Plasmodium vivax is becoming the main cause of malaria outside sub-Saharan Africa. The relapse burden is considerable especially in Southeast Asia and Oceania, where P. vivax relapses early and frequently. Prevention of relapse requires treatment with primaquine, however its efficacy may be limited by poor adherence to the long treatment regimen, and its use limited by the risk of hemolysis in glucose-6-phosphate dehydrogenase (G6PD)–deficient persons in combination with low availability of G6PD testing. In areas where P. falciparumelimination is under way, the proportion of malaria cases caused by P. vivaxincreases when radical cure is not given. Despite the absence of radical cure, the overall incidence of P. vivax decreases. Current strategies utilised for P. falciparum elimination include mass screening and treatment (MSAT) or mass drug administration (MDA). Are these strategies appropriate for P. vivax elimination? P. vivax elimination necessitates radical cure with primaquine, which carries haemolytic risk in G6PD deficient persons and also in persons with intermediate G6PD activity. Can qualitative point of care G6PD tests ensure safe delivery of primaquine to females? How can quantitative point of care G6PD tests be used by malaria post workers? Given the duration of treatment for both G6PD normal and deficient persons, how likely is an unsupervised primaquine course to be completed? Would passive case detection with radical cure be a more practical cost effective, albeit slower way to eliminate P. vivax? Before embarking on P. vivax elimination, there are still questions to be answered.