Medicines for Africa’s Lenias Hwenda highlights the vast gaps in COVID-19 vaccine access globally, especially in Africa where just six percent of the population has been vaccinated. Hwenda argues that the time is now to boost the infrastructure for pharmaceutical manufacturing in Africa as a way out of this pandemic, and as a crucial weapon in the fight against future global health crises.
One year ago in November 2020, Medicines for Africa, an organization that is driving the much-needed conversations around access to medicines in Africa, predicted the dynamics that could be expected to play out around access to COVID-19 vaccines in an article published in African Arguments. Those predictions have come to pass and African countries have yet again had to confront another pandemic the same way they have been doing throughout history – at the back of the queue for medical products. The COVID-19 pandemic response turned out to be riddled with vaccine nationalism, export bans, and the purchase of vaccines far in excess of what rich countries needed, leaving poorer nations with few options.
The African Union has lamented the often-ignored fact that despite having funds to pay for vaccines and other pandemic supplies, countries on the continent were straight from the beginning locked out of the markets for diagnostics and personal protective equipment. Denied the possibility of buying vaccines in meaningful quantities, the continent of 1.3 billion has to date managed to vaccinate just six percent of its population, according to the WHO Africa office. The COVID-19 vaccines that have been made available to African countries have come in dribs and drabs of donations too insignificant to have any meaningful impact to countries. These donations, despite typically being sporadic and often of vaccines close to expiry have often been made with high publicity and pomp. They have been shipped to receiving countries at short notice making it difficult for them to plan and consequently, to utilize them effectively. What’s more, many of the donations have been primarily of the vaccine that Western authorities, including the US FDA and Swissmedic, have shunned because of fears that it is not safe – the AstraZeneca vaccine.
Denied the possibility of buying vaccines in meaningful quantities, the continent of 1.3 billion has to date managed to vaccinate just six percent of its population
The British Medical Journal estimates that rich countries are holding an excess of two billion doses, most of which will expire by the end of 2021 and will be discarded. Having achieved mass vaccination, rich nations are starting to boost their fully vaccinated residents, whilst more than 94 percent of African people have not yet received a single dose of vaccine. According to the WHO Director General Dr Tedros Ghebreyesus, there are six booster doses being given for each primary vaccine given in a poor nation. The mantra “no one is safe until all are safe” that leaders in the West are so fond of repeating whilst simultaneously taking decisions that have the exact opposite effect proves that solidarity is a fallacy. That is why global mechanisms like COVAX, the global vaccine sharing mechanism set up to ensure equal access are unlikely to ever become a plausible approach to solving global health challenges. Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC) captures this sentiment. “The COVID-19 pandemic has shown the limits of multilateral cooperation to serving humanity” said Nkengasong in an interview on the HSS Podcast that covers issues relating to health security and sovereignty in Africa. In the future, greater emphasis ought to be placed on regional cooperation on security because vaccine nationalism is here to stay.
Our experience at Medicines for Africa is that few countries can have security of access to medical products unless they manufacture the products themselves, or they have a strategic relationship with someone who does. This point is supported by the Economist Intelligence Unit which reports that only five African countries are on track to achieve mass vaccination by the end of 2022. These countries, South Africa, Morocco, Tunisia, Egypt, and Algeria have one thing in common: they are all manufacturing vaccines domestically through contract manufacturing agreements. The remaining 49 countries on the continent will not achieve the mass vaccination milestone of 60-70 percent of the national population until late 2023.
This pandemic has finally driven home a truth that has been apparent all along – that global solidarity works better when someone else benefits from the gesture economically. “One thing that COVID has revealed is how there is such disparity, and how unequal the society is. The message for our leaders is – do we still need to be in that position if there is a next pandemic which comes along?” said the previous president of Mauritius, Ameenah Gurib-Fakim of Mauritius in an interview on the HSS Podcast. The answer to the President’s question must be a resounding no, but for things to change, African society, government, private sector and civil society, must start a new conversation, not about what the West can give Africa, but rather, how to initiate and sustain Africa-led manufacturing initiatives that will enable Africans to tackle domestic heath challenges.
This pandemic has finally driven home a truth that has been apparent all along – that global solidarity works better when someone else benefits from the gesture economically
A seismic shift in the mindset of leaders in government is, in fact, emerging. Few African leaders still believe that Africa’s historical dependence on global mechanism is feasible for sustainable development. Samer Kassem, the CEO of Aspen Global articulates this. “I think now it’s clearer that more than ever, we need to do things differently in Africa. And I’m seeing that the governments in general are reacting well, which is a very good starting point.”
