Building the toolkit to address malaria resurgence and radical cure of vivax malaria in Ethiopia: a meeting report.

Abstract

Ethiopia has experienced a substantial resurgence in malaria in recent years, with increasing case numbers and a growing contribution of Plasmodium vivax in several regions. At the same time, new evidence supporting improved radical cure strategies, including high-dose primaquine and single-dose tafenoquine, alongside advances in molecular tools, offers opportunities to address persistent transmission and relapse. Against a backdrop of constrained funding and health system challenges, a stakeholder meeting was convened in Addis Ababa in November 2025 to review emerging evidence and discuss implications for malaria control and elimination in Ethiopia. The two-day meeting brought together 38 representatives from the National Malaria Control Programme, research institutions, regional health bureaus, and implementation partners. Key themes emerging from the meeting included: (i) systemic challenges shaping malaria control, including funding constraints, operational disruptions, and climate-related pressures; (ii) uncertainty around the contribution of relapse to overall P. vivax burden and the potential role of molecular tools to address this gap; (iii) important health system considerations for the introduction of G6PD-guided radical cure, particularly regarding service delivery levels and equity; (iv) the central role of economic evidence, with substantial uncertainty around drug pricing and implementation costs; and (v) the need for strengthened collaboration between researchers and policymakers to support evidence-informed decision-making. The meeting highlighted that, while more effective tools for P. vivax radical cure are available, their adoption in Ethiopia will depend on addressing key evidence gaps, particularly around relapse burden, feasibility, and cost-effectiveness. Given the current challenges, there is a pressing need for context specific research and continued dialogue between stakeholders, which will be critical to inform policy decisions and support progress towards malaria elimination.