Push for African vaccine independence

Partnership of 8 countries mooted at Kampala meeting

COVER STORY | RONALD MUSOKE | A consortium of African civil society organisations has kick-started a campaign to change the continent’s gloomy situation regarding vaccines and other essential pharmaceutical products.

Of all vaccines administered on the continent, only 1% of these vaccines are manufactured locally while 99% are imported with a bigger portion arriving via international procurement mechanisms such as the United Nations children’s charity, UNICEF, and the Global Alliance for Vaccines and Immunization (GAVI).

Afya Na Haki, a Kampala-based health policy thinktank is working with partners in eight African countries to change the situation under a programme called “Advancing Regional Vaccine Manufacturing and Access in Africa (ARMA). The partners are from Uganda, Nigeria, Rwanda, Tanzania, South Africa, Kenya, Senegal and Zimbabwe.

Abdul-Karim Muhumuza, the head of Partnerships and Communications at Afya Na Haki told The Independent during the launch of the programme on March 14 in Kampala that ARMA programme’s major objective is “advancing African advocacy and research approaches that strategically enhance vaccine manufacturing and access in Africa.”

“We are bringing together unified voices and experiences so that we contribute to the ongoing conversation to ensure that Africa builds capacity to ensure that we have adequate vaccines for our populations,” he said.

Until recently, there were only 10 vaccine manufacturers across five African countries –Egypt, Morocco, Senegal, South Africa and Tunisia – jointly producing a tiny fraction of the continent’s vaccine needs.

In fact, most of these countries do what is called “fill and finish packaging and labelling” with very limited upstream production of antigen formulations. This is mainly due to a lack of local scientific capacity, along with weaknesses in the commodity supply chain.

There are also other barriers such as prohibitive regulatory regimes, powerful trade blocs, scarcity of potential buyers, competition with subsidized markets, political instability, geographical and logistical challenges, lack of sustainable financing mechanisms and low economic purchasing power.

“This programme is a campaign in nature and it is aiming at building partnerships across the continent,” said Muhumuza, “We shall ensure that different partners in the region speak to the issues and the challenges affecting vaccine research, development and manufacturing to ensure that we engage our governments, regulatory bodies, civil society and communities to have a unified voice that enables us to have health security as Africans.”

Dr. Moses Mulumba (PhD), the Director General of Afya Na Haki told The Independent shortly after the launch of the programme in Kampala on March 14 that the initiative has been motivated by the consequences of COVID-19.

“When African countries were battling COVID-19, one of the most critical challenges they faced was access to pharmaceutical products; both new innovations such as vaccines but also basic commodities like handwash sanitizers, masks, and Personal Protective Equipment (PPEs) for health workers,” Mulumba told The Independent.

The COVID-19 pandemic systematically exposed these weaknesses and flaws in current health systems of different countries on the African continent. It also exposed the looming inequitable access to health and the strong influence of the Western countries on the health systems in Africa.

Meanwhile, Africa’s position in the current global health environment is critical as is shown by the underdeveloped capacity of member states to conduct Africa-focused research, development and manufacturing of vaccines. Continental oversight bodies have also been found to be lacking the necessary resources to institutionalize vaccine development and are heavily reliant on countries and organizations in the West.

The civil society partners are concerned that the rest of the world rarely cares about diseases that hit Africa but have not impacted them. The partners say the wake-up call came when COVID-19 happened.

“On the African continent, the word ‘global’ does not apply. We have seen it with challenges of monkey pox and Ebola,” says Mulumba, “There has been that realization that unless we ramp up pharmaceutical manufacturing on the continent, we are not going to be able to cope with the disease burden,” says Mulumba, “So, we think that we need to understand the landscape of pharmaceutical manufacturing and this ranges on many things; right from the regulatory aspects.”

The programme wants to ensure that powerful commitments and resolutions made by the African Union and individual African countries are actually implemented.

“Our call to action on vaccine manufacturing is that we should have a holistic approach to ensure that we have the entire infrastructure of delivering to the person who is receiving the vaccine,” Mulumba told The Independent.

