COVID was unequivocal in how it shined a light onto profound global health inequity and access issues. And nowhere was that more clear than across the continent of Africa. Yet, the causes of these issues are not as clear-cut as many might think. They instead exemplify just how long and complicated the process is to get low- to middle-income countries up to their high-income siblings when it comes to pandemic response, vaccine R&D, manufacturing, distribution, and even patient uptake.
“There were multiple drivers for the serious global inequities we saw in access to COVID vaccines,” began moderator Jeremy Knox, Head of Policy of Infectious Disease at Wellcome Trust during the 2023 BIO International Convention panel, Vaccine manufacturing in Africa: Challenges and Opportunities.
“One of the very key issues in terms of the effectiveness availability on the African continent is that 1.2 billion people were entirely dependent on supplies of vaccines from elsewhere in the world. It’s clear this was a particular challenge during a pandemic response, when we saw all sorts of geopolitics at play and disrupted global supply chains, but it’s also an issue when it comes to meeting routine vaccination needs in Africa as well. To compare, today, only 1% of the other continent’s needs are met from within Africa.”
The panel conversation was comprehensive, but the ultimate understanding by panelists was united: While it may take a great deal of time and resources to bring Africa up to speed, it is a fundamentally worthwhile endeavor.
Manufacturing potential in Africa
No two countries in Africa are the same and, as such, the manufacturing potential and challenges across the continent are highly varied. But as biotech companies and government bodies look to where the inception points of biomanufacturing in Africa exist, two countries stand out: South Africa and Nigeria.
Genevieve Keshwar, Manager of Business Development at Biovac outlined the company’s perspective on manufacturing in South Africa saying, “Biovac’s vision for manufacturing vaccines in Africa is to become a center and to do this through partnerships. We need to partner with other companies that have the technology, that have the infrastructure, and that will be able to bring that through to South Africa so that, through partnership, we’ll be able to manufacture and call forward supply for the rest of Africa.”
“The ambition of Africa is to start producing vaccines,” said Glaudina Loots, Director of Health Innovation at the Department of Science and Innovation South Africa. “As such, the African Union, the African CDC, and different parts of African vaccine manufacturing have partnered to look at both industry and policy aspects as needed to grow facilities across Africa. We understand that we have to be realistic. Each country can’t have a vaccine facility. We need to be realistic about that because you still need economies of scale.”
Speaking from the Nigerian perspective, Aminu Umar-Sadiq, Managing Director & Chief Executive Officer at the Nigeria Sovereign Investment Authority (NSIA), explained that the first thing many African countries need to address is self-sufficiency.
“The second would be capacity enhancement, particularly of our regulators,” he said. “The third would be the effectiveness of partnerships both within frontier economies, but also between our respective countries and those that have the requisite skill set to bring in the technical expertise.”
European partnership with Africa
Filling out the panel were two leaders from the European policy sector, Emma Wheatley, Director of Access and Private Partnerships at CEPI, and Pierre Delsaux, Director General at the Health Emergency and Preparedness Response Authority (HERA) European Commission.
“Building walls is important,” said Delsaux idiosyncratically, “and as Europeans, we are investing in building vaccine production facilities in different parts of Africa.”
But Delsaux agreed with the perspective of the African panel experts. “We can’t build a facility in every country. It’s not feasible. We need to be realistic about social indicators. We also need to look at the different technology platforms, because we don’t know what will be needed for the next crisis, and we need to build different types of the platforms to plan ahead effectively.”
“It will happen, but we need to be realistic that development will take time. We should not rush, but you should get something workable going as well,” he concluded.
“Building equity into systems is essential, and that is the main focus for CEPI,” added Wheatley. “In supporting what African countries want to do around manufacturing, we want to make sure that we are helping see forward their plan and support that in the best way that we can.”
Wheatley broke down CEPI’s goals for supporting African countries into three pieces:
- “One is that diversification piece, which is making sure that technologies are available on the continent and that the capabilities are there to support it,” she said.
- “And second is sustainable business models, which are critical. We work to look at those from an end-to-end perspective, from an outbreak perspective, but also from a routine vaccine perspective and looking at how we can innovate to strengthen and provide different inputs to make those sustainable models more realistic.
- The third area for us is the surrounding systems. We work to support the regulatory systems, and how we can use our programs to strengthen the regulatory systems that are needed to work alongside manufacturers, the clinical trial networks, and also the supply chain that goes into the African manufacturing facilities—because without the right inputs, nothing will be able to be made.”
Industry development in Africa
To balance out the panel and give the industry perspective, Hamilton Bennett, Senior Director of Vaccine Access and Partnerships at Moderna, was also present and outlined her company’s key activities toward enabling this sustainable manufacturing.
- “The first activity, from our perspective, is focused on markets,” she said, “and really building sustainable markets, understanding your demand, where vaccine manufacturing demand might lie, and then putting procurement models in place that allow the public to quickly access those vaccines and in line with that access to financing capital. I think in the short term, there is capital available to look at short-term investment in public health, so Moderna is asking, how do we, with a better understanding of the market dynamics, convert that into a long-term investment in the potential and the capability of a healthy populace?
- The second thing we think about is what kind of workforce development is required to sustain this ecosystem. Do we have the right R&D infrastructure to develop products that are required and unique to the region? Do we have the regulatory capabilities to efficiently bring products forward and make sure that they’re manufactured with a high quality and can be exported between countries in Africa and then ultimately beyond?”
Ultimately, despite the varying points of view, it was clear that there is much clearer political mobilization for the long road ahead to expanding biotech manufacturing in Africa.
“What is clear post-COVID is that there is a growing appetite to address manufacturing issues in Africa,” said Knox. “We want to ensure that vaccine manufacturing capacity can be built up in Africa and progress can be made towards self-sufficiency, both for routine needs, but also to respond to future emergencies, whether that’s pandemics like COVID, or other outbreaks like Marburg and Ebola. In recent years, we’ve seen political mobilization behind this agenda.”