A moonshot for Africa’s health security: Co-creating Africa’s own vaccine industry
Cover picture: Dr. Chijioke Umunnakwe, Senior Research Scientist at Ndlovu Research Centre in Limpopo, sequencing Sars-COV samples. Credits: GIZ/Nadia Said
When health workers in African countries read the labels on the vaccine shots they administer – be they against measles or COVID-19 – they mostly find that they were produced on a different continent. Only 1% of the vaccines used in Africa are locally produced – 99% are imported. As the COVID-19 pandemic has unfolded, this lack of local vaccine production capacities has left Africa vulnerable and dependent on the goodwill of international partners. Determined to change this, in April 2021 the African Union (AU) and the Africa Centers of Disease Control and Prevention (Africa CDC) committed to what the economist Mariana Mazzucato would call a ‘moonshot mission’: They launched the Partnership for African Vaccine Manufacturing (PAVM) and set themselves the goal to manufacture 60% of Africa’s routine immunisation needs on the continent by 2040.
Coordinating investments in a mission-oriented approach
In its manifesto (WHO, 2021), WHO’s newly established Council on the Economics of Health for All states that the complex health challenges facing the global community call for a mission-oriented approach – partnerships between public and private sectors aimed at solving key societal problems. Its chair, Mariana Mazzucato, coined the term ‘moonshot economy’ in allusion to the United States’ space mission in the 1960ies. At the time, J.F. Kennedy’s government set ambitious and inspirational targets to catalyse innovation and coordinate government and business efforts on a massive scale for a shared purpose. In less than a decade, this approach put a man on the moon. The new Council proposes that, in the same vein, governments should take on an active co-shaping and co-creating role in health innovation, setting ambitious goals and mobilising public and private sector efforts for their attainment. Building an African vaccine industry is an excellent example of such a mission-oriented approach.
Germany supports Africa’s ‘moonshot’ endeavour
Jointly with other development partners, German development cooperation has pledged to contribute to the African Union’s endeavour through strategic investments in the different elements needed to set up Africa’s own vaccine manufacturing architecture. In total, the German government has committed EUR 500 million to this task. It builds on longstanding German support for local pharmaceutical manufacturing in Africa which started in the early 2000s (see BMZ, 2017) and encompassed local manufacturing of medicines as well as first explorations into local vaccine production, including secondments of integrated experts to the South African pharmaceutical manufacturer Biovac and contributions to a 2015 study on the feasibility of vaccine manufacturing in Africa (AVMI, 2017).
For Dr Bernhard Braune, Head of Division Global Health Policy and Financing in the German Federal Ministry for Economic Cooperation and Development (BMZ), it is evident that the moment has come to support African partners in realising their ambitious vision: ‘Initially many actors thought that this would be too difficult, too complex, too long-term. You cannot achieve this just by throwing money at it. Yet, nothing is as powerful as an idea whose time has come.’
The lack of vaccine manufacturing capacity undermines Africa’s health security
When the first COVID-19 vaccines went up for sale in 2020, African governments found themselves waiting at the end of the line. Despite initial promises of the global community to distribute vaccines equitably, rich countries soon hoarded vaccine supplies, leaving only scraps for African countries. Manufacturers in the US and Europe prioritised their domestic customers. Even in India, where the world’s largest vaccine producer, the Serum Institute, had been licensed to produce the Oxford/AstraZeneca vaccine for the African market, the government temporarily introduced export restrictions to serve its domestic market first.
Even if “big pharma” had shared their patents, as many activists demanded, there would have been no African producers that could have closed the gap in supply. Currently, companies actively involved in vaccine production exist in only five African countries: Morocco, Tunisia, Egypt, South Africa and Senegal. As a consequence, vaccination progress in Africa lags far behind the rest of the world: In November 2021, only about 5% of the African population is fully vaccinated compared to more than 60% in the EU.
There are challenges on the supply and demand side
An attempt to build a sustainable African vaccine industry must tackle a broad set of challenges. The first is unlocking investment capital – either through providing public funds or by convincing African and multinational companies to invest in local production. The second concerns human resources: Increasing manufacturing capacity depends on the local availability of specialised personnel in industrial pharmacy or engineering. While African universities have improved the training of personnel for the medicines industry, vaccine production requires an additional set of skills for which training courses need to be adapted and taught. The third is about regulation: To ensure the quality and safety of vaccines made in Africa, governments need to strengthen their regulatory institutions and qualify them for the distinct challenges of vaccines. Production site sterility, for example, has to be fully assured. Last but not least, vaccine production depends on economies of scale and it will be hard for emerging African companies to sell their products at the prices charged by well-established larger companies in India.
Supporting selected countries to blaze the trail
To get its mission off the ground the AU has decided to initially support a small number of promising countries that can blaze a trail for others to follow. So far, the German government’s support focuses on expanding existing capacities in South Africa and Senegal.
