The Key to Transforming African Health

Apr 20 , 2024
By Jayati Ghosh

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Despite the relentless stream of bad news from around the world, there are still reasons for optimism. One notable example is the renewed push to localise pharmaceutical production in Africa, demonstrating how even catastrophic events like a pandemic can lead to positive, unforeseen outcomes.

The COVID-19 shock underscored the critical need to fund public health systems and expand access to essential technologies and preventive and therapeutic drugs. It should have served as a wake-up call for policymakers and the public worldwide. But, once the virus was controlled, wealthy countries reverted to the policies and practices that had made the initial pandemic response so unequal. No part of the world has suffered more from these extreme global inequalities than Africa.

African countries were the last to receive COVID-19 vaccines, having been crowded out by vaccine-hoarding wealthier countries and denied access to the technologies necessary for domestic production. Although Africa accounts for 18pc of the world's population, the continent received only 3.3pc of all administered vaccines by the end of 2021. By the end of 2022, its share had barely increased to 5.5pc.

Even before COVID-19, Africa was already grappling with the global neglect of major epidemics such as Ebola, Zika, and monkeypox, as well as endemic diseases like sleeping sickness. One of the biggest obstacles to tackling these health crises is the continent's dependence on imported drugs. Despite bearing one-quarter of the global disease burden, only two percent of medical research is conducted in Africa, and more than 90pc of the continent's vaccines and 70pc of its medicines are imported. Of the roughly 375 pharmaceutical manufacturers operating in Africa, 15pc are locally owned, and most of these companies focus on formulations rather than the active pharmaceutical ingredients (APIs) crucial for drug production.

Fortunately, the bitter experience of COVID-19 appears to have catalysed a much-needed policy shift. During the pandemic, the Africa Centre for Disease Control & Prevention laid the groundwork for inter-governmental cooperation by bolstering collective regional responses under extremely difficult conditions. Several African governments and international organisations have recently launched initiatives to boost local pharmaceutical production and promote innovation across the continent.

The African Pharmaceutical Technology Foundation, backed by the African Development Bank (AfDB), is a prime example. This initiative aims to bolster the continent's technological capabilities by expanding access to knowledge, building skills, and expanding product pipelines. The Foundation has pledged to invest up to three billion dollars over the next decade to develop pharmaceutical products in Africa, thereby reducing import dependence.

Another example is the Medicine Patent Pool's mRNA technology transfer program, supported by the World Health Organisation (WTO) and the United Nations (UN). This initiative, which operates from its South African hub at the Cape Town-based biotechnology company Afrigen, aims to develop the necessary technological capacity and know-how to enable 15 low- and middle-income countries to manufacture mRNA vaccines. Initially focused on COVID-19 vaccines, the program has since expanded to other diseases prevalent across Africa and more affordable cancer treatments.

These initiatives face profound challenges, especially their reliance on voluntary technology transfers, which have proven limited scope. To access essential knowledge and force multinational companies to share their technologies, African countries must expand their use of compulsory licensing, in line with their patent laws and the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Notably, the mRNA hub in South Africa has already faced legal challenges from Moderna, itself a beneficiary of US government subsidies and patent sharing. This shows the importance of ensuring that the ongoing negotiations for a global pandemic treaty include specific provisions addressing compulsory licensing.

That said, access to knowledge alone is not enough. Given that production processes require specialised expertise, comprehensive education programs and skills training are crucial to establishing a sustainable foundation for innovation and production in Africa. This requires a broader regional effort, which African governments appear to be considering.

Another major obstacle is competition from large pharmaceutical companies. Novartis, which has previously initiated patent disputes in countries like India, has announced its intention to achieve a fivefold increase in patient outreach in sub-Saharan Africa by 2025. For localisation efforts to succeed, it is crucial to emphasise local ownership and ensure that Big Pharma does not monopolise the benefits. Multinational companies can be unreliable partners, as is evident from Moderna's recent decision to put its planned investment in vaccine production in Kenya on hold because reduced demand makes commercial profitability less likely.

Given that Africa's rich genetic diversity makes it a veritable treasure trove of genomic data, the risk of knowledge and data theft is a pressing concern. While the African CDC's Pathogen Genomics Initiative was celebrated as a major achievement when it was launched in 2019, there are now valid concerns that the pandemic treaty could make these data globally accessible, potentially benefiting large pharmaceutical companies in rich countries without ensuring fair compensation for Africa.

Tellingly, foreign powers are squabbling over who should control access to this invaluable database. The challenges confronting African countries' efforts to take control of their healthcare destiny are immense. Their determination to localise drug and vaccine production is a promising start.

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PUBLISHED ON Apr 20,2024 [ VOL 25 , NO 1251]

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