This process will give us two different polynomial as a function of I and W. Hence, the malaria-endemic equilibrium of system (1) is given by:

E=(S1*,S2*,E1*,E2*,I*,T*,R1*,R2*,V*,W*), (15)

where

S1*=W*βh2+α+μhI*δ2+μhδ1+μhaW*, (16a)
S2*=u1I*δ2+μhδ1+μhaW*, (16b)
E1*=W*βh2+α+μhI*δ2+μhβh1a, (16c)
E2*=u1I*βh2δ1+μha, (16d)
T*=u2I*γ2+μh, (16e)
R1*=qu2+γ1γ2+γ1μhI*γ2+μhκ+μh, (16f)
R2*=I*pγ2u2γ2+μhμh+ϑ, (16g)
V*=μvW*βvT*ζt+E1*ζe1+E2*ζe2+R1*ζr+I*, (16h)

with

a=μh2+γ1+γ2+u2μh+γ2p+qu2+γ1γ2+μh×1βh1δ1μh2+δ1W*βh2+α+δ2βh1+u1δ2βh2μh+δ2W*βh2+αβh1+βh2u1δ1,

while I* and W* are taken from the positive intersection of the following polynomials:

G1=a2(I)W2+a1(I)W+a0(I)=0,G2=b1(W)I+b0(W)=0, (17)

where ai(I),bi(W) for i=0,1,2 has a complex form to be shown. We leave the existence analysis on this malaria-endemic equilibrium as an open problem to an interested reader.

We show the existence of this malaria-endemic equilibrium numerically with the following scenario. To conduct this numerical experiment, we use the following parameter values:

Using the above parameter values, we have the basic reproduction number of system (1) is 1.002169498, which is larger than one. Substituting the parameter values in Table 3 into G1 and G2 yield:

G1=(2.81×1019I+2.4×1011)W2+(1.89×1012I+3.62×106)W2.91×107I=0,G2=6.14×1015(W+150489.34)(W+34834.79)I2.67×109(W+150616.39)W=0. (18)

Table 3.

Parameter values to show existence of E.

Parameter Value Parameter Value
κ 0.333333327466586 γ1 0.199999993947735
ϑ 0.0555555854358188 γ2 1.08631070229205
α 16 βv 1.51190029406934×108
βh1 2.37749246426963×106 ζe1 0.0499997440960968
u1 0.001 ζe2 0.0399997440960968
βh2 1.11742145820672×106 ζt 0.080000001876738
δ1 6.08333998105411 ζr 0.060000000761188
δ2 2 μh 1.165501166×103
p 0.599999998192909 Πh 4003.99766899767
q 0.299999997668467 μv 1.428571429
u2 0.499999999825239 Πv 9,815,514.28571429

Next, we plot G1 and G2 in IW plane. The result is given in Figure 4.

Figure 4.

Figure 4

Illustration for the existence of malaria-endemic equilibrium point.

Since we have an intersection between G1 and G2 in the first quadrant of IW plane, then we have the malaria-endemic equilibrium point, which is given by:

E=(S1*,S2*,E1*,E2*,I*,T*,R1*,R2*,V*,W*)=3400396,20241,200,2,1874,862,1960,9898,6870710,151. (19)

4. Sensitivity Analysis

4.1. Global Sensitivity Analysis on the Basic Reproduction Number

In this subsection, we carry out a global uncertainty analysis of basic reproduction number for the malaria model without control. As we have already shown in the previous section, the basic reproduction number could determine whether malaria will persist or become extinct in the population. Hence, it is essential to analyze the sensitivity of the basic reproduction number with respect to the model parameters. Global sensitivity analysis is used to study the relative changes in epidemic model parameters output, giving input/altered model parameters for the dynamical systems under investigation. Thus, we enabled modelers to identify key model variables that require controlling for the particular disease. To carry out the simulation, we used global sensitivity analysis, which combines the Latin-hypercube sampling and Partial Rank Cross Correlation (PRCC) technique as given in [53] with similar analysis in [54]. Using R-software, we performed 1000 simulations per run, and examined and evaluated the PRCC of the model parameters concerning in R0. The PRCC indicates the degree of monotonicity between the model’s parameters in the R0. Thus, juxtaposing the values of PRCC gives an apparent effect and contribution of each model parameter on R0 in our malaria model. The results from the numerical simulations are given in Figure 5 and Table 4. The sensitivity of the parameters to the basic reproduction number (12) is proportional to the absolute value of PRCC. As we can see in Table 4, we observe Πh,βh1,μh,μv,βv,Πv,γ1, and ξr. From these parameters, we can see that βh1,βv, and μv are the most significant parameters that can be controlled. Increasing μv and reducing βh1 and βv will reduce R0. It can also been seen in Table 4 that all the parameters have p-values <0.05 and thus are said to be significant besides ξe1,κ, and δ1. Therefore, it is essential to introduce intervention to reduce the infection rate with vaccine in susceptible populations, or increasing the mosquito death rate with fumigation.

