As the world recovers from the COVID-19 pandemic, Africa continues to grapple with the double-edged reality of emerging and re-emerging infectious diseases and a rise in non-communicable diseases. Combined, these inadvertently create a significant market for the pharmaceutical industry and given the rapid population growth on the continent, there is a need to increase access to affordable therapeutics, vaccines and diagnostics that meet the international standards for quality, safety, and efficacy in African countries.
Currently, Africa accounts for only 3% of global pharmaceutical manufacturing and about 70 – 80% of medicines in Sub-Saharan Africa are imported. Out of the 55 countries, the continent boasts of only 1 pre-qualified vaccine manufacturing institute, Institut Pasteur de Dakar in Senegal which has been manufacturing yellow fever vaccines for 80 years, and 2 countries, that is Morocco and South Africa that meet above 70% of their pharmaceutical needs from local manufacturing. This significantly undermines Africa’s ability to respond to pandemics and other long-standing public health issues that are unique to the continent. The COVID-19 pandemic exposed the fragility of African health systems and global supply chains, which was compounded by the stock-piling of vaccines by developed countries and the restriction of exports by countries such as India, at the height of the Pandemic. Africa can simply not afford to wait for the next pandemic to catalyse action toward self-reliance and investment in the African pharmaceutical industry.
The Africa Beyond COVID-19 policy brief by Future Africa Forum, anchored on the principles of resilience, productivity and equity, provides overarching and cross-sectoral policy proposals that are needed to steer Africa beyond COVID-19. Key among them are the public policies and private interventions required to bolster emergency preparedness and streamline logistics by leveraging the african manufacturing industry. In light of this, we explore some of the opportunities that through consolidated efforts at continental and regional levels, exist for the African Pharmaceutical Manufacturing Industry.
One crucial opportunity is fostering the development and coordination of public-private partnerships and financing systems that bring together governments, global health institutions, local and global pharmaceutical companies, bilateral and multilateral financing institutions, research institutions, and philanthropic organisations. The Meningitis Vaccine Project (Men Afri Vac) is one such partnership, solely focused on addressing the Meningitis epidemic in Africa, which revealed that through collaboration we can drive innovation, bring down costs and increase access to life-saving treatments without necessarily relying on international pharmaceutical companies that are not in tune with local public health needs. There is evidence of increasing public-private partnerships in the continent and bodies such as the African Union and the Africa Centres for Disease Control and Prevention (Africa CDC) should be keen to ensure regional instruments such as the Partnerships for Vaccine Manufacturing in Africa (PAVM) Framework for Action are implemented in a coordinated manner that fosters a just and sustainable manufacturing ecosystem. The Africa Pandemic Resilience Initiative, through its policy brief, addresses the need to align such partnerships and related global policies and funding with African priorities and common objectives; without forgetting the social context of the geopolitical realities that continue to foster inequalities.
Second is the integration of the African market and the establishment of pharmaceutical industries on an initial basis of regional clustering. This will increase demand and create a favourable market for local manufacturers and investors due to the boost in economies of scale.
Implementing the African Continental Free Trade Agreement(AfCFTA) is going to prove beneficial given the fact that fragmented value chains in Africa currently result in significant margins for pharmaceutical products, relative to the 2-21% margins seen in OECD countries. The AfCTA Secretariat should therefore maintain the momentum to ensure African countries make the most out of this agreement and thus aid in sustaining the political goodwill that has driven its rapid adoption.
Also key is the harmonisation of regulatory systems on the continent through the African Medicines Regulatory Harmonisation Initiative (AMRH) and more recently, the Africa Medicines Agency (AMA) which is set to increase timely access to quality, safe and efficacious therapeutics, vaccines and other health technologies by hastening regulatory approvals, countering falsified and substandard medicines, and centralising pharmacovigilance efforts.
Currently, weak regulatory frameworks present a significant challenge in investing in the African pharmaceutical manufacturing industry, considering the fact that Africa accounts for 42% of all substandard and falsified medicines globally. This is not only a threat to public health but to the integrated market that Africa is working towards, as demonstrated by the recent WHO medical product alert on contaminated cough syrups identified in The Gambia that were linked to the death of 66 children. Therefore, the unanimous ratification and operationalization of the AMA, hosted by the Government of Rwanda, will be critical in building a robust regulatory structure and strengthening the regulatory capacities of African countries and of regional economic communities.
Lastly, Africa has the advantage of adopting novel technologies such as modular manufacturing and continuous manufacturing, which have proven to be cheaper and more efficient. This is in the backdrop of efforts by global manufacturers to phase out archaic technologies and for African countries that offer favourable investment climates such as Rwanda, the rate of adoption and establishment of such manufacturing technologies will be faster compared to other countries. In fact BioNTech has started the construction of it’s first modular mRNA manufacturing facility in Rwanda with production capacity for the Pfizer-BioNTech COVID-19 vaccine estimated at 50 million doses annually, with plans to expand manufacturing to include BioNTech’s investigational malaria and tuberculosis vaccines following their successful development and approval by regulatory authorities. The introduction and adoption of such technologies should however happen in tandem with efforts to expand and support Africa’s base for research and development and technology transfer such as the WHO mRNA vaccine hub for Africa, currently being led by Afrigen in South Africa. This should be utilised as a means of empowering African institutions to not only meet short-term needs such as COVID-19 vaccines but to also address the continent’s long-standing needs and realities that are related to other infectious diseases such as HIV, Tuberculosis, Malaria, Neglected Tropical Diseases, and many other vaccine preventable diseases for which Africa is highly dependent on imports for vaccines, diagnostics and therapeutics.
Despite the valuable opportunities highlighted here, challenges that could slow down existing efforts must be taken into consideration. Key among them is the overemphasis on vaccine development and manufacturing, which is more complex and costly, and the failure to capitalise on low-hanging fruits such as supporting the existing pharmaceutical infrastructure in Africa to boost their fill & finish capabilities, expand the manufacture of generic products, and increase the local production of other pharmaceutical raw material such as starch and ethanol. These manufacturing industries can then gradually graduate to manufacture more complex molecules such as vaccines and Active Pharmaceutical Ingredients (an API is the active component in a pharmaceutical drug).
As highlighted in an article recently published by Think Global, Africa is ready and now is the time to consolidate what we already have on the continent, and strategically shape and build a pharmaceutical manufacturing environment that is conducive for the Africa market. By leveraging the opportunities that exist, driven by sustained political will and commitment from African leaders, the self-reliant African Pharmaceutical Industry that we hope for is fast becoming a reality.
By: Purity Wambui Nyaikamba, Shingai Machingaidze, Gerald Chirinda
The views expressed in this article are those of the author and do not necessarily reflect the views of Future Africa Forum. Future Africa Forum is a pan-African policy think-tank and policy advisory consultancy headquartered in Nairobi, Kenya.
