Preparing for future pandemics - African pharmaceutical manufacturers must join efforts for necessary medical supplies

The African continent, with 55 countries and a population of about 1.2 billion people, has had more than its share of epidemics, with severe consequences on lives and property.

Africa has experienced epidemics such as cholera, anthrax, meningitis, Ebola, dengue fever, monkeypox, Zika, Rift Valley fever, and recently, COVID-19 (Moyo et al, 2023).

Every African nation strives to provide the necessary medical countermeasures for its citizens in times of these pandemics. However, efforts by individual nations have proven inadequate, compelling them to rely on foreign assistance (Lone et al, 2020).

 If it ever comes, foreign assistance is relatively late and sometimes not fit for purpose.

COVID-19

Throughout the critical period of the COVID-19 pandemic, Africa faced an acute shortage of diagnostics, vaccines, medical consumables, and personal protective equipment for healthcare workers.

The challenges were immense, with African governments competing with other countries for the limited available supplies.

Even though the COVID-19 pandemic wave has receded, all countries worldwide have not relented on pandemic preparedness, since no one knows when and where the next outbreak will occur. 

One critical area Africa must focus on in preparation for a future pandemic is the pharmaceutical manufacturing industry.

Potential

The pharmaceutical industry in Africa has the potential to provide timely access to affordable medical countermeasures that meet international standards of safety, efficacy and quality.

The West African Ebola outbreak in 2014 and the COVID-19 pandemic highlighted the urgent need for the African continent to be self-sufficient in producing essential medicines, vaccines and medical technologies on a continental scale.

Currently, the manufacturing base in Sub-Saharan Africa is negligible, accounting for only three per cent of global pharmaceutical manufacturing, compelling the continent to import a whopping 70-80 per cent of its medicine requirement.

The high level of reliance on foreign medical supplies significantly hinders Africa's capacity to effectively respond to pandemics and other public health threats (Wambui et al, 2022).

In Ghana, roughly 32 viable pharmaceutical manufacturing companies collectively produce 30 per cent of the country's drug needs (Food and Drugs Authority, Ghana, 2022). None of these companies is capable of producing vaccines or biologics.

I argue for a continental approach to manufacturing medical countermeasures, where African pharmaceutical manufacturers work together to mass-produce and achieve self-sufficiency for each country on the continent.

Pharmaceutical companies on the continent need to collaborate and pool their resources, with support from African governments, to produce for the continent as a whole.
 

Nature

The global nature of the pharmaceutical industry, combined with the small market size of African countries, makes it difficult for individual countries to produce medicines domestically.

Even industrialised countries have yet to attain self-sufficiency in pharmaceutical production due to the global nature of procuring active pharmaceutical ingredients.

Pharmaceutical manufacturers require large markets to sell their products and break even.

However, over 30 per cent of African countries each have populations of less than five million people, making the market sizes too small to guarantee large-scale pharmaceutical manufacturing at the country level.

Producers of medical products in India, China and America have target populations of 1.442 billion, 1.426 billion and 432 million, respectively.

In Africa, the most populous state, "big brother" Nigeria, with a population of over 230 million, is still a small market relative to large-scale pharmaceutical manufacturing.

Collaboration

Collaboration among African pharmaceutical manufacturers may face challenges such as differing regulatory regimes and standards, and potential competition among companies.

African pharmaceutical companies also face several obstacles, including insufficient infrastructure, unsuitable legal frameworks, limited access to funding and investment, and a shortage of qualified human resources (Adebisi et al, 2022).

However, we can scale over any obstacle if our governments develop a solid commitment to cooperation and muster the necessary political will.

The Africa Union can fast-track the operationalisation of the Africa Medicines Regulatory Agency (AMA) to coordinate such an initiative.

A continental approach to pharmaceutical manufacturing in Africa is the surest way of ensuring access to affordable and high-quality medicines across the continent. 

By pooling resources and expertise, African countries can leverage their collective market potential to attract investment, create jobs and enhance the continent's economic growth.

An increased production of medical countermeasures on the continent will reduce the reliance on foreign aid, prioritise and address the health needs of African people more effectively, and ensure that African countries control the production and distribution of essential medicines within their borders. 

African countries can avoid supply chain disruptions and price volatility, which undermine our public health responses to pandemics, by reducing dependence on imports.

Successful collaboration can also drive innovation and lead to the development of new and effective therapies, quicker drug registration and technology transfer.
 

Evidence

There is evidence of how effective collaboration among pharmaceutical manufacturers has benefited Africa. In December 2022, Eli Lilly, the American pharmaceutical giant, and Eva Pharma, an Egyptian pharmaceutical manufacturing company, joined forces to provide a sustainable supply of high-quality, affordable human and analogue insulin to at least one million people with type 1 and type 2 diabetes in low- to middle-income countries (LMICs), primarily in Africa.

Eli Lilly agreed to supply its active pharmaceutical ingredient (API) for insulin and transfer technology to Eva Pharma to formulate, fill and finish insulin, a lifesaving product in Africa (Eli Lilly, 2022).

In September 2020, at the peak of the COVID-19 pandemic, the Africa Union, through the Africa Medical Supplies Platform (AMSP), entered into a significant collaboration with Novartis, a Swiss multinational pharmaceutical company.

This partnership facilitated the supply of medicines to the fifty-five AU member states, marking a crucial step in the fight against the pandemic (Norvatis, 2020).

The pharmaceutical industry in Africa has great potential to support Africa's pandemic preparedness and response efforts.

 The continental approach to pharmaceutical manufacturing in Africa offers a promising solution, focusing on collaboration, innovation and technology transfer.

By leveraging the strengths of different countries and companies, the approach aims to improve the quality, affordability, and accessibility of medical countermeasures across the continent.

While challenges like regulatory harmonisation and infrastructure development remain to be addressed, the continental approach represents a positive step towards building a sustainable and resilient solution to solving public health challenges in Africa.

With continued investment and commitment from all stakeholders, Africa should no longer throw her hands in despair during pandemics!

The writer is a Pharmacist, Public Health Specialist and Global Health Law Expert. Candidate in Global Health Law and Governance, Georgetown University Law Center, USA.