Dr. Denis Kibira, the coordinator of the Medicines Transparency Alliance (MeTA), a multi-stakeholder initiative that brings together governments, civil society and the private sector on the continent to improve access to pharmaceutical markets also attended the Kampala meeting.

He told The Independent on the sidelines of the meeting that the challenges that developing countries like Uganda faced in accessing diagnostic kits, vaccines and therapeutics during the COVID-19 pandemic, have led to a push to ensure that Africa ramps up local manufacturing of these pharmaceutical products, especially the vaccines.

“There is a push in some capacity for vaccines to be produced on the continent from the lowly 1% to about 60% by 2040,” Dr. Kibira told The Independent. But he quickly noted that, “certainly, this has to be done in a coordinated manner.”

Dr. Kibira told The Independent that as African countries raise their ambitions for vaccine and pharmaceutical production, it is important to understand that not every country should jump on the bandwagon of manufacturing these commodities. “If every country decided to manufacture vaccines, we certainly would not have enough market.”

Africa Union’s lofty ambition

The civil society initiative comes at a time when the African Union Commission and the African Centres for Disease Control and Prevention (Africa CDC) are rallying member countries across the continent to have 60% of vaccines manufactured locally by 2040 through the Partnerships for African Vaccine Manufacturing (PAVM) Framework for Action.

In April, 2021, the African Union and the Africa CDC called for a new public health order which would safeguard the health and economic security of the continent as it strives to meet the aspirations of Agenda 2063—the AU’s ambitious development blueprint that seeks to achieve inclusive and sustainable socio-economic development over the next 30 years.

The expansion of local manufacturing of diagnostics, vaccines and therapeutics was indeed among the resolutions that were reached during a virtual summit in April, 2021. The meeting was organised by the Africa CDC and brought together over 40,000 people including four Heads of State.

Dr. John Nkengasong, who was the Director of the Africa CDC at the time, noted that Africa cannot guarantee the health security of its 1.2 billion population if it continues to consume 25% of the global vaccine supply.

“We have now seen how woefully that setup has failed the continent,” Dr. Nkengasong told GAVI in July 2021, referring to Africa’s continued dependence on vaccine imports, “You cannot guarantee the health security of your people by importing 99% of your vaccines.”

Dr. Nkengasong’s rallying call has been answered by countries such as Uganda. President Yoweri Museveni has, for instance, said Uganda should cease the opportunity and invest in the “Pathogen Economy.”

“Africa’s pathogenic economy which offers huge economic opportunities, is being taken advantage of by others and Africa is totally absent; hence, this project comes at the right time,” Museveni said in a tweet after commissioning Dei Pharmaceuticals in Matugga, in the central Uganda district of Wakiso in October, last year.

The plant which now manufactures COVID-19 therapeutic medications and is now gearing up to produce one billion doses of MRNA vaccines guided by the World Health Organization (WHO) standards was built during the COVID-19 pandemic.

According to the Uganda Investment Authority (UIA), the government agency that is in charge of attracting investment into the country, there are about 30 pharmaceutical and medical devices in Uganda at the moment. Still, the country remains a net importer of pharmaceutical products. This is the scenario that the civil society consortium wants to change. “We actually think that there is a huge need for civil society actors to wake up the policy people to prioritise pharmaceutical manufacturing,” Dr. Mulumba told The Independent.

He noted that the ARMA programme will be tracking efforts of the African continent towards local pharmaceutical manufacturing over the coming years.

“What we are realizing is that they (African countries) are investing in every sector except pharmaceutical manufacturing. So, this programme is looking at the regulatory aspects, the legal policy aspects as well as the actual manufacturing and the potential we do have on the continent.

“What are those factors pushing people from manufacturing medicines? How do they access credit since some of them are complaining about the policy on credit? How do we have another Quality Chemicals here in Uganda? Why can’t we have a pharmaceutical industrial park in this country?”

“We are also realizing that some of the things we need to do on the continent is nurturing partnerships because there is already potential to produce on the continent but the kind of collaboration existing is not sufficient.”

