On November 17th, 2017, Chad was the last country to complete the 2017 SMC round. This marked the last ‘implementation’ day of the ACCESS-SMC project, which is scheduled to end on February 28th, 2018. Through ACCESS-SMC, millions of children under five years old have been protected from malaria during the rainy season since 2015. Over 45 million treatments were given to eligible children, resulting in a significant reduction of malaria cases.
What we learned in the past three years is that, while operationally onerous, SMC is a relatively simple and inexpensive intervention. We should strive to make it sustainable and continue to advocate for an increase in resources to reach eligible children in areas that have not been reached yet. With continued technical support, governments should now begin transitioning costs of the implementation to within the regular government health spending plans in an incremental manner, to increase the likelihood of sustainability. Here’s why.
The estimated number of deaths from malaria in 2016, which is more than 1,200 people every day. Africa accounted for 90 percent of those deaths, and children under the age of five years old made up most of the victims. All but one of the fifteen countries carrying 80 percent of the global malaria burden are located in sub-Saharan Africa, and many of them in the Sahel, where SMC can prevent malaria.
There may be up to this many children living in the Sahel region of sub-Saharan Africa who can benefit from SMC. Taking in to consideration children covered by SMC programs outside of ACCESS-SMC, there is still an estimated gap of 12 to 18 million eligible children who are not currently included in SMC programs and who could benefit from SMC. Nine to 11 million of these children live in Nigeria, the country with the highest malaria burden in the world.
In addition to averting an estimated 40,000 deaths through the 2015 and 2016 ACCESS-SMC campaigns, over 6 million cases may have been prevented. Case control-studies in five countries confirmed that SMC treatments are providing a very high degree of protection from malaria, with an overall estimate of efficacy of 89 percent over 28 days after treatment. SMC is effective.
The estimated average recurrent cost to protect a child from malaria during the rainy season with SMC. Malaria has been estimated to cost African countries USD $12 billion in lost gross domestic product (GDP) each year. SMC is inexpensive and was found to be a high cost-effective intervention in all seven countries as per each country’s GDP per capita.
To meet the potential demand for SMC, these many treatments are needed each year. Despite the high coverage achieved through ACCESS-SMC and success in catalyzing the supply market volume of quality approved SP+AQ from 11 million in 2014 to over 70 million by 2017, many children will still miss out on receiving SMC in 2018 due to lack of funding and limited production capacity for quality assured medicines.
Funding is the key if countries in the Sahel are to move closer to control. As ACCESS-SMC draws to a close, we are happy to confirm that other funding streams will ensure children protected in 2017 will receive SMC again 2018. But, if we are to keep the momentum in reducing child mortality and malaria, it is vital to put our primary focus on supporting the most heavily affected countries so that they can reach universal SMC coverage. Through the Sustainable Development Goals, countries and development stakeholders have made a bold commitment to end malaria by 2030, and though Africa has made significant progress in reducing malaria cases and death, more investments needs to be made before countries can start refashioning control programs towards elimination. Malaria can be prevented, and in the Sahel and sub-Sahel regions of Africa SMC can make an important contribution.
In this last newsletter, I wanted to take the opportunity to thank all the project members who helped making ACCESS-SMC a success, and especially those staff and former staff from partner organizations who contributed most to the project: from CRS, Lanto Razafindralambo, Chada Mohamed, Suzanne Van Hulle, Eric Hubbard; from the LSHTM, Paul Milligan, Paul Snell, Matt Cairns, Sham Lal, Khalid Beshir; from MSH, Gladys Tetteh (now with Jhpiego), Colin Gilmartin and David Collins; from MMV, André-Marie Tchouatieu; from Speak up Africa, Fara Ndiaye; and my colleagues or former colleagues at Malaria Consortium, Johanna Stenstrom, Cristine Betters (now at Abt), Harriet Kivumbi, Timothy Rubashembusya, Donald Dama (now at IRC), Israel Bulikiro, Maddy Marasciulo, Ebenezer Baba (now at WHO), Charles Nelson, Kevin Chaudhary, Hannah Finch, Arantxa Roca-Felter, Andrew Parkes, Diana Thomas, Stephanie Jensen, Leila Noisette (now at FarmAfrica), Alexandra York, Prudence Hamade, James Tibenderana, Oliver Williams, Jocelyn Boughton, Marian Blondeel and many others whom I may have failed to recall; and of course the Malaria Consortium and CRS SMC teams in the field in the seven countries, partners from research institutions (IRSS, CERMES, CSSI, Epicentre, MRC, MRTC, ERIC, Jedima, UGANC), and of most important of all, the National Malaria Control / Elimination teams, health officials, health workers and frontline volunteers in the countries, without whom ACCESS-SMC would have never been possible.
And finally, a special thanks to UNITAID for supporting this fantastic project! -Diego Moroso, Regional Project Director ACCESS-SMC