The Covid-19 pandemic devastated the African continent in many ways – economically, socially and politically – with the disruptions evident in all parts of the world. However, like other pandemics and epidemics, Covid has exposed critical failures in multilateralism and global solidarity.

Africa has remained among the last in line to access necessary medical supplies and tools – from personal protective equipment to diagnostics, therapeutics and vaccines.

Our African local manufacturers are at a competitive disadvantage due to the different market forces, including poor and inefficient production value chains, high cost of production of medicines and vaccines and poor financing and financing models.

It is therefore important to open and sustain financing discussions about raising funds for African manufacturing specifically.

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In response to the systemic failures in global health security architecture, Africa has witnessed remarkable regional and national leadership in responding to the pandemic, and, importantly, in identifying what needs to be done and prioritised in the quest to strengthen both national and continental health security.

The 2nd International Conference on Public Health in Africa (CPHIA) – convened by Africa Centres for Disease Control and Prevention (Africa CDC) in Kigali in December 2022 – presented a platform for different stakeholders to share lessons and outline what needs to be prioritised to strengthen health security on the continent.

The underlying consensus at a side event co-convened by the Coalition for Health Research and Development, the South African Health Technologies Advocacy Coalition and the Pandemic Action Network at CPHIA 2022, was that only a strong and sustainable local manufacturing industry would strengthen global health security and afford Africa a robust system that would sustainably increase access to life-saving health products and reduce reliance on other regions – especially when pandemics and other health crises strike.  

It is easy to forecast this as an important agenda in other conversations this year, including in the upcoming Africa Health Agenda International Conference 2023 in March and the World Health Assembly in May 2023.

Accelerated action

As political leaders, the private sector, academia and civil society actors increasingly show convergence on what needs to be done to enhance health security in the continent, it is time to accelerate the action.

The continent must not be found unprepared and without resilient health systems when the next pandemic strikes. Some key recommendations from the discussions in Kigali point to the areas requiring accelerated action.

First, African governments play a central role in sustainable financing and institutionalisation of a streamlined regulatory system that encourages research and development, domestic product development and sustainable incentivisation of the private sector. These efforts will contribute immensely to attracting investors, as well as pooling expertise and capacities in and across countries and sectors, to enhance coordination in the development of high-quality local products that reach the people who need them.

In view of the above, it is imperative to fast-track the operationalisation of the Africa Medicines Agency (AMA) – a continent-wide platform for strengthening and harmonising continental and regional regulatory authorities. 

With barely half of the 54 member states having ratified the AMA treaty, it is critical that outstanding member states expedite their efforts. 

Cost and access

The focus must also be on addressing the issues of cost and access to medical products for citizens. African governments must demonstrate commitment to purchasing African-made products – an initiative that will require policy and legislative reforms at country level.

Furthermore, African governments must nurture partnerships that seek to prioritise technology co-creation rather than technology transfer. 

Co-creation of technology will sustain a viable ecosystem that incorporates the needs and priorities of the target population from the onset. It will also open doors to a more sustainable and equitable process that is mutually beneficial for African countries and international partners.

Africa’s first mRNA technology and transfer hub, based in South Africa, is a promising initiative that should be supported, as it has the potential to transform medical countermeasure innovation, particularly for vaccine production. 

Collaboration

Finally, there is a need to build strong coordination mechanisms across the manufacturing ecosystem with clear-cut frameworks that leverage private sector engagement and cross-sectoral collaboration. Commercial viability is not an incentive and most would-be investors would shy away from investing in a public good that does not add to their shareholder value.

By working together, we can better understand industry needs – from infrastructure and staffing to business plans and profit margins. To this end, concerted efforts and collaboration of civil society and non-government organisations, governments and multilateral organisations, the private sector and different investors is key to ensuring public good investments that are alive to the needs of society and the commercial viability for resource-intensive business enterprises. 

The African Union and the Africa CDC’s Partnerships for African Vaccine Manufacturing Framework for Action offers a blueprint on how to accelerate local manufacturing in a coordinated way. 

More in-country resources and an enabling environment will provide a domino effect that will guarantee returns in the long run and incentivise governments to facilitate the institutionalisation of frameworks that would focus more on the public good than government bureaucracy and tax obligations. 

Partnerships between African countries – through joint ventures and centres of excellence supported by knowledge exchange, as well as capacity building and legislative frameworks – would guarantee both opportunities for establishing solid export bases and the possibility of consolidating pharma industries. DM/MC

Dr Githinji Gitahi, Aggrey Aluso, Dr Margareth Ndomondo-Sigonda, Prof Geoffrey Setswe and Dr Simon Agwale were panellists at the 2nd International Conference on Public Health in Africa side session on ‘Expanding Local and Regional Production of Medical Countermeasures in Africa’.