Primaquine has two key roles in malaria elimination – blocking the transmission of Plasmodium falciparum and the radical cure of P. vivax and P. ovale. A single, low dose of primaquine is given with standard treatment for transmission blocking while radical cure primaquine is generally given over 14 days. All vivax- and ovale-infected patients need primaquine and, if the WHO recommends primaquine for transmission blocking outside of low transmission areas, then all falciparum patients will also need primaquine.

Primaquine is a cheap antimalarial drug that was developed in the 1940s in the United States where a 15 mg tablet was registered in 1952. Some 10 years ago, a 7.5 mg primaquine tablet was registered in the European Union, bringing the total number of quality-assured primaquine tablets to two. The availability of only two tablet strengths produced to international standards makes malaria elimination virtually impossible.

Added to this is primaquine’s bitter taste which leads to low acceptability and adherence in children who must receive treatment as a suspension of the crushed coated tablet. We need to meet this challenge so that children are adequately treated.

Developing and deploying quality-assured, child-friendly primaquine across a range of doses in optimised regimens for transmission blocking and radical cure would be a very substantial step forward in tackling the global malaria burden of some 229 million clinical cases (2019).

This is the goal of our Developing Paediatric Primaquine consortium.