Five ways to scale African manufacturing of lifesaving health products

From the onset of the COVID-19 pandemic, Africa has remained among the last in line to access necessary medical supplies and tools—from personal protective equipment and diagnostics to treatments and vaccines.

Because there is limited local manufacturing, many countries are reliant on imports, but supply chain disruptions slowed imports and producing countries declined exports to meet their own needs. Additionally, many wealthy countries procured more doses than they could use, leaving little for others with less purchasing power.

But these challenges are not new—the pandemic merely highlighted the continent’s long-standing, inequitable access to lifesaving medical products. As a result, concerted efforts are underway to strengthen Africa’s capacity to develop and produce health products that meet its needs.

Several countries in Africa already have capabilities in vaccine and drug manufacturing and fill and finish capacity—the steps that follow production, such as filling syringes, labeling, packaging, and quality inspection. But there remains a significant gap to close.

Africa, which accounts for almost 17 percent of the world’s population, represents only 3 percent of global drug production. The continent imports more than 80 percent of its consumed pharmaceuticals, a stark contrast—for example—to India, which imports only 20 percent.

Today, the continent remains short on critical, lifesaving medical products, and with new COVID-19 variants and other public health challenges emerging, experts—and the public—worry that the worst is yet to come.

This is why PATH is working with a coalition of partners to reduce the continent’s reliance on foreign countries. Together, we’ve identified five ways to strengthen African manufacturing capabilities and help ensure equitable access to high-quality health products for all people.

Increasing the African continent’s supply of key health products is a critical and under-resourced component of health system resilience and pandemic preparedness and response. But we know that for medical products, if commercial viability is the only deciding factor, companies will often opt out.

This is why the public health community must work together to incentivize investment in these necessary public goods. This will require strong partnerships and meaningful engagement between governments, civil society, international organizations, multilateral organizations, and the private sector.

A key part of this is understanding what industry needs—from infrastructure and staffing to business plans and profit margins. Civil society and nongovernmental organizations can help advocate for support from governments and multilateral organizations. At the same time, we must ensure businesses are willing and able to set affordable prices for equitable access.

Manufacturing within the continent is Africa’s chance to ensure we’re producing the tools we need and that they are accessible to those who need them. This will require advanced coordination.

As the COVID-19 pandemic has shown us, one country or entity cannot create a robust system on its own, and singular, siloed efforts are unlikely to sustainably reach the necessary scale. Achieving this ambitious goal will require a coordinated manufacturing ecosystem.

The African Union and the Africa CDC's Partnerships for African Vaccine Manufacturing Framework for Action offers a blueprint for how to accelerate local manufacturing in a coordinated way. This model could be replicated for diagnostics and therapeutics.

This must begin with an understanding of existing capacity to then map a way forward for developing different types of products—all of which involve differing levels of complexity to produce.

For instance, in places without drug substance or product manufacturing capacity, it might be more efficient to begin developing fill and finish capacities, with a goal of building up over time to drug substance manufacturing.

Thus, careful coordination will need to come with thoughtful investments.

In the past few years, there has been considerable investment in local manufacturing in Africa. However, too often these are one-time investments that don’t consider the full life cycle of a product or the larger manufacturing ecosystem.

To ensure sustainable, high-quality production, funding institutions and other key stakeholders must create a flexible funding environment that encourages innovation and enables long-term planning.

Investors should also ensure that their investments are complementary to and supportive of, instead of competing with, existing efforts. This is why PATH’s Diagnostics team created a local diagnostics company dashboard, which showcases more than 150 diagnostic developers, manufacturers, and distributors in Africa, Asia, and Latin America. In addition to serving as an advocacy and awareness tool, the dashboard highlights key opportunities for investment.

For example, in Africa more than 70 companies are either headquartered in, or have manufacturing capacity in, the region. However, only 33, or less than 50 percent, have reported having standard quality assurance certifications. This highlights that it would be particularly valuable to invest in quality management system capacity.

Filling this gap would enable more local manufacturers to meet the global quality standards necessary for centralized procurement and broader market reach.

Finally, stakeholders must work together to develop and implement policies that protect borrowers, whether governments or private companies, from harmful debt. Advocates and governments must hold accountable multilateral lenders and commercial banks by setting policies that require fair, transparent loan terms.

Developing an effective manufacturing ecosystem will require long-term domestic and foreign financing from public sources, bilateral and multilateral funders, and the private sector. National governments, in particular, have a leading role to play.

Governments can invest in research and development, good manufacturing compliance, and clinical trials to incentivize the private sector. They can also offer subsidies, allocate land for factories, and provide tax breaks to catalyze and strengthen local efforts.

It will also be critical for governments to invest in a streamlined regulatory system that encourages domestic health product development and ensures the quality, safety, and efficacy of the products. To date, countries across the continent have weak, misaligned policies for the regulation of medical products, meaning it can often take years for a single health product to be approved for use in some countries.

The newly ratified African Medicines Agency treaty is a continent-wide platform for strengthening and harmonizing national and regional regulatory authorities. It is expected to streamline this process, but more countries must ratify and invest in the treaty so all African people can fully benefit from high-quality health products.

Even as more medical products are manufactured and approved in Africa, many local manufacturers will struggle to offer prices that are affordable enough for low- and middle-income countries while also adequate enough to cover costs and remain in business. To reach this balance, governments can show meaningful support and leadership by procuring local products.

If the continent makes a concerted effort to scale its manufacturing ecosystem, it has the potential to create global goods that are fit for the African context while leapfrogging over some phases of the process. But to do so, Africa will need to leverage previous learnings and adapt preexisting technologies to more effectively serve the unique needs of the African people.

This is where technology co-creation comes in. Technology co-creation is the collaborative development of new products and services together with experts and stakeholders (such as customers and suppliers). This is different from technology transfer—sharing technology with insufficient detail and only under limited terms—which often leaves national manufacturers still dependent on foreign companies.

Co-creation ensures the needs and priorities of the target population are incorporated from the very beginning. It also opens doors for a more sustainable and equitable process that is mutually beneficial for African countries and international partners alike.