Abstract : In 2013, Asia-Pacific leaders formed Malaria Alliance (APLMA) and declared goal of regional malaria elimination by 2030. Plasmodium vivax is the predominant malaria species in Asia-Pacific, and accounts for >80% of the global burden. Strategies aimed for P. falciparum may not give impact for the elimination of P. vivax as it is not targeting the parasite liver stage. Primaquine remains the only drug that has the ability of killing parasite in the liver. World Health Organization recommended that primaquine should be given over 14 days, thus an observational study in Papua, Indonesia, found that the compliance to unsupervised PQ was estimated to be only 12%. Single dose of tafenaquine as radical treatment sounds promising, however it also poses Glucose-6-phosphate deficiency individuals to the risk of hemolysis, and determine the G6PD status prior to prescribing the drug is crucial. In this paper, we will review several challenges in achieving P. vivax elimination, especially in the Asia-Pacific