Would vaccines made in Africa be viable?

The continent imports more than 90% of its medicines amid calls for a sturdier manufacturing base.

“Vaccine manufacturing is complex and requires huge financial investments and a long-term vision. It’s a long-distance race, not a 100m dash.”
The WHO provides a reality check.
Finding the right infrastructure mix can enable countries to move quickly up the value chain.
Dr Greg Mills, Director of the Brenthurst Foundation

In the race for sought-after vaccines for COVID-19, Africa has found itself at the back of the queue, prompting a new surge of calls for the continent to become more resilient by developing a strong manufacturing base.

In late 2020, South Africa and India called for a waiver on patents on COVID-19 vaccines held by global manufacturing companies, which are at the forefront of vaccine development, to enable emerging markets to make generics at much lower prices and closer to where they are needed.

High-income countries may have just 16% of the world’s population, but they hold the rights to about 60% of the vaccine doses. They have been accused of hoarding the vaccines, leaving less developed regions without sufficient supplies.

The initial resistance to the calls was on the basis that it would set a dangerous precedent for pharmaceutical production and innovation. This argument has, however, given way to support after the US backed the plan and it has since gained real traction, although it is yet to become a reality. The waiver would be temporary, in place until the majority of the world’s population developed immunity.

African countries are part of the World Health Organization’s (WHO’s) global COVID-19 initiative, Covax, which aims to ensure equitable access to vaccine doses. But Covax is expected to provide only up to 20% of countries’ total needs. Governments must also source their own supplies to supplement this provision.

Cost considerations

The concept of manufacturing locally is noble, but is it feasible? Africa has little existing manufacturing capability in general and, in particular, for pharmaceuticals.

There are fewer than 10 African manufacturers with vaccine production capability – South Africa, Egypt, Morocco, Senegal and Tunisia. There is limited upstream production with most local companies only engaging in packaging and labelling, and occasionally “fill and finish” steps, says the WHO.

South Africa, which had been making vaccines since 1935, had not done so since 2001. The country’s biggest drug manufacturer, Aspen Pharmacare, is part of the value chain for local packaging and distribution of the Johnson & Johnson vaccine for local use, and for exports to the African Union for onward distribution. But it is not making the vaccine from scratch.

A public-private partnership formed in South Africa in 2003 to establish local vaccine manufacturing capability, Biovac, has not gone beyond putting measures in place for child disease jabs.

Barry Schoub, chair of the ministerial advisory committee on COVID vaccines and a virology professor at Wits University, said in a recent interview that South Africa had taken its eye off the ball and it would be costly to invest in getting back up to speed, given the increasing sophistication and cost of technology to make modern vaccines. It had become more cost-effective to import vaccines, he said.

The WHO provides a reality check. “Vaccine manufacturing is complex and requires huge financial investments and a long-term vision. It’s a long-distance race, not a 100m dash.” It requires innovative financing, strong local and regional regulatory capacity, research and development investment, skills development and technology transfer, among other things.

This is not the first time that the issue of Africa’s dependence on foreign medicines has surfaced. In 2007, the Pharmaceutical Manufacturing Plan for Africa was endorsed by all member states of the African Union, with the objective of strengthening the continent’s ability to produce high-quality and affordable pharmaceuticals.

The plan seemed to have suffered the fate of many grand Pan-African plans and ended up gathering dust. As a result, the continent still imports more than 90% of its medicines.

A paucity of capability

A bigger issue is Africa’s manufacturing capacity and capability. The continent’s manufacturing base has weakened over the years. The sector accounted for about 11% of the region’s GDP in 2019, down from 13% in 2001 and from a high of 17% in 1981, according to the World Bank.

Infrastructure deficits contribute to this problem. Key among them is a shortage of reliable power. The Energy for Growth Hub estimates that 78% of firms in Africa experience regular power outages and 53.3% engage in self-generation, the highest in the world.

Only 0.8 million of sub-Saharan Africa’s 2.8 million kilometres of roads are paved and only half of these roads are in good condition. The roads are battered partly because dilapidated rail infrastructure has pushed most of Africa’s trade onto the roads.

The African Development Bank maintains that transport costs alone are 63% higher in Africa than in developed countries. The infrastructure funding deficit is considerable, estimated by the AfDB to be in the range of $68 to $108bn of the total funding needs.

Finding the right infrastructure mix can enable countries to move quickly up the value chain, says Dr Greg Mills, Director of the Brenthurst Foundation. “This means turning away from vanity projects and investing only in the most necessary infrastructure as a matter of urgency.” Reducing the cost of doing business and unblocking trade chokepoints are also key in any industrialisation policy for Africa, he says.

COVID-19 has certainly been a wake-up call for Africa to look at how the continent could become more efficient, more economically resilient and more self-sufficient.

It bodes well for the reinvigorated vision to produce Africa’s pharmaceutical needs at home that the African Union has been proactive throughout the pandemic, with its public health agency, the Africa Centres for Disease Control and Prevention (Africa CDC), leading the charge. The African Export-Import Bank would be a key player in supporting the growth of this sector.

The real test of whether anything has been learned from the pandemic will be when the dust settles. Will it be a return to normal, where the healthcare sector once again takes a backseat to other political priorities, or will Africa’s health systems have a real chance of becoming more robust and capable of tackling future crises as a result of lessons learned during the past year and more?

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