Determinants of MDA impact and designing MDAs towards malaria elimination.

Malaria remains at the forefront of scientific research and global political and funding agendas. Malaria models have consistently oversimplified how mass interventions are implemented. Here, we present an individual based, spatially explicit model of P. falciparum malaria transmission that includes all the programmatic implementation details of mass drug administration (MDA) campaigns. We uncover how the impact of MDA campaigns is determined by the interaction between implementation logistics, patterns of human mobility and how transmission risk is distributed over space. Our results indicate that malaria elimination is only realistically achievable in settings with very low prevalence and can be hindered by spatial heterogeneities in risk. In highly mobile populations, accelerating MDA implementation increases likelihood of elimination; if populations are more static, deploying less teams would be cost optimal. We conclude that mass drug interventions can be an invaluable tool towards malaria elimination in low endemicity areas, specifically when paired with effective vector control.