Figure 5.

Figure 5

Tornado plot showing the PRCC values for the model parameters in R0.

Table 4.

PRCC parameter values and p-values for the global sensitivity analysis against R0.

Parameter PRCC Values p-Values Significant?
Πh 0.271036046 0 TRUE
βh1 0.631568463 0 TRUE
μh 0.656060428 0 TRUE
μv 0.856948705 0 TRUE
βv 0.643359162 0 TRUE
ξe1 0.038340724 2.282×101 FALSE
Πv 0.276430743 0 TRUE
δ1 0.003574822 9.106×101 FALSE
γ1 0.162743705 2.486×107 TRUE
κ 0.079425150 1.240×102 FALSE
ξr 0.183579610 5.425×109 TRUE

4.2. Local Sensitivity Analysis on the Model Variables

The sensitivity methods can be used on infectious disease models to determine which variable or parameter is sensitive to a specific condition. In our case, identifying the key critical parameters of system (1) is an effective way to study the qualitative behaviour of the parameters which govern the model. In our proposed model (1), we have 10 compartments xi for i=1,2,...,10 and 22 parameters kj for j=1,2,...,22. Then, the local sensitivities can be calculated using three different techniques: non-normalisations, half-normalizations, and full-normalizations. Firstly, the equation of non-normalization sensitivities is given by

Skjxi=xikj, (20)

where Skjxi is measured as sensitivity coefficients of each xi with respect to each parameter kj. Then, the formula of half–normalization sensitivities is defined below:

Skjxi=1xixikj. (21)

Finally, the equation of full-normalization sensitivities is defined by

Skjxi=kjxixikj. (22)

In this article, we only perform a full-normalization sensitivity analysis on our proposed model in (1) for best-fit parameter of Papua and West-Papua incidence data. The results are given in Figure 6 and Figure 7. We can see from Figure 6 and Figure 7 that the progression rate from E1 to I (δ1) is the most influential parameter for all compartments, except S2 and E2. The second most influential parameter is the transmission-blocking parameter (u2). In contrast to u2, we can see that the impact of pre-erythrocytic (u1) is not as sensitive as u2. This result is similar to our previous sensitivity analysis on R0.

Figure 6.

Figure 6

Local sensitivity analysis with full–normalization technique of all variables with respect to all parameters (a) and without δ1 (b). We use incidence data from Papua and the following initial conditions: S1(0)=3,208,839, S2(0)=0,E1(0)=2000,E2(0)=0,I(0)=2000,T(0)=1000,R1(0)=1000,R2(0)=317,V(0)=6,664,102,W(0)=2781 to run the simulation.

Figure 7.

Figure 7

Local sensitivity analysis with full–normalization technique of all variables with respect to all parameters (a) and without δ1 (b). We use incidence data from West-Papua and the following initial conditions: S1(0)=918,167,S2(0)=0,E1(0)=399,E2(0)=0,I(0)=242,T(0)=51,R1(0)=22,R2(0)=88,V(0)=1,915,967,W(0)=641 to run the simulation.

