South African President, and former Chairman of the African Union, Cyril Ramaphosa, recently said: “Africa must expand vaccine manufacturing to combat the COVID-19 pandemic and future health emergencies, by forging partnerships to boost expertise and investment.”

Indeed, the COVID-19 pandemic is a wake-up call for the African continent. The crisis critically exposed the challenges of its health systems, and many economies are stagnating or even contracting. Health care in Africa is simply unable to cope with the current crisis. The sector requires more investment. Recent deaths among members of the African elite, such as the President of Tanzania, manifest the poor state of the health systems in the entire region.

Before the COVAX arrangement, very few African countries had a seat at the negotiation table on vaccine manufacturing and distribution. The big challenge was access to injections. But it was also about what quantities would be made available, how they would be distributed and which funding mechanism would be deployed. Even with funding for vaccines through the COVAX mechanism, it is unclear how many African countries have the funds for a full vaccine rollout. To date, very few states have had access to inoculations through the COVAX arrangement. It shows how urgent it is to address the matter of COVID-19 vaccines. Currently, just 1.1 per 100 Africans have received one, while in North America, the rate is over 40 per 100 inhabitants.

Time for partnerships

Ghana was the first African country to receive 600,000 vaccines doses through COVAX. Subsequently, others on the continent have been supplied with their first batch. Two months later, there is information that the second doses of the vaccines will be delayed by a month. It raises the issue of dependence on external funding and resources to meet the demands of the health sector. Africa lags in vaccine manufacturing. The continent produces only 1% of the injections required for its health sector. So how do we close the gaps?

Nationalism triggered by the pandemic and dwindling funding has pushed African countries to look inward. They are now exploring inter-agency and multinational partnerships that can counter the health challenges faced by the continent.

In addition, there are calls for establishing manufacturing industries and engaging the youth in this process through training programs and university funding. Future demographic shifts and Africa’s very young population make it essential for this transformation to happen. The continent needs to build the capacity of the future generation now.

Several high-level meetings and conferences have looked at this and other options in the past year. They were spearheaded by international bodies, including the African Union and, most recently, the Africa Centre for Disease Control and Prevention (CDC). John Nkengasong, director of the Africa CDC, said that the continent needs to move the needle from importing 99% of all its vaccines to only around 40% by 2040. However, this might be overambitious. There are several challenges. These include inequality in access for vulnerable groups, lack of funding of Research and Development (R&D) for vaccine manufacturing, lack of infrastructure and technology, and lack of investments in regulatory frameworks to meet international standards. Africa’s share of global R&D spending was only 0.9% in 2020, compared to 2.2% in South America and 44.3% in Asia. Among African nations, only Egypt and South Africa are among the top 40 spenders on R&D globally.

Strengthening Africa’s Health System

Yet, there are some opportunities that the pandemic offers to strengthen Africa’s health systems and disease surveillance for future epidemics. Concretely, they are:

  • Institutions

Individual countries have low bargaining power. It is where the relevance of institutions such as the African Union (AU) and the Africa CDC comes.  The African Union founded the Africa Centre for Disease Control and Prevention in 2016 due to the West Africa Ebola epidemic. Currently, it is at the forefront of coordinating and pooling efforts to attract investments into the manufacturing sector in Africa. The Africa CDC is still relatively new and will need substantial donor support. It remains to be seen how sustainable it will be and its policies to maintain its core activities. Currently, it is working with eight manufacturing companies across the continent to produce vaccines for COVID. Countries such as Algeria and Nigeria are planning to make COVID vaccines with the support of private partnerships.

  • Partnerships

The role of partnerships at the regional level is crucial. Presently, we have GAVI, the Vaccine Alliance in charge of designing the distribution system.  The World Health Organisation (WHO), United Nations Children’s Fund (UNICEF) and many others international organisations play prominent roles in vaccine supply across the continent. Governments also need to give a more significant and inclusive task to the private sector. It must be encouraged to support vulnerable countries. In Africa, partnerships are evolving, but there is still more scope to engage others in this pandemic. Recently, the Coalition for Epidemic Preparedness Innovations (CEPI) and the African Union Commission signed a memorandum of understanding. It aims to strengthen ties between both organisations to enhance vaccine R&D and manufacturing in Africa.

  • Trade arrangements

Among the myriad challenges to vaccine manufacturing are trade bottlenecks. They hamper the movement of goods and services across borders. The African Continental Free Trade Area (AFCTA) can stimulate the economic development of African countries with knock-on effects on the health sector. It can help expand African healthcare markets to incentivise investments in the industry and reduce tariff and non-tariff barriers to the trading of healthcare commodities. The liberalisation of business and finance services combined with ICT can enhance the efficiency of supply chains within the continent.

Africa missed the opportunity to learn from the Ebola crisis and prepare for the current pandemic. COVID-19 has to be the wake-up call. Indeed, there is a push in Africa to come together as one, given that no country can tackle this on its own. In a world after COVID-19, power, wealth and opportunities should be distributed more fairly and engagement platforms more inclusive. Democratising vaccine manufacturing can bring us one step closer to this. The Global South in general, but Africa in particular, needs to become more independent in this regard.

Text editor: Gabriela Keseberg Dávalos

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