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Short abstract:

Vivax malaria treatment requires two drugs to clear the parasite from an individual’s system-a treatment combination called “radical cure”. Using postcolonial STS theory we investigate the origin of the term “radical cure” and its appropriateness to modern vivax case management in endemic settings.

Long abstract:

Treatment for vivax malaria requires a combination of two drugs to clear the parasite from an individual’s system—a treatment combination which is called “radical cure,” a term that originated in post-WWII, malaria research in the United States. However, the use of the term since the 1950s has yet to be questioned in its applicability to the current context of malaria care in endemic countries. Using postcolonial STS theory we investigate the origin of the term “radical cure” and its appropriateness to modern vivax care in endemic settings. Using changes in vivax case management in Cambodia and Ethiopia, two epidemiologically different malaria endemic countries, as a case study, we explore the disease and treatment experiences of individuals infected with vivax malaria against the backdrop of policymakers’ expectations of radical cure. Patient experiences highlight the chronic nature of vivax malaria, while policymakers expect “radical cure” to be the solution to recurrent vivax malaria. However, the risk of re-infection despite preventative measures not neutralised by radical cure, socio-economic insecurity of at-risk populations, and infrastructure required for the treatment to be accessible and effective, do not allow for radical cure to be a cure, but instead a multifaceted complexity for patients and the health system alike. This daily reality stands in opposition to a vision of the accelerated malaria elimination promised by radical cure, calling for a more conservative understanding of the treatment. We argue the term “radical cure” should be retired to give way to a decolonized and holistic understanding of vivax care.