SMC IMPACT aims to expand use of seasonal malaria chemoprevention in five African countries.
The Republic of Korea, through its Global Disease Eradication Fund, has awarded USD 10 million in funding to the MMV-led SMC IMPACT project that will explore the expansion of WHO-recommended seasonal malaria chemoprevention (SMC) for children in five countries in the Sahel region of Africa. In two key countries, the project will also train healthcare workers to administer a new artemisinin combination therapy (ACT), pyronaridine-artesunate (Pyramax® and the paediatric formulation Pyramax® granules), for the treatment of acute uncomplicated malaria.
In addition to MMV, the consortium includes London School of Hygiene and Tropical Medicine, Malaria Consortium and Catholic Relief Services, who will work in close collaboration with the National Malaria Control Programmes of Nigeria, The Gambia, Niger, Mali and Guinea to implement the project.
“We at MMV are extremely grateful to the government of the Republic of Korea for supporting this critical project,” said Dr David Reddy, CEO of MMV. “With this pledge, the government is demonstrating global solidarity with malaria-affected countries and commitment to the global malaria fight.”
SMC – protecting children during the period of greatest risk
Across the Sahel region of Africa, most of the children that suffer from or lose their lives to malaria do so during the rainy season, which typically lasts for 3–4 months. Around 39 million African children aged under 5 years live in regions of defined malaria seasonality, which is estimated to translate into 33.7 million episodes of malaria each year.1
SMC—the intermittent administration of full treatment courses of an antimalarial medicine during the rainy season—was shown in clinical trials to reduce morbidity from malaria by 75% in children who receive consecutive monthly rounds of protection during peak transmission periods,1 and has proved to be highly effective in reducing malaria deaths in young children when implemented.2 Adding one extra month of protection could help maximize SMC’s benefits in areas where local transmission patterns justify an expanded coverage period. SMC IMPACT will be exploring the added value of expanding the distribution of SMC for one additional month in two countries compared to the currently applied schedule, and its impact on the burden of malaria.
Protecting more children
Despite the rapid scale up of SMC over the last few years, coverage gaps remain, especially in Nigeria. SMC IMPACT will contribute to narrowing this gap by expanding SMC to areas not previously reached by SMC campaigns.
Further, the use of SMC is currently restricted to children aged 3-59 months; however, evidence has demonstrated that SMC can be used in older children (up to 10 years of age),3 effectively doubling its coverage, and further decreasing the burden of malaria. As such, in addition to expanding the geographical reach of SMC and exploring the additional benefit of a 5th round during the rainy season, SMC IMPACT also aims to provide additional evidence that could support an eventual WHO policy change, expanding recommendations for the age-range of children for whom SMC can provide protection.
Introducing a new treatment
In The Gambia and Guinea, SMC IMPACT will also deliver training in the use of pyronaridine-artesunate, one of the latest high-quality pediatric ACTs approved by WHO, developed by Shin Poong Pharmaceutical Co. Ltd in collaboration with MMV. Introducing an additional ACT for the treatment of acute, uncomplicated malaria can contribute to reducing drug pressure on a single ACT, potentially delaying the emergence of drug resistance.
“SMC is a valuable tool to protect children from malaria in seasonal transmission settings,” said André-Marie Tchouatieu, Director, Access and Product Management, MMV. “Thanks to this generous funding from the Republic of Korea, together with our partners MMV will be able to maximize the use of this tool, explore new avenues to protect more children and introduce a new treatment to reduce the burden of malaria in some of the hardest hit countries.”
1. Sinclair D, Meremikwu MM, Garner P. Seasonal malaria chemoprevention for preventing malaria morbidity in children aged less than 5 years living in areas of marked seasonal transmission: GRADE tables to assist guideline development and recommendations. Oct 26, 2011. http://www.who.int/malaria/mpac/feb2012/smc_grade_tables.pdf.
2. ACCESS-SMC Partnership (2020) Effectiveness of seasonal malaria chemoprevention at scale in west and central Africa: an observational study. Lancet 2020; 396: 1829–40.
3. Cissé B, Ba EH, Sokhna C, et al. (2016) Effectiveness of seasonal malaria chemoprevention in children under ten years of age in Senegal: a stepped-wedge cluster-randomised trial. PLoS Med 2016; 13: e1002175.