Vaccine manufacturing is capital intensive

At the Kampala meeting, most civil society partners agreed that vaccine manufacturing requires huge investments, including research and development.

“Certainly, there are challenges; production of vaccines is not a very simple thing. It requires a lot of capacity building, financial resources (setting up a vaccine manufacturing plant requires about US$ 60 million whereas a simple pharmaceutical plant would need about US$ 5 million,” noted Dr. Kibira.

“So, you can see that vaccine manufacturing is resource intensive. There are also a number of barriers that have to be addressed; you have to look at the credit rates, human resource capacity and trade protocols.”

“Therefore, it requires a lot of stakeholder engagement and partnership building. So, the role of civil society is to hold government accountable; to ensure that what government does what it has committed to do.”

Interestingly, Dr. Mulumba said on average, the percentage of GDP dedicated to research and development across Africa is just 0.5%. He said African government have been happy to rely on other people who are doing such investments. “We have actually realized that even the minimal investment has been done by the private sector,” Mulumba told The Independent, “That is a time bomb.”

It remains to be seen what the African countries will do to raise their investments in R&D. He noted that the fact that most African governments are not investing in finding out what is happening with the disease burden of their countries.

Partnerships are key

Dr. Nkengasong noted in 2021 that in order for the African countries to play in that space, they need to aspire and work with partners such as GAVI, the Vaccine Alliance and the Gates Foundation to shape the market.

“It comes down to basic supply and demand. If you produce vaccines, there must be somebody who buys the vaccines from you,” Nkengasong said.

He said African countries need to reshape the market so that they do not just make India a kitchen for everybody, where India produces and Africa consumes. He said there should be a balance.

“For that to happen, there needs to be some guarantee that countries and organisations will buy volumes of vaccines from Africa,” he said.

“Africa also needs to position itself in such a way that it does not just look inward and only produce vaccines for the African market, but is competitive and say: If we import from China and India, there is no reason why we cannot export to China and India. We have to have that economy of scale,” Dr. Nkengasong said.

“Achieving this means incentivizing research and development (R&D) and vaccine production in partnership with national governments. But GAVI and its partners must also play a role in trying to support R&D, human capital development and market shaping to free the continent from this permanent dependency mode.”

However, Dr. Nkengasong noted in 2021 that in order to deal with the issue of vaccine nationalism that might crop up in future, African continent will also have to go for what he called a “hub and spoke model,” where everybody does not need to do everything from end to end.

“If we recognize that it takes so many components to produce a vaccine, then we could say country X focuses on glassware for vaccines, country Y focuses on lipids and so on,” he said.

Dr. Nkengasong went ahead and used the example of the Airbus production process. “The final aircraft is manufactured in Toulouse, France, but the parts come from all over the place. That is the formula that we think will work for Africa. It would mean that nobody can just say, first of all, we’re going to immunize 200 million people in this country before anyone else gets anything.”

Going forward, Brenda Akankunda, the programmes coordinator at the Southern and Eastern Africa Trade Information and Negotiations Institute (SEATINI) told the Kampala meeting that addressing gaps in the trade and investment policies on the continent is important.

For Joan Kilande, the programmes coordinator at HEPS-Uganda, a Kampala-based non-profit that promotes health and socio-economic rights of vulnerable individuals, groups and communities in the country, the civil society partners should continue engaging as a coalition but it is equally important to bring on board the private sector.

For Dr. Mulumba, the priority should be around policies that address the fact that pandemics are going to be part of life and are going to be part of the health systems of African countries.

“We need to invest resources and know that this much is dedicated to manufacturing and this much is for research and development.”

“We will also need to invest in human capital because we cannot afford running outside all the time looking for experts. We need to sustain our human capital because part of the problem is that some of the pharmacists who have been doing our pharmaceutical manufacturing are trained here but they continue running out of the continent.

“The infrastructure must be there to encourage them to continue doing the same work here,” Dr. Mulumba told The Independent.