5. Existence of Solution and Characterization of the Optimal Control Problem

We consider our optimal control problem on determining S1*, S2*, E1*, E2*, I*, T*, R1*, R2*, V*, W*, associated with our admissible control parameter (u1*,u2*)Ω on the time interval [0,T], which satisfies our malaria model in (1), non-negative initial conditions S1(0), S2(0), E1(0), E2(0), I(0), T(0), R1(0), R2(0), V(0), and W(0) in order to minimize the cost function in (2), i.e.,

J(u1*,u2*)=minΩJ(u1,u2). (23)

The existence of our optimal control solutions (u1*,u2*) comes from the convexity of the integrand of the cost function in (2) with respect to the controls and the regularity of the malaria model in (1) (See [55,56] for the existence results of optimal solutions).

5.1. Existence of the Optimal Solution

In this subsection we state and prove the existence of solutions for the optimal control ODE system given in Equation (1), before proving the existence of solutions for the optimal control problem. Firstly, it is necessary to establish the boundedness of our malaria model over the modeling time horizon. Now, let S^1,S^2,E^1,E^2,I^,T^,R^1,R^2,V^, and W^ denote the super-solutions with respect to each state variable in Equation (1). Therefore, we obtain

dS^1dt=Πh, (24a)
dS^2dt=S^1, (24b)
dE^1dt=1, (24c)
dE^2dt=1, (24d)
dI^dt=δ1E^1+δ2E^2, (24e)
dT^dt=I^, (24f)
dR^1dt=γ1I^+qγ2T^, (24g)
dR^2dt=pγ2T^, (24h)
dV^dt=1, (24i)
dW^dt=βv(ζe1E^1+ζe2E^2+I^+ζtT^+ζrR^1). (24j)

Writing system (24) in a vector notation format, we get

X¯=M1X¯+M2,

where X¯=S^1S^2E^1E^2I^T^R^1R^2V^W^, M100000000001000000000000000000000000000000000δ1δ2000000000100000000qγ2γ100000000pγ2γ10000000000000000βvζe1βvζe21βvζtβvζr000 and

M2=Πh011000010.

From the above matrices, it can be deduced that our model is linear and satisfies the properties of being semi-positive definite on Ω. Then, it follows that the super-solutions of the system (1) are bounded.

Applying Theorem 4.1 on pages 68–69 of Fleming and Rishel [56], we then show the existence of the optimal control model. Supposed

H={uk(t):0uk(t)1},t[0,tf]fork=1,2.

Theorem 2.

Given the objective functional

J=0tfω1u12+ω2u22+ω3I+ω4R1dt, (25)

which has associated admissible control while subject to the model initial conditions given in Theorem 1. There exists an optimal control pair u1*,u2* which minimizes the functional

J(u1*,u2*)=minΩJ(u1,u2). (26)

Therefore, the conditions enumerated below should be satisfied by our model.

  • 1. 

    The admissible control parameters and each model state variable are non-empty.

  • 2. 

    Control H is convex and bounded.

  • 3. 

    Right hand side of our system is continuous and bounded above by a linear function in the state variables and the control parameters.

  • 4. 

    The integrand of J(u1(t),u2(t)) is concave on H.

  • 5. 
    There exists positive constants b1,b2>0 and τ>1 such that J(uk(t)) satisfies
    J(u1(t),u2(t))b1+b2(|u1|2+|u2|2)τ2.

Proof. 

The proof follows for the stated conditions as follows:

  • 1.

    Applying the methodology of Theorem 9.2.1 on page 182 of [57], the first criteria is fulfilled as the solutions of our model system exist and are bounded in ω as also shown by the existence of the super-solutions.

  • 2.

    Using the definition of H, we have that set as bounded and closed.

  • 3.

    Considering our model in Equation (1) and the cost function (2) is linear in u1 and u2. with the aid of the result of the theorem as in [57], we can then deduce that the right-hand side of our system is continuous and bounded.

  • 4.
    Suppose the objective function
    L=ω1u12+ω2u22+ω3I+ω4R1
    and we set (p,q)Θ,forp,qand0t1. Then L(tp+(1t)p)t(p)+(1t)Lp. Additionally, let (p,q)Θ2 for 0t1, then we have that p=u11, p=u12 and (tp+(1t)q=tu11+(1t)u12). Thus,
    L(tp+(1t)q)=ω3I+ω4R1+ω1(tu11+(1t)u12)2+ω2(tu21+(1t)u22)2 (27a)
    tL(p)+(1t)L(q)=ω3I+ω4R1+ω1(tu112+(1t)u122)+ω2(tu212+(1t)u222). (27b)
    From (2), we observe that
    (tu11+(1t)u12)2(tu112+(1t)u122),
    (tu21+(1t)u22)2(tu212+(1t)u222).