‘South Africa’s capacities both in research and in the pharmaceutical sector are particularly advanced. Moreover, the topic is championed by President Ramaphosa himself. There is great momentum’, says Claudia Aguirre, GIZ, who heads an emerging programme that will strengthen the local ecosystem for vaccine production and distribution. Its interventions will encompass support to universities and vocational training centres responsible for training the required human resources for vaccine production; measures to strengthen the local regulatory authority; and advice to local businesses in the vaccine value chain on how they can play a larger role in South Africa and beyond.
On the financial cooperation side, KfW will support the South African government’s investments into the institutions needed to scale up its manufacturing capacity. Moreover, its private-sector oriented German Investment Corporation (DEG) has already contributed to financing the scale-up of Aspen’s fill and finish operations alongside the World Bank’s International Finance Corporation and multinational pharmaceutical companies. Similar aspirations exist for Biovac which is seen as having the potential to grow from a medium-sized enterprise into a globally competitive vaccine manufacturer.
The second focus country for the German support is Senegal. During a visit in June of this year, Minister Müller committed EUR 20 million to an expansion of the Institut Pasteur’s manufacturing sites, which already produces a WHO-approved yellow fever vaccine (BMZ, 2021). KfW is in discussions with the Senegalese government on how to best realise this commitment. And more projects could follow – in October the German company Biontech signed two further memoranda of understanding to build mRNA vaccine manufacturing facilities both in Rwanda and Senegal.
Strengthening the different elements of a continental vaccine manufacturing architecture
To ensure that country-level efforts contribute to a continental vaccine production architecture, they need to be complimentary and well-coordinated. This is where the newly established Partnership for African Vaccine Manufacturing comes in, providing oversight and technical guidance to member states, including on the marketability of different types of vaccines, to ensure that the envisioned continental vaccine manufacturing ecosystem will beeconomically viable.
GIZ’s African Union cooperation recently entered into a partnership with PAVM’s host institution, the Africa-CDC. Dr Inge Baumgarten, Director of GIZ’s office to the AU, says ‘We are impressed by the Africa-CDC. As an African Union specialised technical institution they have access to highest level decision-makers, are able to mobilise resources and high-profile champions, such as the South African President Cyril Ramaphosa, to advance on a cause that is of great relevance for the future of Africa. They can move Africa to the centre stage – create African-led initiatives! I am glad that Germany decided to support them in this work.’
German support also encompasses strengthening the newly established regulatory body African Medicines Agency (AMA) and advice to AMA and Africa-CDC on how to use the emerging African Continental Free Trade Area (AfCFTA) for the creation of a continental market for vaccines made in Africa.
In addition, PTB, Germany’s National Metrology Institute (the science of measurement), has been commissioned to strengthen the capacities of laboratories conducting quality assurance of vaccines. And in the field of finance, KfW is preparing a partnership with the publicly-owned AFREXIM bank, enabling it to finance the whole spectrum of African companies that contribute to the wider value-chain of vaccine production: ‘Over 100 different products are needed to make a vaccine’, explains Dr Duve of KfW.
Success will depend on finding customers for vaccines made in Africa
Everyone interviewed for this article agrees that, once the pandemic is over, the biggest long-term challenge may well lie on the demand side since locally produced vaccines will likely be more expensive than imports. African governments, however, are looking at the larger picture, weighing the higher cost of vaccines against the positive impacts on the continent’s health security, it’s research and development capacities and the economy more broadly. Still, PAVM and its partners are carefully analysing possible markets. They actively discuss with national procurement organisations and multilateral buyers such as GAVI and UNICEF, highlighting the advantages of purchasing vaccines made in Africa.
German development cooperation also pays close attention to this challenge. GIZ’s South Africa programme plans to conduct studies into the market potential of different products and promoting South African vaccines in talks with GAVI as well as regional procurement bodies. Likewise, demand-side intelligence is a major element of any risk-assessment before DEG invests in a specific company. Dr Marlis Sieburger, KfW, explains that they advise their partners to invest in technologies that fill current supply gaps: ‘New sterile fill and finish sites for COVID vaccines could potentially be repurposed for other products of special relevance to African markets such as vaccines for neglected tropical diseases or hopeful vaccine candidates for Malaria and HIV. These investments also create know-how for building production sites for other badly needed health products such as antivenom against snake bites.’
Moonshot missions require a shared focus and long-term commitments
It took only seven years from President Kennedy’s launch of the man-on-the-moon mission to Neil Armstrong’s giant leap for mankind. In comparison, the 18 years that remain to meet the AU’s vaccine production goal might seem generous. To attain it, however, all involved partners will have to stay focused and cooperate effectively. According to Claudia Aguirre, GIZ South Africa, ‘there are many actors who currently push into this space: industry, banks, development organisations, foundations…coordination is demanding, yet crucial.’ With PAVM, the AU has established a structure that can help monitor and steer the many different players and initiatives. As Team Europe Initiative, European governments are already harmonising their initiatives to avoid duplication.
Dr Braune, BMZ, is aware that establishing a vaccine manufacturing architecture in Africa will take its time: ‘We are firmly committed to this endeavour – and we know this means being in it for the long haul’.
Tobias Bünder, November 2021