To help solve the vast vaccine inequality and vaccine inaccessibility around the world, which is unfolding before our eyes again with mpox, Executive Editor of Business Philippa Larkin interviewed Dr Stavros Nicolaou on what it would take for the continent to be able to manufacture its own vaccines.
Nicolaou is Aspen Pharmacare Group’s senior executive responsible for Strategic Trade Development and who is also the chairperson of Pharmaceuticals Manufactured in South Africa
In Nicolaou’s words:
Africa currently imports 99% of its current vaccines, and produces 1% or less.
In 2020/21 when Covid-19 hit, the whole world, and particularly the African continent, was caught off guard. Wealthier nations bought vaccines ahead of their production - effectively hoarding vaccines. In other words, it's like buying a car, and you pay for it today, and you pay a premium for it because you can afford to pay it, but you don’t know if the car will work .
That exposed Africa, which has a lack of vaccine capabilities. In a health pandemic this lack of local vaccine capabilities became problematic.
The solidarity that nations all spoke about at the beginning of the pandemic, March, April, 2020, went out the window in the face of a public health crisis.
This triggered a vaccine campaign, largely led by the African Union to produce them in Africa. President Cyril Ramaphosa was the chairman of African Union (AU) at the time. This has been continued with the other (AU) subsequent chairs. The Africa Centres for Disease Control and Prevention has been strengthened quite significantly to enable affordable disease control.
The AU upgraded the CDC given the impact of public health emergencies and crises on lives, livelihoods and economies. After Covid-19 the status of healthcare was elevated.
In the four years since Covid-19, Africa said, “Never again shall Africa be caught short and we must be prepared for the next pandemic, regional or global. Four years on we're taking stock and now we're seeing the emergence of impacts.”
But have we managed to execute or implement any of those plans to localise and have regional manufacturing? Can we move to our own vaccine production?
SA local vaccine manufacturing status quo
1. Africa and South Africa don't have research and development capabilities yet. One has to receive an international technology transfer first that can take you 12 months to complete a technology transfer.
2. You have to register the product in South Africa via the domestic regulator, South African Health Products Regulatory Agency (Sahpra). Sahpra has just put out a priority review policy for locally produced products in the interest of health security and security of supply, which is positive.
3. Vaccine manufacturers then have to take the registered product in South Africa and send it to the World Health Organisation (WHO) for it to pre-qualify the product because Africa will only buy the vaccine if it's pre-qualified.
Challenge: Overall, with these three steps, the process takes a long time. It takes 12 to 18 months for a technology transfer, 12 to 18 months to register it here in South Africa. Then another 12 to 18 to pre-qualify at the WHO.
Solution: This needs to be changed to a parallel review. While Sahpra is reviewing a product in South Africa, the WHO should be doing a review as well in parallel so you don't lose out on that 18 months.
But for Africa to produce vaccines three things need to happen:
1. Technology
Technology transfers, because Africa doesn't develop its own technologies. Challenge: Not everyone wants to transfer their technologies.
2. Reforming procurement from Africa
Around 60% of Africa's vaccines are procured through Unicef's Gavi, the global vaccine alliance, which has a number of donors with the US as the biggest donor. The other 40% is from other donors or from governments procuring vaccines themselves.
Gavi carries out the procurement, the contracting and the distribution of vaccines. But the procurement mechanism of Gavi and Unicef hasn't been oriented towards African procurement.
3. Africa pooling procurement mechanism
Africa also needs to set up a pool procurement mechanism to buy vaccines.
African Vaccine Manufacturing Accelerator
On June 20, 2024, a high-level event co-hosted in Paris by the Government of France, the African Union, and Gavi, the Vaccine Alliance, along with the support of Team Europe, launched the African Vaccine Manufacturing Accelerator (AVMA).
AVMA will subsidise for every dose that gets produced in Africa 30 US cents.
But how effective is the AVMA going to be in establishing sustainable vaccine production in Africa?
There have been many failed attempts on the continent where individual countries have put up plants and then shut them down in two years time, or downsized them.
There can only be sustainable plants in Africa if there's an ongoing demand and off-take deals from international procurement agency Gavi and other agencies start to procure domestically or regionally from Africa.
We haven't seen a single order placed yet in Africa, other than small quantities of yellow fever vaccine, hence the 99% import statistic.
Despite the promise of AVMA subsidising vaccines, one needs guaranteed off takes for Africa. That guarantee will change the picture completely. Manufacturers can then invest. Without that vaccine production is unviable.
Reforming the international procurement agencies, procurement mechanisms is key.
What has been successful is former US president George W. Bush's President's $15 billion (R266bn) Emergency Plan for AIDS Relief (Pepfar), launched in 2003 at the heart of the HIV pandemic.
It has been used by the US in supporting 14 of the most affected African countries of HIV, including South Africa and two Caribbean countries, Haiti and Dominican Republic. This turned the tide against HIV.
Pepfar came out recently and said they would procure up to 2 million African patients from African producers of antiretrovirals. This is a firm offtake commitment - a very positive development. Others can learn from this.
The benefits of vaccine production in Africa is security of supply. Thus reforming procurement at domestic and international agencies needs to be done urgently.
Africa also needs to set up a pool procurement mechanism for Africa.
These measures would be a real game changer enabling local vaccine manufacturing in Africa to become sustainable.
BUSINESS REPORT