    Following this observation, we can then generalize that given any (p,q)θ2 for 0t1 we obtain L(tp+(1t)q)tL(p)+(1t)L(q). Hence, the integrand of J is concave.

  • 5.
    Following the fact that the model state variable in the objective function, that is, I and R1 are bounded as shown in 3. Above, there exits positive constants φ1,φ2>0 such that the sum of (I+R1)φ2. If we set φ2=maxn=3,4, we have that
    L(I,R1,u1,u2)η1+η2+η3|u12|+|u22|2τ
    in which τ=2. This implies that there is a positive constant φ1,φ2>0 and a τ>1 such that the integrand component of J satisfies
    L(I,R1,u1,u2)φ1+φ2|u12|+|u22|2σ.

From the above proof, we have that our system satisfies the necessary conditions in Theorem 2, which is completed here. □

5.2. Characterization of the Optimal Control Problem

The Pontryagin’s Maximum principle [58] allows us to utilize costate functions to transform the optimization problem to the problem of determining the point-wise minimum of u1* and u2* of the Hamiltonian. This Hamiltonian function is built using the cost function in (2) and the malaria model in (1). With this, we derive:

H(X,λj,ui)=ω1u12+ω2u22+ω3I+ω4R1+λ1Πh+κR1+ϑR2+αS2βh1S1W(u1(t)+μh)S1+λ2u1(t)S1βh2S2W(α+μh)S2+λ3βh1S1W(δ1+μh)E1+λ4βh2S2W(δ2+μh)E2+λ5δ1E1+δ2E2+(1pq)γ2T(u2(t)+γ1+μh)I+λ6u2(t)Ipγ2Tqγ2T(1pq)γ2TμhT+λ7γ1I+qγ2T(κ+μh)R1+λ8pγ2T(ϑ+μh)R2+λ9Πvβv(ζe1E1+ζe2E2+I+ζtT+ζrR1)VμvV+λ10βv(ζe1E1+ζe2E2+I+ζtT+ζrR1)VμvW, (28)

where X=(S1,S2,E1,E2,I,T,R1,R2,V,W) and λj for i=1,2,10 are the associated adjoints for the model variables S1,S2,E1,E2,I,T,R1,R2,V, and W, respectively.

Next, we will calculate the optimality system of our optimal control problem. The following results is a direct consequences of application of the Pontriagin’s Maximum Principle for bounded controls [59]. The adjoint system can be written as follows:

dλ1dt=LS1=βh1W(λ1λ3)+u1(λ1λ2)+μhλ1,dλ2dt=LS2=βh2W(λ2λ4)+α(λ2λ1)+μhλ2,dλ3dt=LE1=δ1(λ3λ5)+ζe1βvV(λ9λ10)+μhλ3,dλ4dt=LE2=δ2(λ4λ5)+ζe2βvV(λ9λ10)+μhλ4,dλ5dt=LI=ω3+u2(λ5λ6)+γ1(λ5λ7)+βvV(λ9λ10)+μhλ5,dλ6dt=LT=γ2(λ6λ5)+pγ2(λ5λ8)+qγ2(λ5λ7)+ζtβvV(λ9λ10)+μhλ6,dλ7dt=LR1=ω4+κ(λ7λ1)+ζrβvV(λ9λ10)+μhλ7,dλ8dt=LR2=ϑ(λ8λ1)+μhλ8,dλ9dt=LV=βv(ζe1E1+ζe2E2+I+ζtT+ζrR1)λ9λ10+μvλ9,dλ10dt=LW=βh1S1(λ1λ3)+βh2S2(λ2λ4)+μvλ10, (29)

and with transversality conditions λj(T)=0 for j=1,2,10. The optimality conditions requires that Hu1=Hu2=0. Hence, according to our model and cost function, and following the lower and upper bounds, we have:

u1*=minmax0,S1(λ2λ1)2ω1,1, (30)
u2*=minmax0,I(λ6λ5)2ω2,1. (31)

