Why Africa needs to manufacture its own vaccines

Dr John Nkengasong is a Cameroonian virologist and Director of the Africa Centres for Disease Control and Prevention (Africa CDC), which is working to strengthen the ability of Africa’s public health institutions to detect and respond to disease threats and outbreaks. He explains why Africa should manufacture more of its own vaccines, and how to achieve this.

Does Africa currently manufacture any of its own vaccines?

Currently there are at least five African countries that manufacture vaccines at different levels. Some are more focused on fill and finish, while others manufacture vaccines from end to end. The Institute Pasteur in Senegal, for example, manufactures yellow fever vaccines and has been doing so for many years. Then there are other countries, such as Nigeria, Ethiopia and Cameroon, that have been manufacturing animal vaccines over the years and that are aspiring to manufacture human vaccines.

But the African continent, a continent of 1.2 billion people and 55 Member States, still imports 99% of its vaccines and consumes 25% of global vaccine supply. You cannot guarantee the health security of your people by importing 99% of your vaccines. We have now seen how woefully that setup has failed the continent.

What has limited its vaccine manufacturing and development capacity up until now?

Vaccine manufacturing requires that you do research and development as well as production. Africa has not done that and needs to invest in that in a very deliberate way, with its own resources and commitment. However, not every country needs to do this – you can have hubs on the continent, which is what we are promoting within the Africa CDC and the African Union.

In April this year, we held a virtual summit which brought together over 40,000 people with four Heads of State in attendance. We discussed a roadmap for African vaccine manufacturing; it was agreed that between now and 2040 we need to shift the paradigm so that we can begin to manufacture at least 60% of our vaccines. If we do not do that then we fail ourselves.

Has the COVID-19 pandemic changed African health leaders’ attitudes towards this reliance on overseas manufacture of vaccines, and how?

This expression of interest in vaccine manufacturing is coming from the highest levels of the continent, which we have not seen previously. I think there's now huge political awareness that we cannot continue to function in the way that we have been functioning.

We are seeing that these epidemics and pandemics are not going to go away. Just four years ago, when we were discussing Ebola in West Africa, we said: ‘never again’. You could say that Ebola was a small signal that something big was going to come, and something big is now here. You could also argue that COVID-19 is a signal that something even bigger is going to hit us. As a continent, we need to be in a mode where we can address those vaccine needs.

So, what would it take for the continent to manufacture more of its own vaccines?

In order to play in that space, the continent need to aspire to and work with partners such as Gavi, the Vaccine Alliance and the Gates Foundation to shape the market. It comes down to basic supply and demand: If you produce vaccines, there must be somebody who buys the vaccines from you. We need to reshape the market so that we don’t just make India a kitchen for everybody, where India produces and Africa consumes, but we balance up. For that to happen, there needs to be some guarantee that [countries and organisations] will buy volumes of vaccines from Africa.

Africa also needs to position itself in such a way that it doesn't just look inward and only produce vaccines for the African market, but is competitive and says: if we import from China and India, there is no reason why we cannot export to China and India. We have to have that economy of scale.

Achieving this means incentivising research and development (R&D) and vaccine production in partnership with national governments. But Gavi and its partners must also play a role in trying to support R&D, human capital development and market-shaping to free the continent from this permanent dependency mode.

Vaccine nationalism has been a major issue during the current pandemic – how can you ensure that wealthier African nations don’t keep the vaccines they manufacture to themselves, in the event of future health emergencies?

We need to have a whole of Africa approach, which is why the Africa CDC, as a continental public health agency, and the African Union are central to this. We are building what we call a hub and spoke model, where everybody doesn’t need to do everything from end to end. If we recognise that it takes so many components to produce a vaccine, then we could say that Country X focuses on glassware for vaccines, Country Y focuses on lipids, and so on. The analogy we use is the Airbus production process. The final aircraft is manufactured in Toulouse, France, but the parts come from all over the place. That’s the formula that we think will work for Africa. It would mean that nobody can just say, first of all we’re going to immunise 200 million people in this country, before anyone else gets anything.

Besides COVID-19, are there certain vaccines/disease areas that you would like to see prioritised, and why?

