Primaquine for all: is it time to simplify malaria treatment in co-endemic areas?

In most areas endemic for malaria, the major species are Plasmodium falciparum and Plasmodium vivax. Falciparum malaria is more often lethal, develops resistance to drugs easily, and is responsible for most of the malaria burden in Africa. However, particularly in this second era of malaria elimination efforts,1 P vivax requires increasing attention2 because of the intrinsic challenges related to its control. This species can lead to severe or even life-threatening disease,3 can present variable evidence of resistance to chloroquine in relation to geographical area,4 and has few drug options to prevent relapse. Prevention of relapse is essential because up to 80% of reported cases of P vivax malaria could result from hypnozoite-derived relapses, rather than from newly acquired infections.5 The triggers of relapse are not sufficiently understood, but 8-aminoquinolines (such as primaquine, or the newly registered tafenoquine) are the only effective drugs enabling radical cure