**6. Future perspectives**

Resistance of *P. vivax* to the antimalarial drug mainstays, chloroquine and primaquine poses a serious challenge to achieving the global malaria elimination that has been set up in 2030. Despite ambiguous evidence on both of this drug, chloroquine and primaquine deserve further exploration on its efficacy in different geographic setting before being side lined. To ensure the safe provision of primaquine treatment in *P. vivax,* local capacity to determine the existence host genetic factors such as G6PD deficiency as well as CYP2D6 allelic frequency should be established to mitigate the treatment failure that potentially increasing the risk of severe and fatal outcome.

Recent progress on the *in vitro* cultivation of *P. vivax* renew our interest to carefully validate the clinical phenotype of *P. vivax* isolates to the antimalarial drug mainstays, chloroquine, ACT and primaquine as well as the association with the genotype through genome-wide association study. In this context, progress achieved in *P. falciparum* certainly provide guidance to circumvent the limitations in *P. vivax*.

The proven efficacy of ACTs to vivax malaria in general and CRPV in particular, also support for our readiness to circumvent the problem of *P. vivax* resistance toward the remaining years ahead. Although the ACT is hastily paired with primaquine, evidence to date is still supportive.

Apart from our readiness to cope in turn the chemotherapeutic issue in combating *P. vivax,* efforts to mitigate the transmission through vector control should also be encouraged. A regular vector surveillance and control around the dwelling areas should be promoted to prevent the silent transmission of the parasite to Anopheles vector.

## **Acknowledgements**

We gratefully acknowledge Prof. Amin Soebandrio MD, Ph.D, Clin. Microbiol, Chairman of the Eijkman Institute for Molecular Biology for his encouragement and advice and Prof. dr. Budu, Ph.D., Sp.M (K), M.Med.Ed, Dean of the Faculty of Medicine, Hasanuddin University for the support to DS. Therapeutics efficacy studies (TES) for period 2012–2021 in Eijkman Institute are supported by Government of Indonesia (Ministry of Research and Technology/National Research and Innovation Agency and Ministry of Health) and World Health Organisation.

#### **List of acronyms**


Plasmodium vivax *and Drug Resistance DOI: http://dx.doi.org/10.5772/intechopen.97320*

