A Case Study: How the Rephaiah Project Combats Malaria in Young Children

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injectable artemether or artesunate, subject to availability. For most parents, they need to

carry their child a long distance, by foot, in order to receive treatment. Although injections

are helpful, they are only found in hospitals and they only contain one drug, instead of two

as recommended by WHO. Sadly, in many parts of the world, the Plasmodium strain has

developed resistance to several drugs, which is why WHO has advocated two concurrent

drugs, to minimize the risk of widespread resistance.

The Rephaiah project is based on the need for pediatric dosage forms to treat young

children under the age of 5 years. There is a dire need for a simple dosage form, that can

be used, even in the most rural areas. There is a need for a product that contains both drugs

and can be stored in a hot climate, e.g. in health clinics in rural areas. The Rephaiah project

is focusing on providing health and hope to these children, by establishing a not-for-profit

pharmaceutical manufacturing entity in Malawi. The focus is on pediatric dosage forms

for infants and children under the age of 5 years. The company will manufacture pediatric

dosage forms to treat malaria as well as selected neglected tropical diseases such as schis-

tosomiasis (bilharzia/snail fever) a parasitic infection transmitted with freshwater snails,

living in lakes, rivers and even rice fields, and onchocerciasis (river blindness) a parasitic

infection transmitted with small sand flies.

By establishing the entity in Malawi, the company will hopefully meet several needs

and at the same time work toward different UN DSGs:

1. By manufacturing the drug in a country like Malawi, there is a possibility to provide

a drug for affordable prices, even for parents that live on ≦$ 1 per day. In the

USA, the lowest price for the artemether and lumefantrine combination drug, to treat

malaria, cost $ 129,37 (January 2021). The majority of the population in Malawi

cannot afford such a product, when the average monthly salary is around $ 35.

2. Malawi is well located so the drug(s) may eventually be distributed from there to

other Sub-Saharan countries.

3. Manufacturing these drugs where they are needed, will work towards achieving

many of the UN SDGs e.g., lowering carbon footprints, and helping the country

to be self-sustainable.

4. The only pharmacy education in Malawi is at Kamuzu University of Health Sciences.

The BS program in pharmacy started in 2006 and the planning of a MS program is

well on its way and will hopefully start in the near future.

5. Establishing a drug development entity and drug manufacturing company, where

the production is made from raw materials, will strengthen the infrastructure of the

country and make Malawians capable of formulate other drugs, e.g., in a case for

emergency.