Malaria is a major cause of childhood death across the sub-Sahel region in Africa. Most of the malaria morbidity occurs during the rainy season. Seasonal malaria chemoprevention (SMC) during this period has been shown to prevent illness and death from malaria in children.
SPAQ and Supyra®: two drugs for Seasonal Malaria Chemoprevention (SMC)
In 2012–2013, MMV worked with Guilin Pharma, supporting the company’s efforts to obtain WHO prequalification for a co-blistered combination of SP and AQ. WHO prequalification was granted in 2014.
To improve drug availability, MMV later supported the manufacturer S Kant Healthcare in developing a second, dispersible and child-friendly formulation of SPAQ, Supyra.
This work, funded by UNITAID under the ACCESS SMC project, is now completed and Supyra can be purchased using international donor funds for one year while its prequalification review is ongoing.
Early years: strengthening the supply of SMC treatments in the Sahel
Between 2014 and 2017, MMV was a partner in ACCESS-SMC, a Unitaid-funded project co-led by Malaria Consortium and Catholic relief Services, to support National Malaria Control Programmes and roll out SMC in seven countries in the Sahel region.
Thanks to this work, access to SPAQ has increased from around three million children covered in 2015 to more than 22 million in 2019, with a consequent reduction of malaria cases during the transmission period.1 ACCESS-SMC efforts led to increased interest from donor organisations, some of which started investing into SMC from 2017 onwards.
MMV’s role in this effort focused primarily on strengthening and diversifying the supply-side response to the increasing demand for SPAQ. MMV is continuing to roll out an interactive forecasting tool to improve stock management of SMC drugs.
Furthermore, MMV is coordinating the SMC working group gathering together all SMC stakeholders to discuss key questions about the evolution of this intervention. Within this framework, annual review and planning meetings have been organized since 2018 with all partners and all countries implementing SMC. As part of various consortia, MMV is taking active part in evidence generation to improve SMC policy.
Monitoring the deployment of SMC
MMV developed an SMC Tool Kit that addresses planning, training, monitoring and evaluation needs. This tool is used by countries for their effective planning.
MMV, Médecins Sans Frontières (MSF) and Guilin Pharma have developed user-friendly packaging and SMC administration cards to support correct dispensing by healthcare workers and proper use by parents or caregivers.
As part as the SMC working group, MMV initiated and supports the convening of all SMC countries planning and review meetings after each SMC season. This provides a unique platform where country progress and challenges in SMC implementation can be discussed with all stakeholders. MMV has been coordinating this SMC working group which is now scheduled to become part of the larger RBM country and regional support partners committee.
Extending SMC’s scope: research and access
MMV has spearheaded scientific and stakeholder input about desired attributes of next-generation SMC drugs as future alternatives to SPAQ. The data and perspectives gathered via this multi-phased process helped inform a new MMV target product profile (TPP) for chemoprevention. This work led to the identification of several combinations of potential alternatives to SPAQ. Safety studies in healthy volunteers for these new combinations are ongoing.
Following the successful implementation of SMC, MMV designed a programme called the SEAMACE (Seasonal Malaria Chemoprevention Extension) looking at how SMC can be extended in terms of coverage, eligibility, age bracket, season considered and geography. Through several projects, MMV is working with partners to generate evidence on the need to increase SMC age limit, or to extend the duration of the intervention beyond four months in areas where it is demonstrated to add value. This evidence will contribute to the discussion on policy review.