Opinion piece on immediate actions to drive equity
African Vaccine Manufacturing Initiative (AVMI)
Ensuring Africa has the capacity to manufacture vaccines
Global partnerships are the cornerstone of sustainable African manufacturing – the time is now.
06 Dec 2023 - Much has been written about lessons learned from the pandemic.? While debate remains about the global response, there is consensus around the imperative to address the vaccine nationalism and blatant inequity that led to a delayed response in Africa, and the role that regional manufacturing plays in response to future pandemics. This is not an Africa only issue - quoting WHO Director General Dr. Tedros Adhanom Ghebreyesus, ?‘No one is safe, until we are all safe’.
The African Union has stated clearly that by 2040, 60% of the continent’s vaccine needs will be met locally.? Breaking this target down:
The Partnership for African Vaccine Manufacturing (PAVM) has an endorsed Framework for Action and on the basis of committed investments, more than 30 projects in 14 countries have been announced. Whilst some of these projects are underway, it is inevitable that not all announcements will realise. This does not mean that we should not plan for success. Never again should Africans be in the position they were during the pandemic. Through the leadership of the Africa CDC, planned coordination amongst key players on the African continent, and unequivocal long-term support of the multilateral partners, the endeavours of the manufacturing African ecosystem will succeed.
The Partnership of Technology Transfer
Today, Africa is dependent upon others providing the technology needed to expand vaccine manufacturing across the range of platforms needed to ensure health security and the necessary scale for sustainability. ?Technology transfer takes time and resources, but brings with it the ability to build capacity and capabilities for the future.? This is especially true for the manufacture of drug substance (DS). It should not be forgotten, however, that in the intervening period, (likely to be years) the economic opportunity for the existing technology donors/innovators remains and is significant.? There is also sufficient time for the adjustment of incumbent manufacturers , much as has been seen with the introduction of new vaccine manufacturers in India who have become powerhouses, yet space has remained for international legacy manufacturers and new technology entrants.
Initiatives to support Africa’s journey to sustainable manufacturing, including the GAVI’s much anticipated African Vaccine Manufacturing Accelerator (AVMA) and Africa’s proposed Pooled Procurement Mechanism, are needed to send strong signals to technology transfer partners in the medium term – the reality is that Africa’s aspirations for vaccine and health security will not materialize without the support and partnership of the global technology owners.
The Partnership of Investment
The promised investment (actual and committed) in new manufacturing facilities both from the private sector and through partnership models (eg WHO mRNA hub) are to be lauded.? It must be acknowledged though that it will take years for these facilities to come online. It is therefore imperative that development banks, foundations and non-governmental organisations also support existing manufacturers to expand their capacity and capability.? These investments must acknowledge that most manufacturers will start from fill & finish capability to build a sustainable economic foothold, based on the recognition that the complexity of different upstream technology platforms will require time and resources.
For context, it is also necessary to acknowledge the levels of support given to other Developing Country Vaccine Manufacturers outside of Africa, as they underwent their journeys to becoming dominant players in the provision of vaccines to Africa via United Nations Children’s Fund (UNICEF). ?By way of example, India is now a leader in vaccine manufacturing, supplying 50% of the worlds’ and majority of Africa’s vaccination needs. Bill & Melinda Gates Foundation provided funding to three main Indian manufacturers:
Africa desperately needs similar levels of investment to support it’s vaccine self-sufficiency journey. ?Moreover, Africa needs investments from it’s own member states in unlocking continental demand to ensure that over the longer term these volumes drive economies of scale and facilitates global competitive costing by African manufacturers
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The Partnership of Global Engagement
Africa will no longer accept being isolated, nor does it want to become isolationist with regards to Global Health.? Yet, Africa does has a right to demand that African problems need African solutions – recognising that these may not always be easy or straight forward.
Demand allocation (volumes) and demand predictability (long term agreements and offtakes) are critical elements of sustainability. Achieving economies of scale through volumes is the only way African manufacturers can reduce the cost of manufacturing and be able to compete with current UNICEF market pricing. Established/incumbent manufacturers have however articulated that export volumes transitioning from their facilities to facilities in Africa, could lead to increased cost of goods arising from underutilisation of built capacity. Such perceived threats to global prices may well concern investors and funders at national, regional and global levels, but overlooks the ?very real need for African manufacturing to address the security and equity challenges.
In light of the pandemic, there has been a rallying call for global support towards Africa’s vaccine manufacturing aspirations, informed by the need for continental health security as well as a strong ambition to achieve global health equity. GAVI musts therefore be commended for its proposed AVMA with its structured and thoughtful demand side focus covering priority vaccines and with incentives for both near-term Fill & Finish successes as well as longer-term DS endeavours.? This will go some way to facilitate the the necessary funding and investments described above, leading to a more orderly expansion of the continental vaccine manufacturing ecosystem in line with the aspirations of the African Union and its Member States. The AVMA will undoubtedly support the journey of African manufacturers and it is critical that it is approved in the upcoming GAVI board meeting – this mechanism is needed in the short term to provide the necessary certainty and signalling to technology transfer partners.
The African continent has a voice and it needs to be part of the Global governance, it needs to be heard. Attention now is turning to the political and policy structures that are needed to support the free movement of goods and services, incentivising the building of a skilled and capable continental workforce as well as a pooled procurement mechanism that unlocks continental demand and progressively supports an African vaccine ecosystem. ??The aim being to deliver global equity and security as well as greater economic, technical and social participation for Africa by Africa.
The mandate of the ACDC is a specialized technical institution of the African Union (AU), established to support public health initiatives of Member States and strengthen the capacity of their public health institutions to detect, prevent, control and respond quickly and effectively to disease threats.? The mission of the ACDC is a safer healthier, integrated, prosperous Africa in which Member States can efficiently prevent disease transmission, implement surveillance and detection, and always be prepared to respond effectively to health threats and outbreaks.
The AVMI provides a consensus voice for African Vaccine Manufacturers, specifically within the context of the African Union call for a New Public Health Order aimed at safeguarding the health and economic security of the continent. This encompasses the Africa CDC / Partnership for African Vaccine Manufacturing (PAVM) objective of ensuring at least 60% of Africa’s vaccine requirements is supplied by African manufacturers by 2040, up from the unacceptable and dangerously low 1% today.
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