Health: Chemoprevention of seasonal malaria in children, vaccine, and suspension of US funding…, Dr. Atekpe tells us about it (Interview)

Lomé, Monday, March 17, 2025 (Savoir News) – Children under the age of 5 account for the vast majority of malaria-related deaths, a disease that is estimated to have caused 600,000 deaths in 2023, according to the World Health Organization (WHO). The WHO emphasizes that because their immune systems are not yet fully developed, they are unable to fight malaria parasites. The malaria vaccine is a safe and effective shield against malaria in children under five. And during high-transmission seasons, the WHO recommends seasonal malaria chemoprevention (SMC) for children aged 3-59 months.

This question was the focus of a panel discussion that brought together experts in Lomé from February 25 to 28. At the end of one of the panels, Savoir News presented its microphone to Dr. Payakissim Atékpé (Coordinator of the NMCP).

 
Savoir News: What does seasonal malaria chemoprevention actually mean?

Dr. Atekpé: According to the WHO, seasonal malaria chemoprevention, or SMC, consists of intermittently administering a complete three-day course of an antimalarial drug to targeted children during the peak malaria transmission season to prevent the disease. The goal is to maintain therapeutic concentrations of the antimalarial drug in the blood during the period when the risk of contracting malaria is highest.

When did SMC begin in Togo, and what is the situation today?
 

The SMC program began in Togo in 2013 in the Savanes region (far north) with four (04) districts. In 2014, it was extended to all districts of the Savanes region, to the Central and Kara regions in 2016, and then in 2024 to four (04) districts of the Plateaux region. To date, 23 districts in Togo are targeted by this treatment. And with stratification, we were able to increase treatment from 4 months (4 cycles) to 5 months (5 cycles). Since then, we have observed a 21% increase in malaria incidence in non-SMC areas between 2021 and 2023, compared to 9% in SMC areas, which demonstrates the effectiveness of the intervention.

SMC is a high-impact intervention to truly reduce malaria in our countries. The strategy covers more than 600,000 children aged 3-59 months in the Savanes, Kara, Plateaux, and Centrale regions.
 

What are the obstacles to implementing the SMC?

We encounter several obstacles in implementing this intervention in our communities, the main ones being: obstacles related to beneficiary adherence (parental refusal in some communities due to rumors), non-compliance with the treatment schedule, particularly regarding the doses of medication to be administered to children by parents, and the management of data collected by distributors.

Our main challenge is digitalization. And since we digitized the CPS, community distributors of these medications use their phones to send us data. Sometimes the distributor sends the same data twice, and so on, but we are currently reviewing this application (with all stakeholders) to improve it.
 

One of the panels at the SMC stakeholder meeting addressed the inclusion of zero-dose children within the SMC. What does this entail in concrete terms?

It essentially involves optimizing health service offerings by integrating the search for zero-dose or incompletely vaccinated children into the seasonal probabilistic chemoprevention campaign. Indeed, children who have not received any doses of basic vaccines according to the vaccination schedule in Togo are called zero-dose children, and those who have not received all the required vaccines according to their age are said to be incompletely vaccinated.
 

Are there children who are missing out on vaccination in Togo?

In Togo, field teams were able to identify just over 8,000 zero-dose children in 23 health districts. In carrying out this intervention, we were supported by our partner, the Malaria Consortium, to whom we express our gratitude. Of these children identified as having zero doses, we were able to catch up with 75% in health facilities (or with the teams of vaccinators who went from village to village as an advanced strategy). This is a big step because we know that as long as the child is protected by a vaccine, the better.

What impact does the suspension of US funding have on the implementation of SMC in our country?

The United States was helping us implement seasonal malaria chemoprevention. In Togo, we have 39 health districts, 23 of which implement SMC. Of these 23 health districts implementing SMC, the four (04) districts in the Plateaux region (19% of the target children) are fully supported by the US grant. But we were fortunate that the drugs had already been purchased. So, despite the suspension, they agreed to allow these drugs to be delivered to us. And we received them. The main challenge today is operational costs. This is a challenge common to all countries receiving US funding. 

This suspension, scheduled to last 90 days, could continue…

At the Lomé meeting, we unanimously agreed that it was time to develop strategies to support ourselves. And so, we thought about how to use the funding we currently have wisely and efficiently, in the event that this suspension were to continue. If, on the other hand, funding resumed, we would still be interested. Whatever happens, the most important thing for us is that the SMC not be interrupted, because it has enabled us to reduce the incidence of malaria in target areas. And we don’t want to go back to square one because of the suspension of US funding.
 

So, today, malaria vaccination is a reality in many countries. What about Togo?

Indeed. Today, the idea is to talk about malaria vaccination. And we realized that all the countries around us have already introduced the vaccine. Ghana introduced it in 2019, Benin introduced it a year ago, Burkina Faso two years ago, and many other countries in Africa like Côte d’Ivoire and Cameroon. Only Mali and Togo have not yet introduced the malaria vaccine. Mali will start in April, and Togo will also join the dance. It’s already planned, and our country is preparing… 

Specifically, a date, a month…

The vaccine will be introduced during the month of September of this year. We are already carrying out all the preparatory activities, and we are asking the press to help us spread the word because all the countries that have introduced it are sharing with us very positive experiences, the fact that they have been able to significantly reduce the incidence of malaria and the number of malaria-related deaths among children. And we hope that with the introduction of this vaccine planned for this year, we can continue to reduce malaria in Togo. 

Dr. Atekpé, why delay until September?

We’re going until September because the introduction plan requires several preparatory activities. We need to train the various people who will be vaccinating. We need to raise awareness among the population about the periods during which children will receive these vaccines and ensure their full compliance. So, at five months, six months, seven months, and eighteen months. So, we really need to communicate to keep people informed. We need to train vaccinators. We need to roll out the vaccines. In the different districts, we need to ensure that all vaccine storage mechanisms are truly optimal before the actual implementation.

How many health districts do we have in Togo? Do we have enough vaccine to cover all of them?

We have 39 health districts, and Togo is lucky. Other countries haven’t had enough vaccine to cover their entire territory. The quantities we have will allow us to cover the targets in all 39 health districts. 

A word to close this interview…

The malaria vaccine will be introduced in Togo in September 2025. And we call on the press to support us, to support other malaria control interventions in Togo, by sharing information on malaria prevention and treatment measures with the population to encourage their participation. END

Interview by Ambroisine MEMEDE