Only 1% of the vaccines used in Africa are manufactured on the continent. This dependency on the rest of the world has seen Africa relegated to the end of the queue for urgently needed Covid-19 jabs. How soon can this situation be fixed?
On 21 June 2021 the World Health Organisation announced it had clinched a deal with an African consortium to set up its first Covid mRNA vaccine technology transfer hub – to be based in South Africa.
It was one small step in making Africa less reliant on imported vaccines and came after the wake-up call on disease that the Covid-19 pandemic delivered.
It also followed a “vaccines summit” organised by the African Union and the Africa Centres for Disease Control and Prevention in April, at which African leaders pledged to increase the share of vaccines manufactured in Africa from 1% to 60% by 2040.
“We have been humbled, all of us, by this pandemic,” said Abdoulaye Diouf Sarr, Senegal’s minister of health and welfare, at the virtual summit, which drew 40,000 participants.
The 1% figure “boggles the mind”, added virologist Salim Abdool Karim, a former science adviser to the South African government.
Africa, with 54 countries and 1.2 billion people, must import 99% of its vaccination needs – mostly through international procurement mechanisms such as the UN children’s charity Unicef.
But leaders on a Zoom call pledging a manufacturing revolution is one thing, making it happen is another.
In a recent article, Nature magazine stated that kick-starting vaccine manufacturing needs at least four key ingredients: financing of hundreds of millions of dollars; expanded research capacity; a commitment from governments to purchase vaccines; and regulatory bodies that meet international standards.
“Compared with other regions, African countries are lacking in all four,” declared Nature.
According to UK government research, Africa has just 10 vaccine production facilities – in five countries: Egypt, Morocco, Tunisia, Senegal and South Africa. Most of these are what is known as “fill and finish” facilities which do not make the actual vaccine substance and its key ingredients.
For example, the much-publicised Aspen factory in Eastern Cape, South Africa, imports bulk amounts of the Johnson & Johnson vaccine under cold chain conditions and then processes it for distribution – decanting it into vials and labelling it.
The South African government-controlled Biovac facility in Cape Town has the capacity to make vaccine substances – and already does so with the likes of the six-in-one jab for children – but hasn’t yet started making doses for Covid.
Africa’s other vaccine substance manufacturers are the Pasteur Institute of Dakar in Senegal, the Pasteur Institute of Tunis in Tunisia and the Pasteur Institute of Algeria in Algiers – indicating a significant level of aid from France. The Ethiopia Public Health Institute in Addis Ababa and Biovaccines in Lagos, Nigeria, have announced plans to reach a similar level of capacity, according to Nature magazine.
The Covid mRNA vaccine technology transfer hub for South Africa mentioned above is based on a model the WHO created in Asia 15 years ago to teach 11 companies how to make pandemic influenza vaccines. Eventually, six countries had the capacity to produce vaccines against avian flu.
Following April’s vaccine summit, the African Development Bank said it had already made provision to help finance two technology platforms for vaccine production, making 300 million doses per year – with an upfront investment of at least US$400 million.
The bottom line is money – and plenty of it.
Professor William Ampofo, chairperson of the WHO’s African Vaccine Manufacturing Initiative, said in a March 2021 interview that the charity element of vaccine distribution in Africa was, perversely, a hindrance to finding funding to build the vaccine industry.
“Most African countries are supplied with vaccines by Unicef, supported by Gavi, the Vaccine Alliance, with fewer than 10 countries being self-sufficient in terms of vaccine procurement. This has led to a very specific shaping of vaccine markets in Africa where more than 1.5 billion doses are supplied through Unicef,” Ampofo told the WHO’s news agency.
“Consequently, this presents enormous challenges when trying to establish sustainable vaccine industries in Africa which would ideally require advance purchasing support from African governments. In the current dispensation, this is simply not possible when most countries don’t buy their own vaccines and therefore cannot commit to buying locally manufactured vaccines.”
Ampofo said this was where African governments, continental bodies such as the AU and other stakeholders could make a difference.
“The current Covid-19 pandemic presents a great opportunity to harness the various conversations and proposals into an action-oriented road map … that will lead to increased vaccine production in Africa to facilitate immunisation of childhood diseases and control outbreaks of highly infectious pathogens,” said Ampofo.