The problem

Plasmodium Vivax (P. vivax) malaria is the most common type of malaria outside of sub-Saharan Africa. Following P. vivax infection, the malaria parasites can lie dormant in a person’s liver, reawakening later and causing recurrent illness. Tackling P. vivax requires treating both the blood and liver stages of infection, known as radical cure.

Liver-stage treatment has traditionally relied on primaquine, which requires a 14-day treatment which, in certain patients with G6PD deficiency, can cause hemolytic anemia – the destruction or breakdown of red blood cells. The length of treatment and side effects of this drug can result in incomplete treatment and the lack of diagnostic tools that can identify patients at high risk of hemolytic anemia has posed an additional barrier. The lack of quality-assured pediatric formulations further challenges treatment in children.

Our response

Through the Partnership for Vivax Elimination (PAVE), led by the Medicines for Malaria Venture (MMV), Unitaid supported country-led feasibility studies and operational research in collaboration with Ministries of Health and national research institutes in five countries.

The studies assessed the feasibility of introducing G6PD testing to guide radical cure with either single-dose tafenoquine in Peru, Ethiopia and Viet Nam, or a seven-day, high-dose primaquine regimen in Indonesia and Papua New Guinea.

The studies generated real-world evidence on whether these new approaches could be safely and effectively integrated into routine health services, as well as on their cost-effectiveness, acceptability and health-system readiness.

PAVE helped generate the evidence needed to expand access to safer and simpler approaches to preventing P. vivax relapses:

• Single-dose tafenoquine: feasibility and implementation studies generated evidence on how tafenoquine could be introduced alongside G6PD testing in routine health services. This evidence contributed to its introduction in Brazil and Thailand and to the adoption of tafenoquine and G6PD testing in national treatment guidelines in Peru and Viet Nam. Single-dose tafenoquine and its pediatric formulation were WHO-prequalified in December 2024.
• Point-of-care G6PD testing: PAVE supported research and implementation activities to assess how point-of-care G6PD testing could be used to identify patients at risk of hemolysis and safely guide radical cure. The STANDARD G6PD Test was WHO-prequalified in December 2024.
• Shorter-course primaquine: In Indonesia and Papua New Guinea, PAVE-supported studies assessed the feasibility of using a seven-day, high-dose primaquine regimen as an alternative to the traditional 14-day course, generating evidence to inform future implementation.
• Paediatric primaquine: The partnership also contributed to efforts to address the lack of child-friendly radical cure options. The first pediatric formulations of primaquine were WHO-prequalified in November 2025, expanding the availability of quality-assured treatment options for children.

PAVE-supported implementation activities also trained thousands of healthcare workers in the use of radical cure approaches and G6PD testing, while evidence generated through the partnership contributed to WHO guidance and national policy discussions, including a field guide on the case management of Plasmodium vivax malaria published by WHO in 2025.

Together, this work is helping countries move from new products and treatment approaches to practical delivery, laying the groundwork for wider access to safer and simpler ways to prevent P. vivax relapses.