Seasonal malaria chemoprevention (SMC) is an essential health service that saves lives. This remains the case despite the COVID-19 pandemic. In line with World Health Organization (WHO) recommendations[i, ii], Malaria Consortium believes that discontinuing SMC would risk a substantial increase in malaria cases and deaths among those most vulnerable to the disease: children under five. This would put additional strain on health systems that are already under pressure and likely even more stretched because of the need to address COVID-19.
Malaria Consortium’s position
Malaria Consortium is one of the leading implementers of SMC and is uniquely placed to support governments in the fight against malaria. Along with other measures such as vector control and intermittent preventive treatment of malaria for pregnant women – areas in which Malaria Consortium also has extensive experience – the WHO recommends SMC as a core malaria prevention measure.[iii] In 2020, Malaria Consortium’s SMC programme aims to reach around 11 million children in Burkina Faso, Chad and Nigeria – up from six million children in 2019.
We are confident of being able to deliver SMC safely during the COVID-19 pandemic and in line with government strategies. We have established extensive enhanced safety and infection prevention contingency measures for SMC campaign planning and enumeration, procurement and supply management, community engagement, training, SMC administration, supervision, monitoring and evaluation. For example, we have developed guidance for SMC delivery by community distributors, which will ensure the safety of communities and distributors. Our plans can be adapted to different levels of COVID-19 risk to ensure continuity and minimal disruption to the campaign.
Malaria Consortium’s SMC programme in 2020
In 2019, Malaria Consortium delivered SMC to 1.3 million children under five across 23 health districts in Burkina Faso, and to 980,000 children across 20 health districts in Chad. Malaria Consortium aims to maintain coverage at the same level as in 2019 in both countries.
In Nigeria, Malaria Consortium delivered SMC to 3.9 million children under five across 74 local government areas in 2019. Across the country, there was a coverage gap of approximately eight million children living in areas that could benefit but were not reached by an SMC campaign. In 2020, we aim to reach an additional seven million children by expanding to new states, reducing this coverage gap to around one million.
In addition to greatly increasing the number of children that will receive SMC, we are also investing significant resources into improving quality of SMC implementation, including monitoring and evaluation, research, and communications and advocacy; this will enhance the overall effectiveness of the intervention.
Evidence of impact
Multiple studies conducted throughout the last decade have provided evidence to support the positive impact of delivering SMC. A 2012 review of seven trials in West Africa (12,589 participants) found strong evidence that periodic, presumptive administration of antimalarial medicines in areas of seasonal transmission prevents 75% of all malaria episodes, including severe episodes, and can prevent deaths.[iv] One study conducted as part of the ACCESS-SMC programme, which was led by Malaria Consortium and involved the rapid scale-up of SMC in seven Sahelian countries, found that the reduction in the number of confirmed malaria cases at outpatient clinics each year ranged from 25% to 59%.[v] Another study, also conducted for ACCESS-SMC, found that children who received SMC were 88% less likely to develop malaria over 28 days than those who had not received SMC.[vi]
To continue saving the lives of children under five in the Sahel, it is vital that SMC is delivered in 2020. While it is inevitable that the COVID-19 pandemic will present governments with difficult decisions, SMC is a highly effective intervention that must be considered an essential health service. Without it health systems that are severely stretched by COVID-19 will be unable to cope with the increased malaria burden. If Malaria Consortium is unable to deliver SMC in 2020, this could result in up to 1.82 million preventable malaria cases [vii] and 7000-17,000 deaths [viii] among 11 million potential beneficiaries in Burkina Faso, Chad and Nigeria. We are ready to help prevent this unacceptable scenario and offer our full cooperation to governments in the delivery of SMC at this uniquely challenging time.
[i] World Health Organization. Tailoring malaria interventions in the COVID-19 response; 6 April 2020. Available from: https://www.who.int/malaria/publications/atoz/tailoring-malaria-interventions-in-the-covid-19-response/en/.
[ii] World Health Organization. COVID-19: operational guidance for maintaining essential health services during an outbreak; 25 March 2020. Available from: https://www.who.int/publications-detail/covid-19-operational-guidance-for-maintaining-essential-health-services-during-an-outbreak.
[ii] World Health Organization. WHO urges countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic; 25 March 2020. Available from: https://www.who.int/news-room/detail/25-03-2020-who-urges-countries-to-ensure-the-continuity-of-malaria-services-in-the-context-of-the-covid-19-pandemic.
[iv] Meremikwu MM, Donegan S, Sinclair D, Esu E, Oringanje C. Intermittent preventive treatment for malaria in children living in areas with seasonal transmission. Cochrane Database Syst Rev. 2012;(2): CD003756.
[v] Milligan P, Lal S, Cairns M, Scott S, Diallo A, NDiaye JL et al. Assessment of the impact of ACCESS-SMC on malaria cases and deaths in 2015 and 2016; 2018.
[vi] Cairns M, Sagara I, Zongo I, Ceesay S, Kesseley H, Eloike T et al. Assessment of the protective efficacy of Seasonal Malaria Chemoprevention with sulfadoxine-pyrimethamine plus amodiaquine in Burkina Faso, Chad, The Gambia, Mali and Nigeria, 2015-2016; 2018.
[vii] Estimated preventable cases based on analysis conducted by Malaria Consortium
[viii] Estimated total deaths based on analysis conducted by Malaria Consortium