There are a couple of things that we feel we should be looking at. The first is epidemic/pandemic-like vaccines that are unique for the continent, because there are certain outbreaks that particularly affect us. However, the only way that we'll be able to prepare for a Disease X* is for us to also develop those kinds of vaccines that are needed all over the world, which means routine vaccines for diseases such as diphtheria, measles, cholera. That's how the market-shaping will happen, and we become competitive in our pricing.

Presumably, the manufacture of routine vaccines would put the continent in a stronger position in the event of another pandemic – e.g., enabling manufacturing facilities to switch to churning out pandemic vaccines instead?

I always say that the only way we can prepare for the unknowns is to adequately prepare for the knowns. The knowns are the pathogens that we live with, and that are bombarding us every day. We know how to prepare for those, and if we do then the day Disease X hits, we can repurpose and attack that [pathogen]. Despite everything that’s going on, I would discourage setting up structures that are only sitting there and waiting to create a vaccine for maybe COVID-30 or COVID-40. That is not going to be productive.

How can disease surveillance across the African continent be improved, both for new COVID-19 variants, and other diseases of concern?

I think the Africa CDC and the African Union must work with countries in a very direct manner, so that they in invest in public health. I would argue that each member state should have their own national public health institute – their own equivalent of Public Health England or the Nigeria CDC – because you don't do surveillance in a vacuum; it needs a home, which is a national public health institute.

Once that is in place, then there are two major things that we must do: The first is to take advantage of the original collaborating centres that Africa CDC has established, and to build and strengthen regional networks – what we are calling regional integrated surveillance and laboratory networks. Within a region such as West Africa, there are existing powerhouses, such as the Noguchi Institute in Ghana, the Nigeria CDC, the two Pasteur Institutes in Senegal and Côte d'Ivoire, and the Medical Research Council [in The Gambia]. Bringing them all together as a network is key, so that they can then support those national reference centres and national public health institutes.

This means that, if something is happening in Senegal, then through the regional integrated surveillance network, the relevant people in Nigeria are already aware of what is going on, and they're exchanging information with Ghana and Côte d'Ivoire, so that everyone knows what is going on in real time.

The second and last thing is the public health workforce. We need an elite public health workforce on the continent to run that surveillance. Once you have collected information, it is only qualified personnel that can take that data, analyse and make sense of, and then act on it.

To get there, you have to invest and put the dollars into it. The continent is recognising that disease surveillance is not just a health issue; it is an economic issue and a security issue, to pick out these pathogens and to fight them.

We have seen all the damage that the emergence of a disease like COVID has created for our economies. Tourism in Africa stands to lose about US $250 billion, because of a bug – a small thing that we cannot even see with our eyes. If we had good public health institutions, and everything that we have discussed, we would have been able to produce a vaccine, vaccinate at scale, conduct surveillance for variants, and get our people back to work.

Where would you like to see the continent’s manufacturing capabilities ten years from now?

I would put it at twenty years. Twenty years from now, I would like to see us manufacturing 60% of our vaccines. I think that is achievable, but we have to take a position that we are not willing to retreat from.

We have to graduate from this notion of dependency for our health security. In 1996, I was a young public health expert in Côte d'Ivoire, and we were very excited because antiretroviral drugs against HIV were now available. But, because the cost was US $10,000 per patient per year, it would take us ten years before we started having access to these drugs and mortality started decreasing, and during that time, about 10 to 12 million Africans died. Why? Because we are not manufacturing. If that doesn't keep you awake at night, then I don't know what else will keep you awake at night as an African leader.

In 2009, the swine fever pandemic hit. Luckily, it wasn't as expansive as we had feared, but though vaccines were available in the developed world, they wouldn’t get to Africa until after the pandemic was over. If that doesn't keep me awake as a leader, I don't know what else would keep me awake.

Now, we are dealing with COVID-19, where as a continent, we have around 1.5% of the population vaccinated with two doses. I think that Africa has no choice than to be very deliberate and engage in three areas of manufacturing: vaccines, diagnostics and therapeutics.

What impact do you think this would have on African people’s lives?

It would have a huge impact, both at a humanitarian level and an economic level. Estimates suggest that Africa’s existing vaccine market is worth $1.3 billion, and that is expected to grow to about $2.4 billion by 2030. So there is an enormous market for vaccines. Our two biggest challenges are financing and human capital.

*Disease X is a term adopted by the WHO to refer to any hypothetical and unknown pathogen that could trigger a future pandemic.