6. Numerical Simulation of the Optimal Control Problem

From the previous analysis, our optimal control problem consists of the state system, which is the malaria model in (1) with initial condition X(0), the costate system in (29) with transversality condition λj(T)=0, and optimal conditions in (30). To determine the optimal trajectory of u1* and u2*, we have to determine the solution of the state and costate system. Since the state system has an initial condition, while the costate has the final condition, we cannot solve these systems directly forward in time. Thus, we will solve it using the “forward-backward sweep method” [59]. The algorithm is as follows. An initial guess for the control variables should be made. Then, with this initial guess, we solve the state system in (1) numerically forward in time using a Runge–Kutta method. Having the initial guess of control variables and the solution of the state system for t[0,T], we solve our costate system in (29) backward in time, also with the Runge–Kutta method. Having the solution of state and costate for t[0,T], we update the control trajectories using the equation in (30). This process is repeated until the convergence criteria are satisfied. In our numerical implementation, the convergence criteria are when the Euclidean distance between ith and (i+1)th iteration for costate, state, and control parameters are smaller than our chosen tolerance.

Unless stated otherwise, to run the simulations in this section, we used parameter values as shown in Table 1, with the following initial conditions: S1(0)=95%N,S2(0)=0,E1(0)=1%N,E2(0)=0,I(0)=3%N,T=0,R1(0)=0,R2(0)=1%N,V(0)=180%N, and W(0)=20%N, with N is the total of human population in Papua (3,435,430). The values assigned for the weight constant are ω1=1,ω2=1,ω3=5×1011, and ω4=1012. In this section, the impact of control trajectories with various scenarios is studied. We studied the impact on the change of the dynamic of each sub-population (with and without controls), the total of susceptible and infected populations, and the cost related to the scenario.

6.1. Different Combination of Interventions

For the first scenario of optimal control simulations, we conducted our experiment based on the combination of controls that have been used. Let Scenarios 1, 2, and 3 be scenarios when only pre-erythrocytic drugs are used (u1>0,u2=0), transmission-blocking drugs are used (u1=0,u2>0), and both drugs are used (u1>0,u2>0), respectively. The illustration on the dynamics of system (1) and the control profiles for Scenarios 1, 2, and 3 are given in Figure 8, Figure 9, and Figure 10, respectively. From Figure 8, we can see that with a profile of u1 of Scenario 1 in Figure 8k, the number of infected individuals is always decreasing except E2, as a consequence of the existence of individuals who are already vaccinated (S2). It is clearly observed that the pre-erythrocytic vaccine should be maintained at one from the start of the simulation for a long time period to increase the number of vaccinated individuals. With a large number of vaccinated individuals, fewer people will be infected by mosquitoes. Hence, the total number of infected individuals is always smaller than when no intervention is used. The total cost for Scenario 1 is 4.31889×1012, with an average of total avoided infected individuals (E1+E2+I+T) compared to without intervention scenario is 34,679 individuals. Please see Figure 11 for the dynamics of total susceptible and infected individuals, with and without control.

Figure 8.

Figure 8

Dynamics of human (ah), mosquitoes (i,j), and controls (k,l) under the scenario of pre-erythrocytic vaccine intervention only applies. Blue and red curve represents implementation strategies with and without controls.

Figure 9.

Figure 9

Dynamics of human (ah), mosquitoes (i,j), and controls (k,l) under the scenario of transmission-blocking treatment intervention only applies. Blue and red curve represents implementation strategies with and without controls.

Figure 10.

Figure 10

Dynamics of human (ah), mosquitoes (i,j), and controls (k,l) under the scenario of both intervention applies. Red and blue curve present a condition of without and with implementation of control.

Figure 11.

Figure 11

Dynamics of total susceptible human (a) total of infected human (b) for four different strategies (no intervention (red), u1 and u2 (blue), u1 only (black), and u2 only (magenta)).

Simulation results of Scenario 2, when only transmission-blocking is used as an intervention strategy, are given in Figure 9. Similar to Scenario 1, the intervention of transmission-blocking successfully reduces the number of infected individuals significantly. The trajectories of u2 for Scenario 2 can be seen in Figure 9l, where intervention should be given in its maximum effort from the beginning of simulation for 10 months and decreasing slowly as time passes. The total cost for Scenario 2 is 1.33452×1012, which is almost 70% smaller than Scenario 1. The average number of total infected inverted in Scenario 2 is 160,114 individuals. Compared to Scenario 1, the average number of averted cases for Scenario 2 is almost 361% larger.

