For decades, the fight against malaria has been dominated by the battle against Plasmodium falciparum, the parasite responsible for the most severe and deadly cases. But in the shadows of that struggle, another parasite, Plasmodium vivax, has quietly remained one of the most persistent obstacles to the total eradication of the disease. Unlike its counterpart, P. Vivax can lie dormant in the liver, triggering relapses that send patients back into a cycle of fever and chills months or even years after their initial infection.
A global effort to break this cycle has reached a pivotal milestone. The Partnership for Vivax Elimination (PAVE), a multi-country initiative supported by Unitaid and the Bill & Melinda Gates Foundation, has delivered the first substantial real-world evidence that a new suite of diagnostic and treatment tools can significantly accelerate the elimination of relapsing malaria. As the project concludes this month, its legacy is a transformed medical toolbox that moves the goal of a malaria-free world from a distant dream toward a tangible reality.
The challenge of P. Vivax is not just biological, but logistical. To clear the dormant liver stages—known as hypnozoites—patients traditionally required long courses of medication that were difficult to complete and carried risks of severe side effects for people with specific genetic predispositions. By coordinating efforts between National Malaria Programmes, researchers, and funders, PAVE has bridged the gap between laboratory innovation and clinic-level implementation across more than a dozen countries.
The impact of this partnership is most evident in the expanded access to specialized treatments. Through the project’s support, the World Health Organization (WHO) has prequalified several breakthrough tools, including adult and paediatric formulations of single-dose tafenoquine, co-developed by Medicines for Malaria Venture (MMV) and GSK. This single-dose option replaces the cumbersome multi-day regimens that often led to poor patient adherence.
Solving the Safety Puzzle: The G6PD Connection
The primary barrier to using powerful relapse-prevention drugs like tafenoquine and primaquine has always been safety. In patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency—a common genetic enzyme deficiency—these medicines can cause hemolysis, a dangerous breakdown of red blood cells that leads to severe anemia.
Until recently, testing for G6PD deficiency was often slow or unavailable in remote areas, forcing clinicians to either avoid these drugs or risk patient safety. PAVE addressed this by supporting the rollout of the STANDARD G6PD Test, developed by SD Biosensor and PATH. Prequalified by the WHO in December 2024, this point-of-care test allows healthcare workers to determine a patient’s suitability for treatment in minutes, directly at the site of care.
The integration of this test has been a catalyst for policy change. By removing the “fear factor” associated with G6PD deficiency, countries have been able to confidently incorporate more effective treatments into their national health strategies. This is particularly critical for children; in November 2025, the first high-quality paediatric formulations of primaquine, developed by MMV and Fosun Pharma, gained WHO prequalification, filling a long-standing gap in care for the youngest and most vulnerable patients.
From Clinical Trials to National Policy
While laboratory success is essential, the true measure of a public health intervention is its performance in the field. PAVE focused heavily on “real-world evidence,” conducting feasibility studies in diverse environments including Brazil, Ethiopia, Indonesia, Papua New Guinea, Peru, Thailand, and Vietnam.
These studies proved that new regimens—including a high-dose seven-day primaquine course—could be successfully managed by local health systems. The data generated from these pilots provided the political and medical justification needed to rewrite national guidelines. Brazil and Thailand became the first malaria-endemic countries to integrate single-dose tafenoquine into their public health systems in 2024, while Peru and Vietnam have since adopted the combination of tafenoquine and G6PD testing into their National Treatment Guidelines.
| Tool/Milestone | Developer/Partner | WHO Prequalification | Primary Impact |
|---|---|---|---|
| Single-dose Tafenoquine | MMV / GSK | December 2024 | Replaces multi-day regimens; increases adherence |
| STANDARD G6PD Test | SD Biosensor / PATH | December 2024 | Enables safe, point-of-care screening |
| Paediatric Primaquine | MMV / Fosun Pharma | November 2025 | First high-quality treatment for children |
| National Rollouts | Brazil & Thailand | Implemented 2024 | First public health system integration |
Building Sustainable Local Capacity
The project’s architects recognized that new drugs are useless without trained personnel to administer them. To ensure the progress would outlast the funding cycle, PAVE partners trained thousands of healthcare workers on the administration of relapse-prevention treatments and the use of G6PD diagnostics.
This focus on human infrastructure means that the capacity to fight P. Vivax now resides within the ministries of health and local clinics of the endemic countries themselves. By convening regional meetings and sharing best practices, the PAVE network has helped shape national strategies that prioritize the most marginalized communities, who are often the most affected by recurring malaria.
“P. Vivax malaria has remained one of the toughest barriers to elimination, keeping communities trapped in cycles of recurring illness and transmission,” said Robert Matiru, Unitaid Director, Programme Division. “Progress depends on ensuring that innovative tools and approaches reach the people who need them. PAVE’s perform has been instrumental in supporting countries to adopt these diagnostics and treatments and make them accessible to the most vulnerable communities.”
The shift in perspective is profound. For years, the complexity of P. Vivax made its elimination seem nearly impossible. Elodie Jambert, MMV’s Vice President of Access and Product Management, noted that prior to the partnership, countries had limited options and evidence to guide effective relapse prevention, which made elimination feel like a “distant dream.”
As the formal PAVE project concludes, the transition from a project-based approach to a systemic one begins. Gonzalo Domingo, PATH’s Global Programme Director of Diagnostics, emphasized that the partnership demonstrated how country-led implementation can speed up the adoption of new tools. He confirmed that PATH and MMV will continue to support endemic countries in scaling these innovations and addressing the remaining evidence gaps.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Patients should consult a healthcare provider for diagnosis and treatment of malaria.
The next phase of the effort will focus on the broader scale-up of these tools across other endemic regions in Mesoamerica, South America, and Asia, with ongoing monitoring to ensure that the reduction in relapse rates translates into a permanent decline in malaria transmission.
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