London School of Hygiene & Tropical Medicine

The study, named MALCOV, will be conducted in Burkina Faso, led by Professor Chris Drakeley from LSHTM and Professor Sodiomon Sirima from the Groupe de Recherche-Action en Santé (GRAS), and in Kenya, led by the Liverpool School of Tropical Medicine (LSTM) and the Kenya Medical Research Institute (KEMRI).

The researchers will utilise COVID-19 screening conducted by the local Ministries of Health and  ensure that all suspected cases tested for COVID-19 are also screened for malaria. Those who test positive for the virus will then have their clinical and immunological outcomes tracked and compared to those with and without malaria.    

If malaria is found to be a risk factor for the prevalence and severity of COVID-19, it would further emphasise the need for effective malaria control programmes to support the virus control efforts. This would help avoid a repeat of the 2014 West Africa Ebola outbreak, where the diversion of healthcare resources resulted in greater mortality from malaria.

The study also aims to determine if and how malaria affects the immune response to SARS-CoV-2, the virus that causes COVID-19. This is needed to predict whether the presence of malaria, and subsequent anti-malarial treatment, would impact on the effectiveness of a COVID-19 vaccine.

The World Health Organization (WHO) African Region carries a disproportionately high share of the global malaria burden. In 2018, the region was home to 93% of malaria cases and 94% of malaria deaths. Whilst the incidence rate of malaria declined globally between 2010 and 2018, the rate of change slowed dramatically after 2014, with both Burkina Faso and Kenya marked as high burden countries.

Professor Chris Drakeley, Professor of Infection & Immunity at LSHTM and study lead, said: “We’re delighted to have received funding to further our knowledge on how co-infection of SARS-CoV-2 and Plasmodium infection impacts disease progression.

“Understanding the risk factors for development of severe COVID-19 in Africa is crucial, as the virus has the potential to cripple the continent’s fragile healthcare systems, create disruptions in supply chains, and undermine malaria control efforts.”

Risk groups for severe COVID-19 are known to be older age, obesity and other serious underlying health conditions. In Africa however, though the population is relatively young, they are more frequently exposed to infectious diseases that could affect inflammatory responses caused by COVID-19.

There are several other potential compounding factors of risk between malaria and COVID-19 which the project will assess. Firstly, malaria is a major cause of severe anaemia, which affects the body’s ability to carry oxygen. Young children in particular have increased risk of this, alongside the challenges of malnutrition, which may weaken their immune responses to SARS-CoV-2 even further.

Secondly, malaria may also increase the viral load of SARS-CoV-2 (the amount of the virus in the blood), or the virus shedding, when a virus replicates in the body and is released into the environment. This could potentially lengthen the amount of time someone with COVID-19 is infectious, and thus needs to be understood in areas where malaria is common.

Professor Drakeley added: “If malaria is found to be a COVID-19 risk factor, the resulting morbidity and mortality from the pandemic may expand to a broader age range that includes infants, children, and younger adults. It would also highlight the need for continued effective malaria control in managing the pandemic.”