In the Sahel and sub-Sahel regions of Africa, malaria transmission rates are particularly high during and immediately after the rainy season. Approximately 39 million children across Africa live in areas affected by seasonal malaria, and have little or limited immunity to malaria, making them most at risk.1 Since 2012, in the absence of a highly effective vaccine, the WHO has recommended seasonal malaria chemoprevention in eligible countries (countries that experience at least 60% of malaria cases during the rainy season, usually 3–5 months of the year). SMC is the administration of full antimalarial treatment courses to children aged 3 months to 5 years at regular intervals during periods of seasonal transmission to prevent malaria infection.
The SMC working group ‘SMC Alliance’ is formally endorsed by Roll Back Malaria’s Country/Regional Support Partner Committee with MMV as the host-organization and secretariat. It serves as an umbrella body between partners and countries interested in, and currently implementing, SMC. SMC Alliance, national malaria programme teams, and local healthcare workers have ensured continued delivery of SMC during the COVID-19 pandemic.
Dr André-Marie Tchouatieu discusses SMC and the global effort to eliminate malaria.
1. As SMC protects children from malaria and reduces hospitalization, it became an even more critical tool during the COVID-19 pandemic, yet there were also pandemic-related challenges. Can you talk us through the actions undertaken to address these challenges?
In response to the recent Ebola crisis, people began avoiding health facilities, refusing drugs and not receiving healthcare providers. SMC Alliance and partners anticipated these issues during the COVID-19 pandemic and, to mitigate them, provided additional funding for personal protective equipment for health workers as well as extensive training on social distancing.
In addition, SMC Alliance and countries that implement SMC quickly began reviewing their planning and included additional preparations for SMC. A tracker was developed to share information between partners to track drug deliveries, including weekly updates. As amodiaquine was being investigated as a COVID-19 therapy, drugs were also secured for SMC campaigns to help prevent stockouts.
2. What was the role of partnerships in making this happen?
Solidarity has been key. Partners shared information widely on drug procurement, quantities and ordering. At the country level, collaboration allowed for the exchange of stocks to benefit those in need. SMC Alliance was very important in offering a platform for collaboration between all stakeholders during the COVID-19 pandemic crisis.
3. How is SMC contributing to the global effort to eliminate malaria?
SMC reduces the incidence of clinical attacks and severe malaria by about 75% in clinical trials,2 and it can be deployed across a large population relatively easily. SMC, therefore, has a huge role in malaria control. Over a single season, we can see its effect in reducing the incidence, parasite prevalence and mortality. It is important to note that investment will continue to be key for the success of SMC. Governmental and private sector investment can have a huge impact on malaria elimination and is essential for efforts to continue.
4. Why is MMV developing alternatives to SPAQ?
Drug resistance is a key concern. Today, some countries that could benefit from SMC do not implement it due to the presence of resistance to SP. In addition, it is important to anticipate the emergence of resistance in countries already implementing SMC. SMC is a very cost-effective intervention and would be of great benefit if deployed more widely. The challenge will be having new treatments that are as low cost as SPAQ.
1. Cairns M et al., Estimating the potential public health impact of seasonal malaria chemoprevention in African children. Nat Commun. 2012 Jun 6;3:881.
2. World Health Organization. Seasonal Malaria Chemoprevention (last updated: May 1, 2017). https://apps.who.int/iris/handle/10665/337978