Cape Town - It has been three months since the confirmation of the first known infection in South Africa and the African continent from severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19).
The arrival of Sars-CoV-2 in an already burdened continent, where communicable and non-communicable diseases are endemic to certain regions, places already struggling health systems under considerable strain.
In sub-Saharan Africa, infectious diseases account for approximately 69% of deaths, with diseases such as malaria, tuberculosis and HIV being the most prominent contributors to the disease burden.
This is complicated by armed conflicts and exacerbated by socio-economic conditions, as well as by sharply increasing rates of chronic diseases such as diabetes, cancer, and heart disease.
Poverty, conflicts, inadequate nutrition, lack of sanitation, and hopelessly under-resourced health-care systems, together with the double burden of chronic and communicable diseases, all combine to severely constrain the continent’s ability to respond to pandemics.
These adversities highlight the importance of biomedical science - and in particular, the ability to develop and manufacture vaccines - for Africa’s development. African governments, for their part, have shown little enthusiasm for local vaccine production. This presents a major obstacle to Africa’s development, condemning it to the role of a passive consumer, rather than an active player.
India provides a good example of how to break free from this dependence. India’s vaccine industry has been developed over a number of years, with private manufacturers collaborating with institutions of higher learning. Brazil and Cuba also offer lessons in using public institutions to establish local vaccine production. These countries committed to build their own biopharmaceutical manufacturing industry, initially focused on domestic needs and subsequently expanded to supply international markets through the UN Children’s Fund and the Pan American Health Organization.
According to UN forecasts, four African countries - Ethiopia, the Democratic Republic of Congo, Tanzania and Uganda - will be among the 20 most populous countries in the world by 2100. A glance at the situation in Ethiopia indicates the potential for expansion, as well as the current shortfalls.
According to Ethiopia’s pharmaceutical strategy document, there are approximately 200 importers of pharmaceutical products and medical consumables in the country.
The local industry comprises 22 pharmaceutical and medical suppliers and manufacturers, nine of which are involved in manufacturing pharmaceutical products. However, these manufacturers operate well below their capacities and supply only about 20% of the local market. One of the challenges facing Ethiopian manufacturers is their limited product portfolios, which reportedly enable them to supply only 90 of the more than 380 products on the national essential medicines list.
It is also worth noting that Ethiopian entrepreneurs collaborate mostly with investors from China, India, Jordan, Saudi Arabia, Sudan and the United Arab Emirates - in other words, with noticeably few African investors.
There can be little doubt that the Sars-CoV-2 pandemic is going to have a long-lasting global impact. It is all the more important, therefore, for African governments to do a volte-face on the question of building local vaccine manufacturing capacity.
This will undoubtedly be an expensive task, and one that will test the continent’s ability and willingness to collaborate. The implementation of continental science strategies, such as the Science, Technology and Innovation Strategy for Africa 2024 (Stisa-2024) and the Pharmaceutical Manufacturing Plan for Africa, will, therefore, be critical for creating a conducive environment for effective intra-African collaboration.
Reducing the skills mismatch and leakage of biomedical science skills will also be key to achieving the objectives of Stisa-2024, as well as the socio-economic development goals.
In South Africa, for example, an estimated 40% of these skills are lost to the finance sector. To help address this, multinational companies hosted in African countries should be required to commit to industrial development through intensive and targeted training.
Through collaboration between regional economic blocs, there is ample opportunity for developing vaccine manufacturing in the continent. South Africa is showing what is possible through its investment in the Biovac Institute, a public-private partnership aimed at advancing vaccine manufacturing in the country.
Among other achievements, Biovac has established fermentation suites for vaccine formulation and the purification of ingredients, and developed a technology package for the manufacture of a conjugate vaccine for Haemophilus influenzae type B, a bacterium responsible for severe pneumonia, meningitis and other invasive diseases in children under the age of 5.
The 2009 H1N1 influenza pandemic and the 2013-16 Ebola epidemic in West Africa exposed the continent’s lack of capacity for developing strategic vaccines. Now, the Sars-CoV-2 pandemic is challenging African countries to respond in a determined, concerted fashion, both to invest in this capacity and to address the socio-economic conditions that render their populations so susceptible to infectious diseases.
Dr Sekhejane is a Research Specialist at the Africa Institute of South Africa within the Human Sciences Research Council.