Figure 10 shows the dynamics of each subpopulation in system (1), and it controls trajectories for Scenario 3. It reflects the success of the combination between the pre-erythrocytic vaccine and transmission-blocking treatment. This scenario suggests the intervention of transmission-blocking should be given in its maximum effort, much longer than the pre-erythrocytic vaccine. With the total cost for Scenario 3 being 1.334401×1012, the average number of avoided infections is 170,680 individuals.

The comparison of all scenarios in one figure can be seen in Figure 11. We can see that reducing the number of infected individuals between Scenarios 2 and 3 is almost similar, which is more successful than Scenario 1. Hence, with the set of parameters and initial conditions in this article, we can conclude that transmission-blocking treatment is more significant in reducing the number of infected individuals than the pre-erythrocytic vaccine. We have to state that the estimation of parameters on our model does not include the number of individuals who already use both forms of intervention. Hence, it is important to do another parameter estimation when the data for the number of individuals who use both interventions are already available and re-simulate our optimal control simulation.

6.2. Different Initial Condition of Population

In this subsection, we analyze the impact of the initial condition of the population on the dynamics of control variables. We use parameter values and initial condition of Scenario 3 in Section 6.1 as the base case, and change the initial conditions as follows: S1(0)=80%N,S2(0)=0,E1(0)=5%N,E2(0)=0,I(0)=10%N,T=0,R1(0)=0,R2(0)=5%N,V(0)=150%N, and W(0)=50%N, with N being the total human population in Papua (3,435,430). Let us call this Scenario 4. In Scenario 4, we can see that the number of infected individuals in the human and mosquito population is larger than in Scenario 3. The result of this scenario is shown in Figure 12. We can see in Figure 12k that the dynamics of u1 are only given in its maximum effort for just a few days of simulation, and start to decrease rapidly compared to in Scenario 3 (Please see Figure 10k). Since the rate of vaccine is the maximum given in a concise time period, then the increased number of S2 in Scenario 4 is not as significant as in Scenario 3. The dynamics of u2, which present the transmission-blocking treatment, should be given its maximum value over a longer period than u1 to reduce the number of infected individuals. Consequently, the number of treated individuals increases very rapidly and decreases as they begin to recover. The cost for Scenario 4 is 4.6189×1012, which is much larger than Scenario 3. Although the number of infected cases avoided in Scenario 4 is 1,177,307, which is more significant than in Scenario 3, the cost to achieve this result is almost 330% larger than in Scenario 4. Hence, we can conclude that when the number of infected individuals is relatively large at the beginning of the intervention period, most of the intervention should be focused on reducing cases, which in our model is the implementation of transmission-blocking treatment. With more infected individuals at the beginning of the intervention period, more costs are needed to control the spread of malaria.

Figure 12.

Figure 12

Dynamics of human (ah), mosquitoes (i,j), and controls (k,l) under the scenario of both intervention applies, but with a higher number of infected individuals at time t=0. Red and blue curve present a condition of without and with implementation of control.

6.3. Different Initial Basic Reproduction Number

In this subsection, the optimal control simulation aims to see the effect of the initial value of the basic reproduction number when pre-erythrocytic intervention and transmission-blocking treatment is not yet implemented. In this case, the basic reproduction number of system (1) is given by (12).

For this simulation, we used parameter values as from Table 1, except that u1=0,u2=0, and also other parameters that related to the control parameters are zero as the base case (case 3 in Table 5). We run our simulation in seven different cases, and the differences are based on the value of βh1,βh2, and βv. Hence, we also have a different initial basic reproduction number R0, as shown in Table 5. It can be seen that the greater the value of R0, the higher the costs to reduce the high number of cases in the field. If we pay attention to Figure 13k,l, the higher the R0 value, the longer the transmission-blocking treatment intervention should be given to its maximum value, and at the same time, the pre-erythrocytic intervention should be reduced in intensity to avoid high intervention costs. On the other hand, when R0 is smaller, the pre-erythrocytic vaccine should be given for a longer period at its maximum level to avoid an increase in the number of malaria-infected individuals.

