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Developing Health Security, Resilience in Africa through Vaccine Manufacturing

Resource constraints pose a very real barrier to the ability of vulnerable countries to manage the global health crisis. The pandemic is spreading rapidly across Africa, including a new variant of the virus that spreads at a faster rate, which will compound the existing health challenges that the continent already faces. Therefore, the only way to end the pandemic is global vaccination. However, economic models of vaccine manufacturing indicate many countries won’t be likely to achieve widespread immunization until the end of 2022.

Covid-19 vaccine vials on a production line at a GlaxoSmithKline factory in northern France. Western Europe is one of the main global vaccine manufacturing hubs, with regions such as Africa and western Asia left behind. (Photo by Francois Lo Presti/AFP via Getty Images)

Africa is lagging behind in realizing the opportunities of reducing burden of disease by vaccination. During the pandemic, African countries have been at the back of the queue for getting adequate test kits and consumables, personal protective equipment and now vaccines. COVID-19 has underscored the critical gap in vaccine manufacturing in Africa, which represents 26 per cent of the world’s population but has less than 0.1 per cent of world vaccines production. The continent’s low manufacturing capability exposes Africans to supply chain risks such as the one experienced with the current COVID-19 vaccine challenges.

The whole world is hunting for the currently scarce corona vaccines. Rich countries have the longest straw. Covid-19 vaccine production is highly concentrated in the US, Europe, China and India, where more than 90% of all doses are expected to be made. While vaccine nationalism is a key reason for Africa’s slow rollout, the vaccination effort is also being held back by India halting exports of vaccines to protect the domestic population as it faces soaring COVID-19 cases.

That’s because India is home to the world’s largest vaccine manufacturer, the Serum Institute of India, which is also the biggest supplier to the COVAX facility. The rest of the world especially most of Africa, Asia and Latin America is simply not part of the picture. Africa and western Asia are particularly devoid and removed from the process, much as they are from the world’s largest foreign investors, across all sectors. Shortages of medicines and vulnerable supply chains for critical medicines are issues for nearly all developing countries. In Africa, in particular, there’s limited manufacturing capacity. Over 20 countries don’t have any capacity at all. And many regions continue to import at least 95% of their pharmaceutical requirements.

According to the Africa Centres for Disease Control and Prevention (Africa CDC), its mainly poor nations are falling behind in the global coronavirus vaccination race with under 13 million doses administered so far to the continent’s 1.3 billion people. Many African countries have received their initial shipments from the COVAX facility and from bilateral deals, in some cases months earlier than in previous pandemics such as H1N1, but on the whole Africa has struggled to secure timely access to adequate supplies. Africa must therefore start producing vaccines itself, according to the European Commission. But rigid intellectual property rights and national export restrictions around vaccines and the inputs needed to produce them have led to global shortages in supplies.

Vaccines are the Way Out of the Pandemic

Vaccination is one of the most important medical practice ever introduced, it has been essential to reduce mortality, improve life expectancy and economic growth. Africa is lagging behind in realizing the opportunities of reducing burden of disease by vaccination. Thanks to the Global Alliance for Vaccines and Immunization (GAVI), vaccines are becoming widely introduced. However, the concern is how to sustain such vaccines and whether countries would afford new vaccine introduction after graduation from GAVI. Even if economic cost-benefit evaluation is one of the criteria relevant for priority setting in health, decision on vaccine introduction for most African countries would likely depend on pure program cost. The more vaccines introduced in a country, the more expensive is the country’s vaccination programme in terms of vaccine procurement, cold chain capacity and programmatic logistics. In part, it is due to poor governance, massive under-investment in human capital development, wholesale corruption and an over-dependency on external assistance.

Recently, the Biden administration’s backing for patent waivers on Covid-19 vaccines, saying this would advance production in Africa and elsewhere. However, the move has been widely suspected to be more of an empty promise out of political calculation, attempting to avoid international criticism for hoarding vaccines and stopping or delaying exports of its vaccines to other countries. The US has been drastically lagging behind in fulfilling its pledge made by Biden to lead vaccine distribution around the world.

In contrast, experts say intellectual property rights aren’t the bottleneck in producing enough vaccines for the whole population. They note that there are also significant shortages in supply chains, and few existing factories that are capable of producing mRNA vaccines like the ones developed by Pfizer/BioNTech and Moderna. Retrofitting existing sites could cost billions of dollars. Solving these problems requires more than waiving rights it will require significant investments from high-income countries. Covid-19 has made it clear that Africa cannot depend on donors to meet its vaccine and medicine needs. It is time to do things differently: to assemble the partnerships and commit the resources to develop African vaccine-manufacturing capacity.

There are fewer than 10 African manufacturers with vaccine production and are based in five countries: Egypt, Morocco, Senegal, South Africa and Tunisia. Earlier this month, three Ghanaian companies working to produce Covid-19 vaccines locally presented proposals on their plans to the government. There is very limited upstream production with most local companies only engaging in packaging and labelling, and occasionally fill and finish steps.

Today, African nations only produce 1% of the vaccines used on the continent, with scattered, limited capacity. Some of the barriers to quickly ramp up production include inadequate incentives for investment, skills gaps, weak regulatory environments, and unknowns around the long-term demand for COVID-19 vaccines. Thus far, only around 2% of the world’s vaccination against Covid-19 has taken place in Africa.

Africa faces a huge dilemma in mobilizing resources to manufactures vaccines. The road to vaccine manufacturing in Africa is a difficult task fraught with risks and potential costs. Given the unprecedented levels of support for increased vaccine security and self-reliance in response to the COVID-19 pandemic, there is an opportunity to accelerate efforts now. There have been some significant recent signs of progress which can help towards creating a positive eco-system on the Continent. These include significant improvements in regional regulatory harmonization, the implementation of an African Continental Free Trade Area, the African Development Bank support for purchasing vaccines for the African Union and the exceptional leadership demonstrated by the African CDC in the COVID-19 response. Hopefully the soon to be established African Medicines Agency will add a further important milestone.

Increasing the manufacturing capacity for Covid-19 vaccines in Africa could help ensure the continent does not lag behind in vaccinating its population. On 13 April 2021, Africa’s leaders pledged to increase the share of vaccines manufactured in Africa from 1% to 60% by 2040. This includes building factories and bolstering capacity in research and development. The efforts of the African Union, African Vaccine Acquisition Task Team and African Export-Import Bank show the potential impact of pooled funding and purchasing of Covid-19 vaccines. Governments need to improve logistics and optimise distribution of the vaccines they have access to.

It is time for African governments to strengthen national research programmes and partnerships. They need to do this by working with the local scientists to prioritise domestic programmes for targeted research funding. In routine times, each country’s drug regulatory agency evaluates the safety, quality, and effectiveness of vaccines before they are authorized for use in the country. The establishment of a supply-chain infomediary could help suppliers and purchasers navigate this turbulent environment.

Addressing supply chain bottlenecks and sustainably expanding manufacturing capacity around the world will not only help address immediate needs but will also ensure that the world is much better prepared to combat the next pandemic. African countries should identify opportunities to scale-up African vaccine manufacturing capabilities which is critical to establishing Africa’s health security by developing the capabilities and capacity to respond to current and future pandemics and outbreaks in a more rapid and agile manner.

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