South Africa and the rest of the continent have survived the Covid-19 pandemic, but not unscathed. According to the World Health Organization (WHO) 102,595 people in South Africa had lost their lives due to Covid-19 by the end of September 2023 with this number likely underestimated given excess death figures.

This highlights the devastating human cost of the pandemic, which is above and beyond the immense cost to the country’s economy. This is the impact of a rapidly spreading infectious disease. Lives lost, and families robbed of loved ones and their economic security.

We are still recovering from this impact almost four years after the disease emerged. This also critically highlights that the case for supporting vaccine manufacturing is far more complex than a per unit cost consideration, which can be applied to other goods and services. Rather, it is a consideration of national interest and health equity.

In the opinion piece “Local is lekker, but government’s overreliance on localisation is a potential disaster waiting to happen” (Daily Maverick, 26 September 2023) the authors make a broad argument about the dangers of localisation for the economy, viewing cost as a decisive factor in their analysis of the policy across several economic sectors.

This response is not about the merits of their overall argument. It is a clarification of the importance of the rationale which underpins building a local vaccine manufacturing sector with long-term sustainability. Simply put, not all sectors are equal when it comes to which economic policy approaches and considerations best serve national interests.

When vaccines first became available for Covid-19, it became painfully apparent that the initial global solidarity that the emergence of the virus had fostered evaporated in the face of constrained initial supply. This led to developing nations, including South Africa, being placed at the back of the queue, reliant on the goodwill of other nations.

Recent media reports have highlighted that during the pandemic, price and availability of life-saving vaccines on the global market were significant factors which drove inequitable access to these medicines. This brings into sharp relief the importance of being able to manufacture these life-saving products locally and build sustainability into the sector, which achieves increasingly lower prices.

Held to ransom by overseas manufacturing

The pandemic was a wake-up call for South Africa (and the continent) on how reliant our populations are on the developed world for vaccines. The last two years have also seen outbreaks of cholera, albeit on a significantly smaller and regionalised scale.

Mirroring the events of the Covid-19 pandemic, globally there is a limited supply of cholera vaccines because the incidence of the disease has seen an unanticipated upward trend in recent years. So much so that the World Health Organization started rationing supply, thereby trying to stretch supply as much as possible – and despite this shift, supply of the vaccine still ran out in December 2022.

Support to foster a local vaccine manufacturing sector is first and foremost about being able to protect South Africa from dread diseases. In the case of pandemics, the national interest must surely be about the matter of timely access to medicines, which will mean life or death, rather than about unit cost. It is therefore not a nice-to-have, but a matter of health security.  

This is a sentiment which was shared repeatedly in recent global fora such as at the United Nations General Assembly held in New York where the pandemic prevention, preparedness and response (PPPR) aims to further mobilise political momentum, including through the integration of a multisectoral approach towards pandemic prevention. Part of this plan is to ensure that there is localisation of vaccine manufacturing within regions.

Whereas globalisation has enabled countries to rely on the comparative and competitive advantage of other nations, which allows for lower marginal costs for almost any good and service, when it comes to infectious diseases and the availability of the medicines which treat them, it does not serve any country to be reliant on another’s altruism if supply is constrained.

In other words, if one discounts the other benefits of building local manufacturing (such as jobs and building a skills base), there is a significant difference between a consumer being able to buy more affordable foodstuffs or a microwave oven, for example, and having no option to access a vaccine for a dread disease timeously during an outbreak.

The cholera, Ebola and mpox outbreaks and global vaccine shortages illustrate that this is not just an issue during pandemics. Emerging and known pathogens, especially in the context of climate change, will likely increasingly impact South Africa. These outbreaks, because of the nature of how air and waterborne diseases are spread, are more likely to impact vulnerable and economically marginalised communities most. These lives do and must count as part of the consideration.

When disease can be prevented, whether through proactive immunisation campaigns or reactive ones during an outbreak, access to vaccines should never be the deciding factor in achieving health equity. DM