Vaccine production in Africa: Will initiatives survive?

Document

Cited in

Jurisdiction	South Africa
Date	01 April 2023
Pages	2-3
Author	Ames Dhai
Published date	01 April 2023
DOI	10.7196/SAJBL.2023.v16i1.1040

2 April 2023, Vol. 16, No. 1 SAJBL

EDITORIAL

For decades, there have been huge concerns at the lack of vaccine

production in Africa. Africa is the only major world region that does

not have significant vaccine manufacturing capacity.[1] Early on during

the COVID-19 pandemic, it became evident that once again there

was an acute need to develop local manufacturing capacity, and to

increase that capacity where already present. For a significant period,

Africa received only relatively small doses of vaccines. Frequently, the

supplies were unpredictable, and there was little warning on when

the vaccines would arrive and what type of vaccines they would be.[2]

Challenges to vaccine manufacturing in Africa include weak

investments for vaccine manufacturing by African governments,

weak regulatory capacity for vaccine research, development and

production, low interest in vaccine production in Africa by global

vaccine stakeholders, uncertainties in the demands for vaccines

made in Africa by African countries,[3] manufacturers ceasing

production as a result of inability to compete with imported

vaccines, dependence on global supply chains, which at times

are hampered by intellectual property issues, trade barriers,

monopolised supply and export bans, dependability on external

suppliers posing severe problems to Africa’s health resilience, and

a preference by African countries and their governments for ready-

made vaccines that they can import.[2] Therefore, the focus has been

on securing deliveries rather than manufacturing. It is easier to secure

funding or pool resources from foreign donors to facilitate payment

and procurement, compared with the cost of vaccine development,

preclinical testing and clinical trials. While significant investments

and grants backed by the state are made available to produce

vaccines in wealthier countries, African manufacturers face the high

costs of vaccine production with little or no funding support from

the states, and a lack of political commitment in this context. This

will have a bearing on problems of sustainability of any vaccine

manufacturing initiative undertaken. In addition to insufficient

funds to medical scientists, research and development, African

technological innovations have been undermined to create markets

for the foreign-led products, including vaccines.[2] Africa’s reliance

on foreign suppliers for vaccines impacts public health security, as

evidenced during the COVID-19 pandemic. This means that Africa

could remain last in line and face significant procurement challenges

in the future. These many longstanding barriers faced by African

research centres and biotechnology facilities in accessing several

important steps of the value chain, such as pre-clinical research

and good manufacturing practice (GMP) batch manufacturing

for clinical trials, means that it is currently not possible to move a

vaccine concept from research through to clinical trials entirely on

the African continent.[4] This market failure needs to be addressed

urgently.

Seven out of 10 vaccines used in Africa are donated to the

continent by the Global Vaccine Alliance (Gavi). Most are for childhood

immunisation programmes, and are manufactured in India or by

multinational vaccine manufacturers in North America or Japan.[5]

It can be stated that these donations perpetuate dependence and

add to the impediments in the development of vaccines and other

interventions against diseases in Africa. The COVID-19 pandemic

underscored how fatal this dependency on imported vaccines could

be. In addition, Africa cannot rely on fellow states in the Global

South. This is well illustrated by India halting vaccine supplies to the

continent early in 2021, at the height of the Delta variant outbreak,

when only 1.5% of the African population had received a vaccine

dose at that time.[5]

As a response to these bottlenecks, a foundation to provide financial

and strategic support for the development of the pharmaceutical

industry and the consolidation of regional vaccination programmes

in Africa has been established by the African Export-Import Bank

and the African Development Bank. Development and/or expansion

of national vaccine industries commenced in several countries from

2020. Egypt, South Africa (SA) and Senegal have each partnered with

private-sector manufacturers to expand volume capacity. Ghana has

reconfigured part of its pharmaceutical industry to make vaccines.

Rwanda has commenced on work to manufacture messenger RNA

(mRNA) vaccines from scratch. These countries have moved forward,

signed major agreements, and continue raising finance.[4,6]

Even though only 1% of vaccines used in Africa are manufactured

on the continent, there are more than 30 new vaccine manufacturing

initiatives underway, with momentum gathering to make the

expansion possible. The first technology transfer hub for mRNA

COVID-19 vaccines was established in SA in the second half of 2021

to scale up production and access to doses across the continent. The

hub also provides training on mRNA technologies for manufacturers

from low- and middle-income countries, and issues licences to

them so that they can move forward with manufacturing. The World

Health Organization (WHO) took the lead in establishing the hub

in partnership with the international COVAX initiative, Biovac, a SA

company that serves as a vaccine developer, Afrigen Biologics and

Vaccines, a SA company that serves as a manufacturer, universities

and the Africa Centres for Disease Control and Prevention (Africa

CDC). The WHO received assistance from the Medicines Patents

Pool to negotiate with technical partners and support governance

of the hub.[7] In February 2022, SA scientists at this hub reproduced

Moderna’s COVID-19 vaccine, achieving a major milestone for the hub

and the continent.[8]

To address the many bottlenecks described above, the African

Union (AU) and the Africa CDC have called for a New Public Health

Order, the aim of which is to safeguard the health and economic

security of the continent, with a key pillar being that of expanding the

local manufacture of vaccines, diagnostics and therapeutics. In April

2021, at a gathering of African leaders, the Partnerships for African

Vaccine Manufacturing (PAVM) was established by the AU to deliver

on the goal of enabling the African vaccine manufacturing industry

to develop, produce and supply over 60% of the total vaccine doses

for Africa by 2040.[4]

For the vision of the New Public Health Order to be realised, an

integrated ecosystem approach will be necessary. Investment will