Africa is home to about 375 pharmaceutical manufacturers, according to a 2019 McKinsey report. For a comparable population, India and China have 10,500 and 5,000 drug manufacturers respectively.
Of the 1.8 billion Covid vaccine doses shipped under COVAX, 0.6 billion made their way to Africa. With an internal vaccine demand of over a billion dollars, Africa itself produces only 0.1% of the global supply. As for medication, the African continent imports over 70% or $14 billion worth of its requirements.
It is no surprise, then, that in May 2022, Heads of State of the African Union lamented the low Covid vaccination coverage rates, then at only 16%. During the pandemic, international supply chain disruptions led to added challenges in accessing essential drugs for other health conditions across the continent, including in Rwanda, Kenya and Nigeria. The pandemic also undermined progress Africa had made till then in access to HIV, malaria and TB medicines. Patents on foreign technologies, export bans imposed by vaccine-supplying countries and inadequate domestic infrastructure held the continent back in its fight against the pandemic.
For some years now, Africa has been taking steps to develop its own healthcare and pharma ecosystem; the continent has been establishing key institutional bodies and regulatory frameworks to enable indigenous pharma solutions. Considering the effects of the pandemic, in 2021, the African Union outlined a vision to manufacture at least 60% of their vaccines by 2040.
On the development front, in 2019, the New Partnership for Africa's Development (NEPAD) became the African Union Development Agency (AUDA-NEPAD) with a mandate to strengthen capacity and regional integration in service of Agenda 2063. Specifically, on the healthcare front, the Africa Centers for Disease Control and Prevention was formally launched in 2017 to support African Union governments' public health initiatives by addressing gaps in infrastructure, regulation, human capital investment, market access, surveillance, diagnostics and emergency preparedness.
Pan-Africa bodies are also in development to promote innovation and manufacturing. In June this year, the African Development Bank approved the setting up of the African Pharmaceutical Technology Foundation, which will focus on developing solutions to diseases that disproportionately affect the continent and supporting an R&D ecosystem, local production capacities and regulatory quality. As for the African Medicines Agency (AMA), as of September 2022, 34 governments have ratified the AMA Treaty, setting the stage for establishing the Rwanda-headquartered agency. The AMA will work to fortify local pharma production via market authorization, inspection, surveillance, safety monitoring, clinical trial oversight and quality control.
The harsh lessons of the Covid pandemic have quickly sparked increased investment in African pharma manufacturing - by regional governments, development agencies and international companies. In partnership with Sweden's Recipharm, Morocco has started construction of a 3-line plant for the manufacture of Covid and other vaccines, APIs and biotherapeutics; it is estimated to have a production capacity of 116 million units by 2024 and will require €400-500 million investment. In a 2021 joint venture between China's Sinovac Biotech and Algeria's Saidal, the African nation started production of Sinovac vaccines in Constantine, with an eye to producing 96 million doses per year. Senegal is seeing international support from the US International Development Finance Corporation, the International Finance Corporation, the European Investment Bank and the French Development Agency for their vaccine manufacturer Fondation Institut Pasteur de Dakar (IPD); this $200 million manufacturing hub is expected to be producing 25 million vaccine doses by the end of this year.
Ghana has also indicated a commitment to making within Africa - it has announced the commencement of Covid vaccine production by early 2024 and the establishment of a National Vaccine Institute. Earlier this year, the Botswana President and NantWorks CEO launched the construction of the NantBotswana Vaccine Manufacturing Plant, which will produce the Corbevax vaccine. In Nigeria, the Lagos state government is setting up an Infectious Diseases Research Institute. Moderna has announced a $500 million facility in Kenya, whose Ministry of Health is collaborating with Amref Health Africa and AstraZeneca to launch mobile clinics for rural Kenya. BioNTech has begun constructing a 39,000 square metre modular facility in Kigali, Rwanda to produce the Pfizer-BioNTech Covid vaccine and also develop a malaria vaccine.
Egypt is a frontrunner in the run to make locally - in 2021, state-owned VACSERA was already producing Sinovac's vaccines in millions; now the country is in discussions with the company to expedite vaccine tech transfer and work on a 150 million vaccine dose capacity warehouse. In partnership with UAE and Saudi Arabia, Egypt's Gennecs Pharmaceuticals is setting up a $150 million multi-vaccine facility with an eye on domestic as well as other African markets.
Finally, in South Africa, Aspen's agenda is to enhance the manufacturing of Johnson & Johnson's Covid vaccine, while Pfizer is partnering with the Biovac Institute in Cape Town to manufacture the Pfizer-BioNTech Covid vaccine. South Africa also houses the WHO's mRNA vaccine tech transfer hub in Cape Town, where 6 African countries - Egypt, Kenya, Nigeria, Senegal, South Africa and Tunisia - will receive training. Afrigen Biologics - who is mandated with establishing the technology - runs the hub along with the South African Medical Research Council and Biovac.
Gavi, the vaccine alliance, published a 10-point plan of action this month to support the AU's vision for vaccine supply security. The plan proposes actions for stakeholders - G7 development ministers, African countries, international partners, the private sector, and Gavi itself - to ensure sustainable investment across the entire value chain of the industry. As one of the world's largest vaccine purchasers, Gavi will be central to the success of African vaccines in the market; its recently published plan calls for Advanced Market Commitments, skill development, vaccine technology transfer and robust regulation to create an ecosystem in which the African vaccine industry can flourish.
While several foreign governments and private entities are increasingly growing their commercial footprint in the African region, the scope of Chinese investment stands out. Even the Africa CDC - and the construction of its headquarters, currently underway in Addis Ababa - is funded by China. These investments have been criticized for their potential geopolitical implications ranging from increased soft power in the region, gaining political favours and accessing natural resources to creating a market for its health products. International investment in the continent is inevitably being framed as a question of health diplomacy.
Nonetheless, the benefits on the horizon for Africa are innumerable. By 2040, the African vaccine market size is expected to grow to US$ 2.8-5.6 billion. Regional pharmaceutical manufacturing will result in improved health outcomes by means of equitable access and affordability of vaccines and medicines. A robust regulatory framework, a developed market, better training and resources will also help retain healthcare professionals who otherwise emigrate from the region.
