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Transforming the malaria landscape in the Sahel:
seasonal malaria chemoprevention
Diego Moroso, Malaria Consortium
10 Jan 2016
Strategic intent
Shape the market
Demonstrate feasibility, safety and
effectiveness at scale
ACCESS-SMC: Goals and Achievements
Shaping the market
• SP+AQ procurement, delivery and administration
The Gambia,
331,664
The
Gambia,
363,868
Niger,
2,445,055
Mali,
3,501,318
Guinea,
1,038,334
Burkina
Faso,
2,900,000
Nigeria,
3,441,989
Chad,
1,075,824
2015: 14.7M treatments
Niger,
4,203,729
Mali,
5,666,788
Burkina Faso,
8,224,674
Nigeria,
7,636,650
Guinea,
1,665,707 Chad,
2,270,788
2016: 30M treatments
Shaping the market
120
100
Eligible target
(100M)
80
60
Funded treatments
40
67M
20
0
QA treatments
available
16.8M
2015
2016
SMC market comparison, 2015 vs 2016
Shaping the market
• Support the introduction of child-friendly,
dispersible SP+AQ
 Administrative support (registration, packaging)
 Advocating for accelerated ERP process
• Support to additional manufacturers
2014
2015
2016
Feasibility at scale
Over 3.2M children in 2015
3,500,000
3,000,000
The Gambia
2,500,000
Guinea
2,000,000
Chad
1,500,000
Niger
Burkina Faso
1,000,000
Mali
Nigeria
500,000
Cycle 1
Cycle 2
Cycle 3
Cycle 4
Feasibility at scale
Over 6.4M children in 2016
7,000,000
6,000,000
The Gambia
5,000,000
Guinea
4,000,000
Chad
3,000,000
Niger
Burkina Faso
2,000,000
Mali
1,000,000
Nigeria
Cycle 1
Cycle 2
Cycle 3
Cycle 4
Feasibility at scale
Achieving high administrative coverage
100
94.2
95
90
96.5
97.2
93.9
94.3
90.8
85
85.1
2015
80
2016
76.9
75
70
65
Cycle 1
Cycle 2
Cycle 3
Cycle 4
Feasibility: at what cost?
•
Improving the affordability of SMC delivery
How can we bring down the costs of delivery?
What are the key cost drivers?
Is SMC expensive?
•
What are the benefits?
•
Is SMC cost-effective at scale?
Feasibility: is SMC safe?
•
Safety monitoring and support to pharmacovigilance:
• Are there any major safety concerns in distributing SMC to
a large target population?
Implementation Year
Children reached Severe Adverse Events
2015
3,227,855
9
2016
6,679,270
2
Feasibility and effectiveness
•
Coverage surveys:
• Are the right children reached (age / geography)?
• Are they reached during all 4 cycles  effectively protected?
Feasibility and effectiveness
Feasibility and effectiveness
•
Coverage surveys:
• Are the right children reached?
• Are they reached during all 4 cycles  effectively protected?
•
Efficacy studies and resistance monitoring of SMC drugs:
• Do local parasites remain sensitive to the drugs?
• Will widespread use lead to the selection of drug resistant
parasites  loss of efficacy
Feasibility and effectiveness
•
Coverage surveys:
• Are the right children reached?
• Are they reached during all 4 cycles  effectively protected?
•
Efficacy studies and resistance monitoring of SMC drugs:
• Do local parasites remain sensitive to the drugs?
• Will widespread use lead to the selection of drug resistant
parasites  loss of efficacy
•
Assessment of effectiveness on disease burden:
• What is the protective effect of SMC at scale?
Feasibility and effectiveness
The Gambia
25000
Over 5yrs
5000
Under 5yrs
Predicted cases without SMC
20000
Number of cases per month
4000
15000
10000
3000
2000
5000
1000
0
0
2012
2013
2014
2015
2012
2013
2014
2015
65% reduction in cases <5yrs in 2015
Courtesy S Ceesay (MRC),
M Cairns, P Milligan (LSHTM)
Feasibility and effectiveness
Burkina Faso
LSHTM
Feasibility and effectiveness
Mali
LSHTM
Feasibility and effectiveness
Chad
LSHTM
Feasibility and effectiveness
Senegal
Courtesy JL Ndiaye
UCAD
Feasibility and effectiveness
Senegal
Courtesy JL Ndiaye
UCAD
Summary
• Contributed to shaping the market:
 Influencing supply
 Driving the introduction of a child-friendly formulation
• SMC at this scale is:




Feasible
Reasonably priced
Safe
Probably effective if all conditions are met
Perspectives
Beyond ACCESS-SMC
Uncertainties about funding:
 Keep the momentum for institutional demand
 Expand further
Government ownership (beyond MoH/NMCPs):
 Financing strategy
Coordination:
 Joint planning and procurement
 Data collection and monitoring (impact, resistance, PV)
 Regional coordination
Beyond ACCESS-SMC
Cost-saving initiatives:
 Innovative delivery approaches
 Prospects for integrating interventions
Targets and duration of SMC
 Expand the target group (10 yrs)  help elimination?
 Plan the potential development for drug resistance
 Expand the geographical scope to SP resistant areas
Conclusions
SMC is not a magic bullet, but in the Sahel is an effective
complementary prevention approach to malaria control and,
possibly, elimination.
The time to invest is now, while drugs are still efficacious,
and in line with a multi-faceted effort to reduce malariarelated cases and deaths in line with the WHO Malaria
Strategy.
Continued support to research is necessary to monitor
effectiveness and drugs efficacy
Over 10M children who could potentially benefit from this
intervention currently fail to do so due to lack of funding
Thank you
www.access-smc.org