Six hundred million doses of Covid-19 vaccine were administered worldwide by the end of March. However, only 8 million had been given out in sub-Saharan Africa, a region with 1.3 billion people. By contrast, more than 35 million shots were administered in the same period in the UK (population: 67 million). The glacial pace of vaccination in the developing world, and in sub-Saharan Africa in particular, amid vaccine nationalism in developed countries, raises questions about how Africa can lessen its dependency on donors for its health security. One answer lies in an Africa-based pharmaceutical sector capable of manufacturing essential drugs and vaccines. It could also jumpstart Africa’s broader economic development.
But to begin, how dire is the current situation? The best estimate is that Africa might secure 720 million doses of vaccine through the World Health Organization’s Covax facility to reach 60 percent vaccine coverage by mid-2022. So, more than a year from today, Africa still will not reach “herd immunity.” No Covid-19 vaccine is currently produced in Africa and most countries in the region cannot afford to outbid developing countries for vaccines. Indeed, many developed nations have reserved for themselves more doses of vaccine than they need for their population. Canada can inoculate its people five times over with the number of doses it has reserved. Moreover, with second-generation vaccines likely to have emerged by this time next year, will Africa’s competition with the West start all over again?
Yet Africa has the potential to guide its own destiny. Pharmaceutical companies exist in nearly 40 African countries. The problem is, most do very basic work. For the most part, the industry is limited to packaging already manufactured medicines, or buying active pharmaceutical ingredients (APIs) to combine into medicines. Only three companies, two in South Africa and one in Ghana, actually manufacture APIs themselves. None undertake research and development.
The Covid-19 pandemic has shown the importance of thinking globally and acting (rapidly, pro-actively and robustly) locally. It has also raised questions as to the potential benefits of localizing pharmaceutical production, and expanding production across the Global South. The example of the Serum Institute of India, which has been licensed by AstraZeneca to produce over 100 million doses of vaccine a month, has shown how stronger partnerships between pharmaceutical companies based in the Global North and those in the Global South can play an important role in responding to a global health crisis. With new technologies that allow for the more rapid production of drugs and vaccines, and the resurgence of public-private partnerships in driving forward research and development, the question is whether it is possible for the success of the Serum Institute to be replicated in sub-Saharan Africa.
The expansion of the African pharmaceutical sector would provide a more local and secure source for key vaccines and drugs, reducing the need to rely on the goodwill of developed-country donors. The use of new small-scale responsive technologies, for example, computational science in developing new drugs, as well as technologies that allow for the small-scale production of drugs, might result in highly localized centers of production better able to respond quickly to local outbreaks (and in doing so, support global health security).
Direct economic gains achieved from import-substitution might be relatively small, not least because of the highly complex supply chains for APIs that would likely remain globally sourced. The number of people directly employed in a significantly expanded sector would still remain relatively small.
But the ancillary impact of investing in this highly skilled sector could magnify economic gains and encourage further investment in areas such as chemical production, distribution networks, equipment manufacturing and so on. Research on the impact of the production of insecticide-treated bednets for malaria, in Tanzania, for instance, suggests that the presence of a local factory directly stimulates new income-generating activity within the area.
But, as previous efforts to develop an African pharmaceutical sector have found, there are a number of constraints that must be overcome.
First, pharmaceutical manufacturing, and especially research and development, is capital intensive and will require partnerships between governments, donors and private pharmaceutical companies. The latter will need to be persuaded that they can still make profits from licensing drug production to Global South partners.
Donors, in whose countries many of these companies are based, will need to be persuaded of the value of shifting production out of their own jurisdictions. But the emergence of new medicines reliant on partnerships between public-funded research and the private sector has changed the cost calculations and enabled governments to negotiate production licenses outside the Global North. There is no reason why this can’t be extended to Africa.
Next, any large-scale development of an African pharmaceutical sector would almost certainly be limited to a number of regional hubs. A strong pharmaceutical sector, and one that can respond to local, regional or global health crises, must be able to easily and cheaply distribute across borders. This highlights the importance of tariff-free trade. There has been substantial progress in removing internal barriers to trade, but much more work needs to be done.
Lastly, regulatory constraints, such as slow and disconnected drug-licensing systems and over-zealous protection of intellectual property rights, will need to be addressed. Working closely with the World Health Organization, and embedding health-product regulatory systems in the African Union, could help not only manufacturing, but research and development. This will encourage manufacturers to innovate beyond just producing to a license.
As the world begins to slowly move out of the worst phase of this global health crisis, now is the moment to think about remodeling pharmaceutical production and manufacturing in ways that better meet the health needs of the Global South majority. Investing in an African pharmaceutical sector could be an important part of that recalibration. Indeed, if electronics allowed East Asia to jump the development hurdle, pharmaceuticals might do the same for Africa.
Michael Jennings is Reader in International Development at the School of Oriental and African Studies, or SOAS University of London, where he works on issues related to global health and the politics and history of global development.