Africa’s Pharmaceutical Industry

Between the 12th and 13th of April 2021, the African Union held a conference on the theme “Africa’s Vaccine Manufacturing for Health Security”. Throughout the conference, participants learned that the continent’s leaders were aware of being bystanders whilst vaccine nationalism prevented them from obtaining enough doses to vaccinate 60% of the continent’s population to achieve herd immunity. The array of speakers selected from presidents, global business leaders, public health practitioners, world-renowned scientists, the World Health Organisation (WHO) etc. knew that the current situation Africa found itself in was not tenable.

A quote from Paul Kagame, the President of Rwanda, summed it all up. In his view, “vaccine equity cannot be guaranteed by goodwill alone. Africa needs to, and should be capable of producing its vaccines and medicinal product”. Thinknovate Ghana is of the view that no truer words have been spoken in the field of African pharmaceutical industrialisation. The basis of our assertion is because, between 2018 and 2022, the continent’s pharma market was expected to grow by 5.9% to a size of US$25 billion. Of this, it is estimated that countries on the continent will control less than 10% (US$2.5 billion) of the market with the majority of returns (US$22.5 billion) accruing as jobs and profits to citizens of other continents. This in our view cannot be right.

COVID-19 pandemic mitigation included lockdowns and travel restrictions across the world. As a result, the just in time manufacturing and delivery approach that many African countries had relied on to obtain their generic medicines from abroad broke down. This resulted in hikes in the prices of basic medicines in many African countries. Africa has low purchasing power, poor health Insurance policies and many citizens self-funding their healthcare; the situation will get worse. Africa cannot afford this. That said, there are significant bottlenecks that would need to be addressed to ensure that Africa becomes a net producer and not an importer of essential medicines.

Africa could learn from India which was without a viable pharmaceutical industry in the 1970s but today is a major player with a pharmaceutical industry worth US$20.03 billion. India’s pharmaceutical industry is growing at a rate of between 8% and 9% annually. It is estimated that by 2030, India’s pharmaceutical industry will be worth US$ 130 billion (double the current size of Ghana’s entire economy). Whilst at it, India has become a net exporter of pharmaceuticals and boasts of being the world’s largest vaccine manufacturer, Serum Institute of India. We will want to state that building this industry has come at a considerable cost to the Indian citizens and their environment.

 Though pharmaceutical manufacturing is highly regulated, India set out with a trade-off where they lacked regulatory rigour but built the manufacturing capability anyway. The result was that India had many workplace accidents which led to some loss of life. There were also instances where substandard and spurious medicines were manufactured and supplied; a situation we would not wish for. Africa would have to learn from this and work to avoid replication. It was gratifying therefore to note during the conference that participants were aware of medicines regulatory gaps across the African continent.

We expect that the proposed setting up of the African Medicines Agency would help to address these regulatory gaps.

Another advantage India had was a large market, due to its population size. The population of India is currently approximately equal to the population of the entire African continent. The pharmaceutical market in Africa is not homogeneous, even with 54 countries in Africa, most of whom manage their borders. This poses a challenge, as pharmaceuticals manufactured in one country cannot be moved freely across the continent. The challenge could be addressed if the African Continental Free Trade Agreement (AfCFTA) is rectified and operationalised by all countries. This is important because some countries have populations sizes less than five million and will have difficulty attracting investment to build such industries. Such countries could benefit from sub-regional pharmaceutical manufacturing hubs servicing their markets.

Though these obstacles exist, Africa cannot ignore the advantages that would accrue if a viable continental pharmaceutical industry were to be built. Currently, only 1% of all vaccines used in Africa are manufactured on the continent. Africa has ten manufacturing sites in seven countries (South Africa, Egypt, Algeria, Senegal, Morocco, Tunisia and Nigeria). Hence, even if Africa were to succeed in convincing COVID-19 vaccine developers to wave their intellectual property and transfer their technology, it will be a struggle to find manufacturing sites to produce vaccine doses required for the continent. A thriving pharmaceutical industry will ensure this is addressed and place the continent at an advantage during future pandemics.

It will also ensure the training of skilled human resource. Additionally, it will drive the emergence of raw materials and intermediary products manufacturing required for medicines manufacture. One material that comes to mind is starch, which one of the main excipients in the manufacture of tablets and capsules. This can be made from cassava which is a tuber that grows freely in many African countries. The advantage is that this starch is gluten, grain and nut-free, as well as vegan, vegetarian and paleo. Therefore, any pharmaceuticals manufactured using cassava starch could be used by many with gluten allergies or dietary restrictions. We cannot ignore the jobs that could be created through the establishment of such an intermediary industry and the potential foreign exchange that the export of any excess could yield.

Then, there is the potential to boost the continent’s private and public sector pharmaceutical research and development space. This could be done by collaboration between African scientists and those on other continents. The benefits of the collaboration will include the expansion of the intellectual property, and enhancement of postgraduate training. Additionally, this will attract funding into tertiary research hubs and further expand the job market on the continent. 

Having suffered the initial setbacks, India is now the beneficiary of some of these advantages. Before the COVID-19 pandemic, it was estimated that 50% of all generic medicines in the USA were supplied from India. This is mainly due to the fact that it is 33% cheaper to manufacture medicines in India compared to the USA. India is globally ranked third by way of volume of pharmaceuticals produced.

Over the years, political and public health leaders in India have been able to ignore medicine patents and manufacture generic versions of certain pharmaceuticals to drive down medicine prices for their citizens. This approach, though fiercely contested by many European and North American countries, was important at the height of the HIV/AIDS pandemic. It was one of the drivers of the decreased cost of generic medicines that have converted AIDS from a death sentence to a chronic disease globally. With an established pharmaceutical industry, Africa could also apply some of these techniques to ensure its citizens can afford healthcare.

The conference on vaccine manufacturing in Africa is a great start. It is our hope that the commitment of all parties, most importantly the political leaders, is maintained. COVID-19 may have destroyed many economies on the continent. However, Africa cannot afford to let this crisis go to waste. The time to open up this sector of socioeconomic manufacture is now.

Featured Image Courtesy of AL.Eyad

Edited by Winifred Awa