Seasonal malaria chemoprevention (SMC) was recommended by the World Health Organization (WHO) in 2012 to protect children from being infected in areas of high seasonal malaria in the Sahel region of Africa.1 However, in 2014, fewer than 5% (~3 million) of all eligible children benefitted from SMC.2
At this time, there was no child-friendly formulation available either, making administration a challenge. Infants and very young children are generally unable to swallow pills; as such, tablets needed to be crushed and mixed with water before administration, leading to possible under-dosing. Some tablets also had an unpleasant bitter taste, causing children to spit them out.
MMV’s partner Fosun Pharma has developed child-friendly dispersible formulation for the oral administration of sulfadoxine–pyrimethamine and amodiaquine (SPAQ).
As part of the Unitaid-funded ACCESS-SMC project3 initiated in 2014, MMV has been contributing to efforts to overcome barriers to the scale-up of SMC. The project was completed in 2017, and MMV continues to support SMC scale-up in the Sahel region. MMV is working with manufacturers to increase the supply of child-friendly SMC medicines and is working towards the development of a new generation of drugs for this intervention.
MMV was a partner in ACCESS-SMC, a Unitaid-funded project led by Malaria Consortium supporting National Malaria Control Programmes in seven countries in the Sahel region to roll out SMC. Thanks to this project, access to SPAQ has increased from around three million children covered in 2015 to more than 6.5 million in 2016, with consequent reduction of malaria cases during the transmission period. MMV’s role in this effort focuses primarily on strengthening and diversifying the supply-side response to the increasing demand for SPAQ.
As part of that work, MMV has supported the manufacturer S Kant Healthcare in developing a second, dispersable and child-friendly formulation of SPAQ, Supyra®, to improve drug availability. This work is now completed, and the dossier was submitted to the WHO prequalification programme in July 2018, then subsequently to the Global Fund Expert Review Panel (ERP) in September 2018. The ERP panel gave a positive opinion in Febuary 2019 and allowed Supyra to be purchased using international donor funds for a period of one year while its prequalification review is ongoing.
Market authorization of Supyra has now been achieved in two countries and review is ongoing in a further five. Since the launch of SMC in 2014, the number of protected children has increased from 3 million in 2015 to over 20 million in 2019. This dramatic scale-up has been achieved in part by the distribution of 96 million treatment courses of SPAQ (Fosun Pharma and S Kant products combined) in 13 countries in 2019, bringing the total number of courses distributed since 2014 to 357 million.
More information in an interview with Dr Djermakoye Hadiza Jackou, Coordinator of the National Malaria Control Programme, Niger.
World Health Organization. WHO policy recommendation: Seasonal malaria chemoprevention (SMC) for Plasmodium falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa (2012)
The UNITAID-funded ACCESS SMC Consortium includes: the Malaria Consortium (prime recipient), Catholic Relief Services (joint lead), MMV, Management Sciences for Health, Speak Up Africa and the London School of Hygiene & Tropical Medicine.