Plasmodium vivax elimination from India may need therapeutic efficacy studies - Informed shift to artemisinin-based treatment

India has significantly reduced its <i>Plasmodium vivax</i> (<i>P. vivax, Pv</i>) malaria burden. However, threat of chloroquine (CQ) resistance can undermine these gains. Artemisinin-based combination therapies (ACTs) have demonstrated superior efficacy compared to CQ, particularly in regions where resistance <i>Pv</i> has been confirmed. Their benefits include rapid parasite clearance, improved tolerability, effectiveness against mixed-species infections, and reduced relapse rates when combined with primaquine (PQ). While the World Health Organization recommends changing the first-line treatment if the total failure rate exceeds 10%, some countries have acted earlier based on surveillance of putative drug resistance molecular markers. In India, therapeutic efficacy studies (TES) coverage can be expanded is sparse along with molecular data to track early warning tools of <i>Pv</i> resistance. This review synthesizes clinical, molecular, and pharmacological evidence supporting a shift from CQ to ACTs for <i>P. vivax</i>. We argue that India may prioritize TES expansion and adopt an ACT-based regimen to sustain its elimination momentum and prevent therapeutic failure.