What doesn’t kill you makes you stronger: Malaria versus COVID-19

“What doesn’t kill you makes you stronger” is a song on Kelly Clarkson’s 2011 album ‘Stronger’.

This statement implies that a harsh event or condition that does not cause your death toughens and strengthens you to face even harsher events later.

One such condition is malaria, a disease caused by parasites called Plasmodium and transmitted by females of mosquitoes belonging to the Anopheles group. Anopheles mosquitoes like most mosquitoes require a blood meal to develop their eggs and thus obligatorily seek blood meal from warm-blooded animals including humans. In order to prevent the blood meal from clotting inside their gut, these mosquitoes inject saliva into the veins of the host while taking the blood meal.

When a female Anopheles bites an infected individual, it picks up the parasites. The parasite develops and multiplies inside the mosquito’s gut and then migrate into its salivary gland. In the process of biting another individual, the parasites are injected alongside the saliva into the new host, causing the individual to become infected and spreading the disease.

Malaria is an age-old disease prevalent in the tropics with 3.3 billion people in 106 countries globally at risk. The disease is endemic in Africa, causing high morbidity and mortality with pregnant women and children under-five being the most vulnerable.

Malaria challenges the human body, triggering several immune responses as the first line of defence against infection of the parasite. This enables the infected person to build an adaptive immune response by producing  T-cells, B-cells and antibodies against the parasite. Thus people who live in malaria-endemic regions such as Sub-Saharan Africa have high adaptive immune systems due to several episodes of malaria as they grow.

Beyond malaria, the tropical environment is very conducive for several pathogens and this presents a great challenge to human health. These infectious diseases, despite killing some individuals, leaves the vast majority who survive with an adaptive immune defence against other infectious diseases.

In the last quarter of 2019, a novel coronavirus, SARS-COV 2 was identified in Wuhan, China causing coronavirus disease (COVID-19) and has since spread across the globe, presenting severe challenges to health systems in several countries. The WHO declared COVID-19 a pandemic and several countries have either implemented lockdown or declared states of emergencies, placing restrictions on local and international movements.

The spread of COVID-19 and its severity appears to be a sharp contrast of the global distribution of malaria (Fig. 1). Countries that are hardest hit by COVID-19 (Fig. 1A) fall outside the malaria belt (Fig. 1B) and the malaria-endemic countries appear to have low incidence rates and higher proportions of asymptomatic infected individuals.

The hardest-hit countries in the Africa sub-region, are South Africa and Algeria, with Algeria accounting for 55% of COVID-19 deaths reported in the region. These countries fall outside the malaria belt of Africa, reiterating the fact that regions endemic for malaria are less impacted by the disease.

Taking a cue from Kelly Clarkson’s song, it seems that for countries which have a high prevalence of malaria; malaria that doesn’t kill the people, makes their immunity stronger against withstanding COVID-19 Indeed, the level of severity of COVID-19 in any individual depends on the person’s level of immunity. It is widely accepted that dealing with COVID-19, once you are infected is a battle with your immune system, making much of the treatments being touted dependent mainly on boosting the immunity of infected individuals.

Can we hypothesize then, that, the more robust immune systems of individuals in malaria-endemic regions makes them less susceptible to falling severely ill when infected by SARS-COV 2?  Does a high incidence of malaria make us stronger against COVID-19? Your guess is as good as mine.

Today is World Malaria Day, an international observance commemorated every year on 25 April to recognize global efforts to control malaria. This day is usually marked in a grand style in Ghana with the National Malaria Control Program (NMCP) holding awareness campaigns across the country. Since 2017, the Ghana Atomic Energy Commission and its partners including the NMCP mark this day with the Malaria Awareness Campaign in the communities where we carry out mosquito research.

The theme for World Malaria Day 2020 is “zero malaria starts with me”. As we struggle to keep pace with the fight against COVID-19 and all focus and resources are being directed towards COVID-19, my call is for us not to take our eyes off malaria— Let us continue to work to sustain the gains made and use every opportunity to prevent, detect and treat malaria because “zero malaria starts with me”.

Dr. Michael Osae is the Director of the Biotechnology and Nuclear Agriculture Research Institute of Ghana Atomic Energy Commission with over fifteen years of experience working on malaria vectors. He is also the President of the Entomological Society of Ghana and a Member of the Malaria Vector Control Oversight Committee of the National Malaria Control Program. 

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