There is no doubt that Covid-19 has spurred a lot of thought and reflection across a number of areas and elements. Today, people are questioning the future of work and the workplace with a move towards hybrid working models. Other areas such as retail and tourism are also going through this reflective phase. However, I believe that one of the most important discussions and reflections the world needs to stop and make is the future of vaccinations in Africa. It is most probably safe to say that no one living today has ever thought quite so much about these invaluable substances. Before, especially in developed countries, vaccines were taken for granted however Covid has made everyone focus on the supply and roll-out of vaccinations. Rollouts of Covid-19 vaccines are well underway in some countries, however not for all. This is especially the case for the African continent which has struggled to secure timely access to adequate supplies. Africa relies heavily on vaccine imports: the continent imports almost 99 percent of its routine vaccines today. The Covid-19 pandemic has revived a long-standing question in African and global circles: What would it take for Africa to manufacture its own vaccines? Africa is home to more than 17 per cent of the world’s population, with sub-Saharan Africa alone projected to account for the majority of global population growth over the next few decades. In addition, Africa’s existing vaccine market, estimated at $1.3 billion, is expected to reach a value of up to $2.35 billion by 2030, supported by population growth, expanded vaccination and new products being required. Nonetheless, the African Vaccine Manufacturing Initiative (AVMI) estimates that the continent can currently produce less than 1 per cent of its vaccine needs. This demand and supply imbalance is likely to become even more acute in the future if it is not addressed now. The goal should be transitioning the continent from dependency to agency and security of supply. Vaccine manufacturing is complex and multi-step as a process. There are three main phases which each phase having a further three sub-phases. In the first phase; the antigen manufacturing process; one needs to first grow the organism, then inactivate it before then purifying the antigen. In the second phase; the formulation and filling; there is the blending process followed by filing the vials then freeze-drying them. Finally, there is the packaging and distribution phase which includes the packaging, storing and distribution processes. Each step requires specific equipment, facilities, skills and more importantly each vaccine requires specific elements. Vaccine-manufacturing strategies and consequent cost implications are complex and multidimensional and cannot be generalized, given that many design choices and cost-influencing factors come into play. However, a number of factors are coming into play and which might have a direct impact on the viability and feasibility of vaccine manufacturing. These include technology, the possibility of scaling and the innovations happening both in processes and manufacturing-models. There is also a growing support and lobby for Africa to reduce its dependency on vaccine importation. The past year has in fact seen a deepening of the political and regulatory support required to manufacture vaccines in Africa. Notable shifts include increased political commitments from African and global leaders in steering the local vaccine-manufacturing agenda and improvements in regionalization and the integration of vaccine markets across the continent. This year’s launch of the African Continental Free Trade Area (AfCFTA), as well as the promise of greater harmonization of markets offered by the African Medicines Agency (AMA) and regional economic communities, seem to be helping. Still, more work needs to be done across the enabling environment. Late last week, European Commission President Ursula von der Leyen announced at the G20 Global Health Summit in Rome a Team Europe initiative on manufacturing and access to vaccines, medicines and health technologies in Africa. The initiative will help create an enabling environment for local vaccines manufacturing in Africa and tackle barriers on both supply and demand sides, backed by €1 billion from the EU budget and the European development finance institutions such as the European Investment Bank (EIB). This amount will be further enhanced by contributions from EU Member States. The Team Europe initiative is an integrated and comprehensive support package that will tackle barriers to manufacturing and access to health products and technologies in Africa from all angles and will place the continent’s own actors and institutions at its heart. On the supply side, together with the EIB and development banks, the initiative will incentivise and de-risk investment into local pharmaceutical and biotech companies. The Team Europe initiative will support technology transfer and develop a number of regional manufacturing hubs in alignment with the African Union and the Africa Centres for Disease Control and Prevention (Africa CDC) which recently launched the Partnerships for African Vaccine Manufacturing. On the demand side, the initiative will work with African leaders and communities to tackle the fragmentation of local markets and help consolidate demand, facilitate market integration and the use of locally produced goods. The initiative will greatly strengthen pharmaceutical and health systems, thus creating an enabling environment for sustainability. It will contribute to developing human resources by investing in skills and education, by increasing African research capacities, and by enhancing scientific cooperation between the two continents. As Rwanda continues to position itself as a key regional hub, vaccine manufacturing is also high on the agenda as reiterated by President Kagame during the Global Health Summit last week. Building vaccine manufacturing capacity should be part of a broader strategy to build a life-sciences and pharmaceutical ecosystem. This is definitely something Rwanda should aim for. Malta, the country where I am based, is a small island in Europe with a population of just 500,000. However, through a mix of niche regulation related to pharmaceuticals and other tax and fiscal incentives. In fact, due to this, Malta is home to world’s leading generic pharmaceutical companies and medical device companies that use Malta as their manufacturing hub to access the European market. There is no reason why Rwanda cannot replicate this for vaccine and pharmaceutical manufacturing. Expanding vaccine manufacturing in Africa is a complex undertaking, requiring several factors to align. Critically, the nascent industry needs widescale collaboration among a broad range of stakeholders, including pan-African leadership organisations, regional economic governments, national governments, private-sector players, and global-health actors. The global Covid-19 pandemic presents a unique moment for leaders across the public, private, and social sectors to align on the importance and potential for developing this sector. The case for homegrown vaccine manufacturing is by no means obvious, but with the right level of commitment and support it is not out of reach for some countries, Rwanda being one of them. The writer is a partner at Seed, a research-driven international advisory based out of Malta, Europe. jp@seedconsultancy.com | www.seedconsultancy.com