Table 5.

Numerical results for various initial value of the non-controlled basic reproduction number.

Case Scenario for βh1, βh2 and βv R0 Inverted Case Cost Colour
1 Reduced 50% from case 3 1.005 52,787 7.038×1011 Red
2 Reduced 25% from case 3 1.508 129,702 1.101×1012 Green
3 As in Table 1 for Papua data 2.011 170,680 1.334×1012 Blue
4 Increased 50% from case 3 3.016 185,168 1.857×1012 Cyan
5 Increased 100% from case 3 4.022 183,584 2.67×1012 Magenta
6 Increased 150% from case 3 5.027 184,294 3.573×1012 Yellow
7 Increased 200% from case 3 6.033 185,505 4.562×1012 Black

Figure 13.

Figure 13

Time series dynamics for; humans (ah), mosquitoes (i,j), and controls (k,l), but different initial R0 when no control applied. The color in the legend are explained in Table 5.

7. Conclusions

In this paper, we formulated and analyzed a deterministic compartmental model for malaria transmission. The model consists of eight compartments for humans and two compartments for mosquitoes. The malaria-free equilibrium is locally asymptotically stable if the basic reproduction number is less than unity. The basic reproduction number of our model presents the combination of infection paths in our transmission model, such as the bite of susceptible mosquitoes to the exposed human (with/without the vaccine), infected, treated, or carrier recovered individuals, or the bite of infected mosquitoes to susceptible humans (with/without vaccine).

Our model parameter values were estimated using incidence data from the Papua and West Papua provinces in Indonesia. We found that without implementing any type of intervention, the basic reproduction number of malaria in Papua and West Papua is greater than one, which suggests that a massive intervention should be made to reduce the spread of malaria. Our sensitivity analysis of the basic reproduction number shows that transmission-blocking is more sensitive to reducing the basic reproduction number compared to the pre-erythrocytic vaccine.

Several scenarios on the optimal control simulation were carried out based on the combination of interventions (first scenario), different initial conditions (second scenario), and the value of the basic reproduction number (third scenario). From the first simulation, in order to understand the most effective combination strategies, we found whether using both vaccine and treatment as a single or combined form of intervention will be more effective compared to other possible combinations. Our analysis shows that using both interventions is the most successful strategy in reducing the number of new infections. However, the number of averted infections with this strategy is only slightly different compared to that of implementing transmission-blocking treatment as a single form of intervention, but with a cheaper cost of implementation. On the other hand, the pre-erythrocytic vaccine is not recommended as a single form of intervention, as the result in reducing the number of infected individuals is not as significant as other strategies. From the second scenario, we concluded that more cost is needed to control malaria when the number of infected individuals is already high. For the last scenario, we run our simulation for various values of the basic reproduction number to indicate that the level of endemicity of malaria when vaccines and treatment are not yet implemented. Our results suggest the larger the basic reproduction number of an area, the larger the scale of the implementation of transmission-blocking treatment is needed to reduce the spread of malaria. Additionally, the pre-erythrocytic vaccine should be implemented at its maximum rate for a short period to minimize the intervention cost.

Acknowledgments

We thank anonymous reviewers for their valuable input and comments to help strengthen this paper.

Author Contributions

Conceptualization, B.D.H., R.A.R. and D.A.; Formal analysis, B.D.H., R.A.R., C.W.C., S.H.A.K. and D.A.; Investigation, R.A.R., D.A. and S.H.A.K.; Methodology, B.D.H., R.A.R. and D.A.; Writing—original draft, B.D.H., R.A.R., C.W.C., S.H.A.K. and D.A. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The data that been used in this research is from personal request to Papua and West Papua Provincial Health Office.

Conflicts of Interest

The authors declare they do not have any competing interest.

Funding Statement

This research was funded by Universitas Indonesia with PUTI Q2 research grant scheme, 2022 (ID: NKB-646/UN2.RST/HKP.05.00/2022).

Footnotes

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that been used in this research is from personal request to Papua and West Papua Provincial Health Office.


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