Navigating the Future of Malaria Prevention: Balancing Cost, Innovation, and Sustainability  

January 20, 2025

Navigating the Future of Malaria Prevention: Balancing Cost, Innovation, and Sustainability  

By Anika Ruisch, Colin Gilmartin, and Justice Nonvignon 

The evolving landscape of malaria control  

Malaria-endemic countries face the persistent challenge of addressing malaria with the right mix of approaches and technologies amidst funding constraints, competing priorities, and shifting malaria burdens. This challenge is further complicated by the continuously changing landscape of malaria control and prevention technologies, with the recent introduction of malaria vaccines adding a new dimension to the decision making process. Seasonal malaria chemoprevention (SMC) is one such intervention, protecting 53 million children against malaria in 18 countries in 2023. 

Despite the widespread adoption of SMC, a critical evidence gap remains in understanding its full implementation cost. Understanding the costs and resource needs of SMC helps countries in several ways. It enables better budgeting and financial planning, ensuring that funding is available for consistent implementation. By analyzing effects and costs, stakeholders can prioritize or align SMC with other malaria strategies like insecticide-treated nets, indoor spraying, or vaccines to maximize their collective impact. This integrated approach ensures that resources are used efficiently and supports the broader goal of malaria prevention and control. 

Addressing the evidence gaps of costs

A recent publication by MSH and the University of Ghana highlighted some of these evidence gaps as part of a study examining the financial and economic costs of SMC at the country level. The review shows that the financial costs (i.e., expenditures) per child receiving a full course of SMC ranged from $1.71 to $12.46, while economic costs (i.e., true value of resources) per child ranged from $2.11 to $29.06. Drug administration costs were the largest cost driver, followed by SMC drugs and supplies and training.   

A mother receives seasonal malaria medications for her children from an MSH-trained health worker in Nigeria. Photo credit: MSH

Despite the widespread implementation of SMC, the review identified only six studies with primary cost data on the delivery of SMC published between 2016 and 2021, spanning nine countries. Most of these studies were based on pilot programs or early campaigns. This underscores the need for updated and routine cost data to better understand the resource requirements of SMC, especially as programs have matured and expanded to scale. To our knowledge, this is the first systematic review documenting and comparing detailed cost data of delivering SMC. 

The review also uncovered significant inconsistencies in the types of costs reported and the resources captured, leading to an incomplete understanding of the true resource requirements for SMC implementation. For example, one study explicitly reported per diems for volunteer SMC distributors as part of the total delivery cost, while others grouped these expenses under broader line items like delivery to distribution points, and only two studies reported the cost of pharmacovigilance. Similarly, SMC delivery methods were not always clearly captured, even though drug transport and supply chain costs can vary significantly depending on whether campaigns are conducted door to door or from fixed sites. These disparities underscore the urgent need for adopting standardized costing methods to enhance comparability across studies and interventions. Standardization would enable better resource planning, more accurate budget forecasting, and ultimately more efficient and cost-effective SMC delivery. 

Toward informed, sustainable malaria prevention policies 

To achieve both immediate reductions in malaria burden and long-term elimination goals while also ensuring sustainability, there is a need for robust cost data, clear cost-effectiveness analyses, and careful planning to integrate innovations with existing interventions. Understanding SMC costs can help countries prioritize resources to effectively fight malaria. Our review underscores the need for a standardized approach and routine data to be able to make these decisions. Moreover, to truly compare interventions, we must consider the costs to households of accessing malaria technologies. Only with a clear understanding of both financial and societal costs can policymakers effectively implement the best mix of interventions to control and prevent malaria in children.