TNF and malaria: However, this is unlikely to explain the association between CD4+ TNFα+ T cells and protection from clinical malaria for two reasons: The direction of confounding was in the opposite direction in this cohort (i.e. microheterogeneity led to a confounded association between increasing antibody levels and increasing risk of malaria rather than protection), and the association with protection is more marked in RTS,S/AS01E vaccinees rather than control vaccinees.