Dr André-Marie Tchouatieu
Associate Director, Access & Product Management, Medicines for Malaria Venture (MMV)
As anxiety around the COVID-19 pandemic is felt around the globe, the voices of those at risk of malaria ring in parallel – voices that often go unheard.
According to the World Health Organization (WHO), malaria takes a child’s life every two minutes.
The vast majority of incidence and mortality occur in sub-Saharan Africa, where health systems are fragile, and any extra burden placed on scarce resources could be the difference between saving or losing lives.
Protecting young children from malaria
In the Sahel sub-region of Africa, 60% or more of total malaria cases occur during the four to five month rainy season between July and November.
During this period, Seasonal Malaria Chemoprevention (SMC), a WHO-recommended strategy, is used to protect young children from malaria.
The intervention requires the administration of doses of a child-friendly medicine once per month (over three days) for the duration of the season and has been proven to prevent malaria in children under five by approximately 75%.
Recent progress has been remarkable in the scale-up of this intervention. In a UNITAID-funded project, seven countries in the Sahel region received support in piloting and increasing the reach of SMC.
By project end, coverage had more than doubled from 2.6 million children in 2014 to over 6.5 million in 2016. Medicines for Malaria Venture (MMV) supported the project by strengthening and diversifying the supply of medicines to meet the growing demand for SMC. In 2018, SMC coverage ensured protection for up to 20 million children. Currently, MMV is supporting the scale-up of the intervention in 13 countries.
A shortage of funding
Despite major progress, there remain challenges to the implementation of SMC. Although key funding partners have remained committed and increased their support, the intervention is out of reach for many eligible children, particularly in Nigeria, Chad and Guinea Bissau: about 10 million children do not yet benefit from SMC due to a shortage of funding.
The lack of resources also constrains the potential for expansion of SMC to older children between five and ten years of age, who remain unprotected.
COVID-19 and SMC
In addition, the COVID-19 pandemic has brought new obstacles, threatening both the supply of critical medicines and the ability of national and regional authorities to coordinate adequate supply and coverage.
The intervention also relies heavily on the impressive determination of community health workers who walk miles from village to village each day, to ensure that children receive their preventive medicine treatment.
Unfortunately, safety measures to cope with COVID-19 include social distancing for the protection of villagers and health workers alike; these measures will make deployment that much more daunting.
The WHO Global Malaria Program recently published new guidance including measures that can be taken to reduce the risk of health workers being infected with COVID-19 during the delivery of community-level malaria control interventions in order to address these challenges.
To realise the maximum benefit that can be provided by SMC, more country-based funding is needed, not only to expand access to the over 10 million children who remain at risk and without protection, but to ensure that, during this time of uncertainty, SMC can continue to save young lives.