A new study published in the New England Journal of Medicine has delivered a striking insight into the global fight against malaria. Ivermectin—a widely used antiparasitic drug—has been shown to reduce malaria incidence by 26% in a large-scale trial conducted in Kenya. While ivermectin’s role in treating diseases like river blindness and elephantiasis is well-known, its impact on malaria prevention opens the door to a new, complementary strategy in high-risk regions. The finding is especially significant as malaria control efforts face stagnation due to growing resistance to traditional tools like insecticide-treated nets.Malaria remains one of the deadliest diseases globally, with nearly 600,000 deaths and over 260 million cases reported in 2023 alone. Africa accounts for the vast majority of these cases, where bed nets and indoor spraying have long been the frontline defense. But here’s the problem: mosquitoes are adapting. Insecticide resistance is on the rise, and some species have shifted behavior, biting outdoors or at times when nets offer no protection.The need for an alternative, preferably one that can work alongside existing tools, is urgent. Enter ivermectin.How Ivermectin Works Against Malaria?Ivermectin doesn’t target the malaria parasite itself. Instead, it turns humans into mosquito killers.Here’s how: when a person takes ivermectin, the drug circulates in their bloodstream for several days. If a mosquito bites that person during that window, the drug is toxic to the mosquito. This reduces the mosquito population and, by extension, cuts malaria transmission.This “endectocide” approach—targeting parasites both inside and outside the body—adds an entirely different layer to malaria control.The BOHEMIA (Broad One Health Endectocide-based Malaria Intervention in Africa) trial is the largest study to date exploring ivermectin’s impact on malaria. Led by the Barcelona Institute for Global Health (ISGlobal), the study took place in Kwale County, a malaria-endemic region of coastal Kenya where the use of insecticide-treated bed nets is already high. Here’s what the researchers did:84 clusters of households were randomly assigned to receive either ivermectin or a control drug (albendazole).Participants (nearly 29,000 people in total) were given their respective drugs once a month for three months during the region’s rainy season, when malaria transmission spikes.Researchers then tracked malaria infection rates specifically in children aged 5 to 15, testing them monthly for six months.Children in the ivermectin group had 2.20 malaria infections per child-year, compared to 2.66 in the control group—a 26% relative reduction.What stood out in the findings was the gradient effect—the farther a child lived from the border of the study clusters, the stronger the protection. This points to a community-wide benefit, not just an individual one. In simpler terms, the more people around you who take ivermectin, the less likely you are to get malaria.The protective effect also met and surpassed the World Health Organization’s minimum efficacy threshold, which recommends at least a 20% reduction in infection lasting one month after treatment.Dr. Carlos Chaccour, co-principal investigator of the study, called the results “thrilling,” adding that ivermectin “could complement existing control measures.” His colleague, Dr. Regina Rabinovich, emphasized the drug’s potential in areas where traditional tools are beginning to fail.Safety is always a sticking point with mass drug administration. But in this trial, ivermectin had a favorable safety profile, consistent with its use in other public health campaigns against neglected tropical diseases.No serious drug-related adverse events were reported. The few side effects that did appear—such as dizziness or nausea—were mild and short-lived.This is crucial because any tool proposed for broad-scale use, especially in children, must not only be effective but also safe.Where Does This Leave Us With Malaria Treatment?In an accompanying editorial, US-based malaria experts have praised the study as “well-conducted” and “not unexpected.” Noting that ivermectin has long shown potential but hadn’t been tested at this scale until now. He also raised a practical point—future studies may explore longer-acting formulations or more frequent dosing, although delivering such strategies at scale could be challenging.But he also sounded a sobering note: funding for malaria control programs is being slashed across the globe, including Africa, Asia, and the Americas. Without renewed investment, progress could stall—or worse, reverse.The study results have already been reviewed by the World Health Organization’s Vector Control Advisory Group, which acknowledged the impact and called for additional studies. National health authorities in Kenya and elsewhere are now considering whether to include ivermectin in their malaria control toolkits.The BOHEMIA team also hopes this will trigger more large-scale research to evaluate the most effective dosing schedules, combination strategies, and delivery methods.Ivermectin is not a replacement for bed nets or other established tools but it adds a much-needed weapon to the malaria arsenal, especially in regions where mosquitoes are outsmarting traditional methods.This trial shows us that with the right strategy, an old drug can offer a new solution to one of the world’s deadliest diseases. As malaria continues to evolve, so must our response. Ivermectin might just be the unexpected ally the global health community needs to push the fight forward.