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Table 1 This is an example of how the potential scenarios for a proof-of-concept study could be considered

From: Ivermectin to reduce malaria transmission II. Considerations regarding clinical development pathway

  Residual transmission Insecticide resistance Transmission Targeted for elimination Artemisinin resistance Burden of malaria Testable
Elimination in the GMS +++ + + +++ +++ + Possibly
Elimination in selected areas of sub-Saharan Africa ++ +++ +++ +++ +++ Yes
Reduce disease burden in high-transmission areas + Any +++ +   +++ Yes
Stem insecticide resistance in well-defined areas Any ++++ Any + Any + Difficult
Elimination from hotspots in the endgame ++ +++ +++ +++ Any +++ (local) Doubtful
Stem of outbreaks + Any ++ Any Any + Doubtful
  1. Testable refers to the potential implications of the transmission pattern on sample size and the feasibility of controlled clinical trials for each particular scenario
  2. GMS Greater Mekong Subregion