It’s been just more than three years since the Covid-19 pandemic shut down the world. In May this year the World Health Organization finally declared the global health emergency over. In large part this was achievable because of the development, production and distribution of life-saving vaccines.

And this week the world’s health authorities gather in Geneva at the World Health Assembly to discuss pandemic preparedness and readiness. Foremost on the agenda should be how local vaccine manufacturing can and must be better supported.

While Covid-19 vaccinations have been freely available in South Africa for many months now, it is worth remembering that this was not always the case. When the vaccines were first developed, these were only made available to developing countries months after the developed world had begun receiving them.

Once they were made available locally there were long queues, standing anxiously distanced but together with hundreds or even thousands of others at health facilities, or waiting to be treated after being infected with the virus. Nations jostled to secure tranches of these critically needed medicines which would save the lives of the most vulnerable and reopen shuttered economies.

Covid-19 shone a light on the options available to countries with no domestic vaccine manufacturing capacity (and relatively reduced purchasing power). They become wholly reliant on other states acting for a common cause, against their own self-interest. All too painful for South Africa, a UN expert on human rights described the inequity in access to Covid-19 immunisations between nations as “vaccine apartheid”.

Fortunately, South Africa’s democratic government has long recognised the need for local vaccine manufacturing. Since 2003 it has worked with the private sector towards securing domestic vaccine security. This entailed investment into an entirely homegrown vaccine public-private partnership, Biovac.

That investment has been a distinctive success against the backdrop of numerous failed initiatives. Today, Biovac is the only local vaccine manufacturing company (not just “finish and fill” using materials from foreign states and companies) and is partially owned by the government through the Department of Science and Technology’s Technology Innovation Agency. The government’s nearly 20-year investment meant Biovac could produce Covid-19 vaccines during the pandemic on home ground.

Even more promisingly, South Africa is just about to start reaping the long-term rewards of that enlightened investment.

Biovac’s operations, and the range of vaccines produced, have steadily and sustainably expanded since inception towards global competitiveness.

Biovac has enormous potential… for ground-breaking world firsts based on our domestic medical research and innovation capabilities.

Biovac has built a highly qualified, skilled workforce, the majority of whom are scientists, with an industry leading a more than 90% black and more than 52% female demographic profile. Biovac has proudly facilitated foreign direct investment in response to the President’s Global Investment Drive, attracting more than R1-billion, including from Pfizer and the Bill and Melinda Gates Foundation.

Through its operations, direct, indirect and induced employment, as well as backward value chain links, the company contributes a compelling R10.3-billion to the national economy each year.

Biovac has been able to attract global partnerships such as Pfizer and Sanofi and in addition has been able to secure funding for research and development activities from the likes of the Bill and Melinda Gates Foundation and the Wellcome Trust.

Read more in Daily Maverick: SA’s short-sighted vaccine manufacture and procurement policy compromises Africa’s development

The bedrock of these global partnerships has always assumed support afforded by the government in providing Biovac with a market in which it competes fairly. The Department of Health has procured numerous vaccines from Biovac under the immunisation programmes. Having the department as a secure client gave Biovac the reliable revenue runway to sustainably plan for and grow its operations, which currently includes the development of a vaccine against cholera – an African first.

And there are more in development, with one product expected to earn significant revenues for the country once it goes to market, including the associated socioeconomic benefits.

Gains at risk

Biovac has enormous potential, not just for vaccine security or the economy – but for ground-breaking world firsts based on our domestic medical research and innovation capabilities.

However, a procurement decision by the Department of Health this year could result in all these gains being lost, at a critical point. A recent tender for pneumococcal vaccinations, which Biovac manufactures locally (specifically the PCV13 shot) and has been part of the department’s childhood immunisation programme since 2011, was awarded to a foreign supplier to provide a cheaper vaccine that is not similar to what newborns have been receiving to date (PCV10).

More crudely put, South Africa’s infants and children will now be receiving PCV10 vaccination with less pneumococcal disease-specific coverage when compared with the locally made and more advanced PCV13 vaccine tendered by Biovac.

The implications of this decision are enormous – for jobs, for economic growth, for future investments and for the health of our population. Biovac is on the very cusp of being able to run sustainably without reliance on South African government tenders. These capabilities have been built over decades and need to be nurtured and supported through a supportive ecosystem of regulatory reform and legislated preferential procurement policy.  

The Biovac reality is a cautionary tale of the grave implications when political will is not supported by policy coherence.

But this is not just Biovac’s experience talking. The cases of Bangladesh, Argentina, Brazil and Indonesia are instructive. Bangladesh specifically, recognising the needs of its growing and diverse population, began supporting its local pharmaceutical sector in the early 1980s.

And those early, insightful investments and initiatives have delivered massive long-term success. Bangladesh now exports pharmaceuticals to about 151 countries; and in 2016-17 it earned revenue from exports amounting to $131-million. The sector also employs about 150,000 people.

There is much South Africa can learn from the Bangladesh case. The aim of government support is not to give an emerging company or sector an unfair advantage. Rather, it is to support them to reach a scale where they can compete with international peers sustainably, recognising their inherent importance to the country’s national interest.

Read more in Daily Maverick: Health Department comes to Cipla’s defence after Biovac claim tender was unfair

The perplexing fact is that localisation of vaccine manufacturing is already stated policy in South Africa. It is also President Cyril Ramaphosa who has spearheaded the African Union agenda for Africa vaccine sovereignty with a request that 30% of all vaccines destined for African countries be procured from African manufacturers.

The Biovac reality is a cautionary tale of the grave implications when political will is not supported by policy coherence.

While there are many products or services which one could present arguments for in favour of purchasing for price over local development considerations, vaccinations should not be among them.

We have already faced down the existential threat to life that the scramble for Covid-19 vaccines revealed. We should also be reminded that the threat of outbreaks continues after Covid, as demonstrated by cholera, monkeypox and Ebola outbreaks.

Having local capacity within South Africa has already made a crucial difference. It meant the country could and did – through Biovac – produce life-saving vaccines during the pandemic.

But without the continued support of the government, in line with its stated policy on localisation, we will lose all hope of this dream remaining true. DM