Christiaan Schultz and Kate Nathan

A serious shortage of paediatric malaria prevention drugs looms in South Africa in the short term, but lodges and operators are taking precautionary measures to assist travellers.

The South African Society of Travel Medicine (SASTM), South African Paediatric Association (SAPA) and the Southern African Society of Paediatric Infectious Diseases (SASPID) along with the South African Malaria Elimination Committee (SAMEC) and academics, have jointly issued a press release saying there is likely to be an imminent stock outage of malaria prophylaxis for children in the South African market ahead of the winter holidays, a time when many families travel to high-risk malarial areas.

“It has come to our attention that there is an imminent stockout of the only medicine for the prevention of malaria in toddlers and young children in South Africa, as stocks of the only current supplier, AcinoSwiss, will expire by end July 2023.

“This comes at a critical point when many families will be heading out to malaria endemic areas in the Lowveld and neighbouring states, eg Mozambique, and it follows on mefloquine, the only medication suitable for babies and pregnant women who must travel to malaria risk areas, no longer being marketed in South Africa.

“The only other prophylactic available in South Africa is doxycycline but this is not suitable for use in toddlers, young children (under 8 years) and in pregnancy. There have also been intermittent shortages of doxycycline in the last two years.

“Malaria is the most common, preventable infectious disease and cause of death in African travellers. Adult formulations of the tablet containing the same active ingredients, atovaquone/proguanil, remain available, but for practical and pharmaceutical reasons these tablets cannot be used in children.

“Representatives of the societies and SAMEC met with AcinoSwiss, the sole supplier of Malanil Paediatric, earlier this week, to find an urgent solution. The company is immediately making available a supply of tablets still in stock, but with short expiry dates, at end July 2023. The tablets will be available at certain travel clinics and pharmacies.

“Potential solutions discussed for once that stock expires, include urgently bringing to market generic tablets already registered in South Africa and/or the importation of alternative generics. New formulations would have to be approved by the South African Health Products Regulatory Authority (SAHPRA), a process that can take months. An ad hoc steering committee offered to engage with SAHPRA to request speeding up the review process once a potential supplier is identified.

“As an interim measure, South Africans are advised not to travel to high-risk malaria areas if travelling with young children, unless travel is unavoidable. If travel cannot be deferred at all, travellers should make strict use of all measures to avoid mosquito bites at all times and seek urgent, expert medical advice for anyone with the symptoms of a flu-like illness, namely fever, headache, cold shivers, nausea and vomiting, muscle and joint pain. These signs and symptoms may be difficult to detect in babies and young children, increasing the risk of a delayed diagnosis and death.”

The South African Society of Travel Medicine represents approximately 500 travel health practitioners in Southern Africa. Its mission is to guide the profession in all aspects relating to the practice of travel medicine, liaise with the travel industry, consult with relevant authorities, advise the public and collaborate nationally and internationally on all aspects relating to travel medicine.

Response from industry

Tourism Update spoke to Isaac Phaahla, Kruger National Park GM: Communications and Marketing, who said KNP had not seen a decline in traveller numbers out of fears of contracting malaria, as the park had mitigation policies in place.

“We work with the Department of Health in both Limpopo and Mpumalanga to spray homes and tourist accommodation. We also continuously communicate to tourists to take appropriate prophylaxis when visiting the park, alternatively, to use effective preventative measures against mosquito bites. There is ongoing education to our colleagues and tourists,” said Phaahla.

Onne Vegter, MD and Co-founder of Wild Wings Safaris, told Tourism Update that his company had ordered malaria prevention drugs and received them soon after. Wild Wings Safaris offers safaris trips in and around the Kruger region, amongst others.

“We ordered Malanil last week and the pharmacy received it within three days, and I’ve had no complaints from guests who were unable to obtain malaria prophylaxis,” Vegter said.

Thornybush Game Lodge in the Greater Kruger National Park, said it did offer precautionary measures against malaria, and has suggested that travellers who fear contracting the disease, travel during certain times of the year.

“Although we are situated in a low-risk malaria area, this does not rule out that it does exist here. We will always encourage our guests to take precautions that they feel most comfortable with, and as a lodge group, we do our best to keep guests as safe as possible.

“If travellers are looking for months where malaria is at its lowest risk, travelling between May and September over the dry winter months is suggested. However, during the wetter months, October to April, we offer precautions such as unlimited insect repellent and mosquito netting at night and tell our guests to wear clothing that covers them up,” the lodge said in a ‘Facts and Fears about Malaria’ blog post.