The Africa CDC has declared security of access to medical products to be a national security issue. This highlights Medicines for Africa’s philosophy, that no country can secure its economy without securing health, and medical products are necessary to effective delivery of healthcare services. This makes the third pillar of Africa CDC’s recently announced new public health order for Africa – the strengthening of local pharmaceutical manufacturing capacity a significant development.
It is untenable that the region with the worst disease burden in the world (25 percent of the global burden of disease) accounting for over 90 percent of the world’s malaria deaths and 70 percent of all people living with HIV/AIDS, has a pharmaceutical manufacturing capacity that can be at best described as negligible. According to the WHO, Africa accounts for just three percent of pharmaceutical manufacturing and 0.1 percent of vaccine manufacturing globally. Africa has tackled and continues to tackle its enormous burden of disease by importing 99 percent of vaccines and 95 percent of its medicines needs. African experience in the history of pandemics including the current COVID-19 pandemic shows that such hyper-reliance on imports leaves the continent extremely vulnerable to emerging disease threats. Equally, it makes Africa the weakest link in the global pandemic response and the necessary global economic recovery. In this geopolitical context, the only way African countries and by extension global health will ever achieve genuine health security is through domestic pharmaceutical manufacturing in Africa.
Developments on the continent reflect this understanding. African countries are leveraging regional cooperation to drive pharmaceutical industrialization on the continent with visible progress. Governments, investors, and partners are collaborating on building an ecosystem to enable a thriving pharmaceutical and vaccine manufacturing industry and an assured market for its products. To facilitate trade in the region, the continent has begun integrating its market under the African Continental Free Trade Area. The African medicines regulatory environment is also being harmonized. On the 6th October 2021, enough African member states had ratified the African Medicines Agency (AMA) for it to go forward and it is now expected to launch before the end of 2021. The AMA will play a critical role in supporting the continent’s vaccine manufacturing plans by strengthening ongoing medicines regulatory harmonization and by harmonizing Africa’s vaccine manufacturing environment. It will also optimize the use of scarce resources by pooling expertise and capacities.
The private sector is also taking action with investment cases that are clearly compelling enough for investors to part with their money. Large deals have been announced to develop new pharma production facilities and to scale up existing ones. Major investors including the International Finance Corporation, the Africa Development Bank, the European Investment Bank and many others who have responded by creating financial vehicles to support the development of necessary infrastructure to build this industry. Aspen, Africa’s largest pharmaceutical company, invested in a vaccine production facility in Durban, and after a difficult start, has been manufacturing vaccines primarily for the African continent from October 2021. In addition, several countries are contract manufacturing vaccines, including South Africa’s Aspen Pharmacare making the J&J vaccine, Egypt’s Vacsera, which is making Sinovac’s COVID vaccine and Morocco’s Sothema, manufacturing Sinopharm’s vaccine in partnership with the Swedish company, Recipharm. In Rwanda and Senegal, BioNTech has entered into agreements to establish local mRNA vaccine production, and South Africa has established the first mRNA technology Hub at Afrigen Biologics led by Prof Petra Terblanche.
Big Pharma and Africa’s development partners now have an opportunity to change this picture. They can do this by becoming allies to Africa’s efforts to improve health security on the continent and getting behind Africa’s pharmaceutical industrialization revolution
The level of momentum shows that Africa is walking its talk, but the question is whether the efforts can be sustained once the urgency of the pandemic passes. The success of the entire effort depends on the extent to which the region will be able to recalibrate domestic and international procurement dynamics on the continent and localize the market so that local manufacturers are not disenfranchised, according to Stavros Nicolaou, an Aspen Pharmacare senior executive. There will be election cycles to think about and the effort will face the inevitable resistance and pressure from bilateral partners who prefer a status quo that keeps Africa right where it is – as a market for their private sector and sustained by donations in return for concessions that secure the economic interests of donors. Unfortunately, this kind of expression of solidarity preferred by Africa’s partners has proved very harmful to global health security.
Big Pharma and rich nations have been complicit in denying the people of Africa access to vaccines during this pandemic and others before it. When J&J began shipping vaccines manufactured by Aspen on the African continent to Europe, it missed a golden opportunity to show real solidarity with the people of Africa. Big Pharma and Africa’s development partners now have an opportunity to change this picture. They can do this by becoming allies to Africa’s efforts to improve health security on the continent and getting behind Africa’s pharmaceutical industrialization revolution. Everyone stands to win from such a constructive stance which would embody the kind of solidarity needed to drive sustainable African economies, create jobs for the millions of unemployed youth in Africa, and at the same time strengthen the global pandemic response for the benefit of all of humanity and the global economy.