Introduction

The continent of Africa, 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, monkey pox, Zika, Rift Valley fever, and recently, COVID-19. 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. If it ever comes, foreign assistance may be relatively late and is sometimes not fit for purpose.

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.

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 Africa 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 3% of global pharmaceutical manufacturing, compelling the continent to import a whopping 70-80% 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. In Ghana, roughly 32 viable pharmaceutical manufacturing companies collectively produce 30% of the country's drug needs. None of these companies is capable of producing vaccines or biologics.

In this article, 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. 

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% of African countries each have populations of less than 5 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.

I acknowledge that 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.

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, prioritize 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.

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 analog 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.

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 forward in the fight against the pandemic.

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 to medical countermeasures across the continent.

While challenges like regulatory harmonization 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!

Dr Bedima Duut is a Pharmacist, Lawyer, Public Health Specialist and Global Health Law Expert. Currently a candidate in Global Health Law and Governance, Georgetown University Law Center, USA) (PharmD, MPH, LLB/BL, LL.M.)

References

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•  Lone, S. A., & Ahmad, A., COVID-19 Pandemic – An African Perspective, Emerging Microbes & Infections, 9(1), 1300-1308 (2020). https://doi.org/10.1080/22221751.2020.1775132

• Purity Wambui Nyaikamba, Shingai Machingaidze, and Gerald Chirinda, The African Pharmaceutical Manufacturing Industry: Opportunities and Challenges for Growth, Future Africa Forum (November 2022)

https://forum.futureafrica.com/the-african-pharmaceutical-manufacturing-industry-opportunities-and challenges-for-growth/

• Food and Drugs Authority, Ghana, List of Local Pharmaceutical Manufacturing Facilities as at July 2022 https://fdaghana.gov.gh/img/reports/LIST%20OF%20LICENSED%20LOCAL%20PHARMACEUTICAL%20MANUFACTURING%20FACILITIES.pdf

• Adebisi et al, Revisiting the issue of access to medicines in Africa: Challenges and Recommendations (2022). Public Health Challenges, 1(2), e9. https://doi.org/10.1002/puh2.9

• Eli Lilly and Company, Lilly and EVA Pharma Announce Collaboration to Enhance Sustainable Access to Affordable Insulin in Africa (December 2022) https://investor.lilly.com/node/48096/pdf

• Norvatis, New collaboration between Novartis and Africa Medical Supplies Platform to Facilitate Supply of COVID-19 related Medicines (2020)