- Malaria caused by Plasmodium vivax presents a particular challenge: the parasite can remain dormant and cause relapses weeks or months later.
- Radical cure options, such as tafenoquine, can simplify treatment through a single dose for eligible patients.
- Safely implementing these options requires specific tests and health systems equipped to deliver them.
For someone who has had malaria, recovering from an episode does not mean the disease is behind them. When malaria is caused by the parasite Plasmodium vivax (P. vivax), it can remain dormant in the liver and cause a relapse weeks or months later. Each new episode can mean days of missed work, school absences, and expenses that disrupt family life.
Preventing these relapses is important both for people living with this uncertainty and for countries working toward malaria elimination. Radical cure of P. vivax malaria with tafenoquine treats both the infection in the blood and the dormant forms of the parasite that could trigger new episodes. But ensuring these benefits reach patients requires more than access to medicine: health services must be able to identify each eligible patient, provide appropriate treatment, and support their recovery.
The Regional Malaria Elimination Initiative (RMEI), administered by the Inter-American Development Bank (IDB), supports countries in strengthening the capacities needed to put their elimination strategies into practice. RMEI takes a comprehensive approach to radical cure, placing it alongside other interventions that can be applied according to the epidemiological context, such as targeted or reactive drug administration, reactive vector control, and the investigation of and response to cases and outbreaks.
Traditional treatments for P. vivax malaria require taking medication over several days. Completing the regimen can be difficult for people who live far from a health facility, travel frequently, or cannot take time off work.
Introducing tafenoquine as a medication for radical cure expands the available options. For eligible patients, it allows treatment targeting the infection in the blood and the dormant forms of the parasite that can trigger new episodes to be administered in a single dose.
Its use, however, requires specific conditions, including prior testing of the activity of a particular enzyme—G6PD—to identify who can safely receive it. Protocols, medicines, and supplies must also be available. The decision to introduce this option rests with each country’s authorities, in accordance with their regulatory processes, national guidelines, and epidemiological context.
Costa Rica illustrates how this innovation can help accelerate progress toward malaria elimination. Between 2023 and 2025, the country reduced locally acquired cases from 546 to just 22 and, in 2025, became the first country in Central America and the Caribbean to introduce tafenoquine treatment. With RMEI support, the country began introducing it in 17 health facilities, located primarily in areas with high levels of population mobility and malaria transmission. This included training staff and introducing the testing needed to administer the medicine safely, alongside treatment and case surveillance. During the first six months, 97% of patients with P. vivax malaria received a G6PD test, and 17 eligible individuals received a single supervised dose of tafenoquine.
The experience is also generating lessons for the rest of the region. Six RMEI countries have incorporated radical cure with G6PD testing into their acceleration strategies for 2026–2027. Honduras, for example, plans to begin in Puerto Lempira, Roatán, and Santos Guardiola; El Salvador plans to establish a testing site in each of its 14 health regions; and Belize aims to extend this capacity to all six of its districts. Guatemala and Colombia are also moving in this direction.
Implementation must also respond to local conditions. The detection, diagnosis, treatment, investigation, and response strategy (DTI-R) organizes elimination activities around foci and microareas where malaria transmission is occurring or has recently occurred. Through microplanning, health teams can tailor their work to each area: understanding where cases occur, how people move, and what barriers they face in accessing diagnosis and treatment.
Microplanning also strengthens community participation. Local leaders, community health workers, and other stakeholders can help identify risks, reduce barriers to access, and build trust in health services and treatments.
Recent progress demonstrates the importance of strengthening strategies tailored to local conditions, advancing therapeutic innovation, and developing local capacities, alongside health systems prepared to address these challenges. These elements are essential to sustaining and consolidating the progress achieved. Malaria elimination in our region is possible—and it is an increasingly attainable goal within everyone’s reach.