Should individuals be paid to participate in mass drug administration to control malaria?

Mass drug administration (MDA) is a malaria control strategy in which antimalarial drugs are offered to a whole community. Although MDA can potentially clear malaria from a community, it is not routinely used in eradication efforts because of ethical concerns and past failures to achieve lasting elimination. One potential means to improving the outcome of MDA is to incentivize individuals to participate, for example, through monetary payments. In this study our aim is to inform the decision to use MDA to eradicate malaria and explore whether individuals should be incentivized to participate. Through the lens of a mathematical model, we clarify how the costs and benefits of MDA are context-dependent. We highlight that in a community experiencing a good improvement in clinical case management - relative to the prevalence of malaria in the community - the addition of MDA can catalyze stable elimination. However, participation rates are critical and individuals who avoid every round of treatment can prevent elimination. We explore how, in this scenario, individual incentives could change the cost-benefit breakdown, measured at three levels - personal, local community and wider community.