Mass drug administration and mass fever treatment are two strategies that have been used differently in the past and are now sometimes considered as a response to malaria epidemics caused by P. falciparum.

Distribution of antimalarials in Italy in the 1930s. Attempts to control malaria through mass treatment with antimalarial drugs date back to at least the early 1930s. (Source: Archivio Casini, Sezione di storia della medicina, University of Rome 'La Sapienza')

Mass drug administration (MDA) is the treatment of all persons in a given population or geographic area with a curative dose of an antimalarial drug, regardless of whether these persons have malaria infection or not.

The World Health Organization does not recommend MDA for the following reasons:

1. Insufficient evidence to suggest an overall benefit. While MDA may result in a short-term reduction in malaria parasitemia among the population, it has little impact on malaria transmission rates over time.
2. Promotion of drug resistance. Indiscriminant use of medicines for MDA may result in sub-therapeutic levels of the drug in large numbers of persons, increasing the risk that malaria parasites will develop drug resistance.

Mass fever treatment (MFT) refers to the treatment of symptomatic patients with fever within a well-defined population or geographic area with a curative dose of an antimalarial drug. MFT is a rapid measure that can be considered as part of an outbreak response. The criteria for drug selection are the same as for the national policy for treating uncomplicated malaria (most likely an artemisinin-based combination therapy). Rectal artesunate or intramuscular injectable artemether would be the choice for severe malaria cases since quinine may be impractical in an outbreak setting. WHO states that mass treatment of fever cases with an artemisinin-based combination therapy (ACT) is appropriate as a strategy to reduce mortality once malaria has been established as the cause of the epidemic.

A current example of how mass fever treatment might be used comes from Zanzibar. In Zanzibar, malaria has recently been controlled and a malaria early epidemic detection system implemented. Weekly reports are submitted from over 50 health facilities. The epidemic detection system is intended to trigger a response from health authorities upon a sudden increase in malaria diagnoses in one or more health facilities. Part of the response will include field investigations to confirm whether an increase in malaria transmission is real or not. Once the increase is confirmed as real, a component of the immediate response may include MFT with an artemisinin-based combination therapy (ACT) for people with fever (independent of laboratory-confirmed malaria) in the affected area. This strategy aims to get treatment to people with probable malaria cases as quickly as possible to cure illness, avert death, and help contain the epidemic. Once the outbreak response is more fully implemented in the community, laboratory confirmation of malaria parasites will precede treatment.

Mass screening and treatment (MSAT) refers to screening all people in a population with an appropriate malaria diagnostic test and providing treatment to those with a positive test result.   This intervention assumes that most of the people who can serve as an infectious reservoir will have high enough levels of parasites in their blood to be detected at the time of screening. Both MFT and MSAT would be more acceptable if concerns over administration of the 8 aminoquinolines without screening for G6PD deficiency in the population can be overcome.