MICHAEL MYNHARDT & NICAISE NDEMBI | How can we build on Mandela’s healthcare legacy?

Former president Nelson Mandela was a renowned advocate for improved public health outcomes in Africa. He made significant contributions to the wellbeing of South Africans. His legacy in health care lives on through the Nelson Mandela Foundation, where his work on the HIV/Aids epidemic helped save millions of lives in our country.

It has been a decade since his passing, and just a few years since the global outbreak of Covid-19. It is time we asked ourselves how we can build on his legacy, by saving millions more lives — not just in our own country but across the African continent. A good starting point would be to take a pan-Africanist approach towards expanding our pharmaceutical manufacturing industries, to strengthen African health systems over the next 10 years.

In Africa, 99% of all vaccines administered to people are imported. The consequences of this are notably concerning — and became painfully evident after Covid-19. African countries were last in line to receive their shots, with foreign vaccine manufacturers controlling their distribution based on their preferred commercial agreements.

This meant that affluent countries — where vaccines were being made — received their vaccines first, simply because they could pay more. Sadly, this is not the first time that Africa and its people have been excluded from the latest developments in healthcare and vaccine technology.

Navigating capital expenditure towards strengthening Africa’s healthcare systems

The start-up costs for any manufacturing plant are significant. To simply set up a respectable tablet or capsule manufacturing facility, you’re looking at a minimum spend of more than R50m. For vaccines, that number balloons to an excess of R600m or more.

This constitutes a material capital outlay to simply lay the groundwork, and it does not include any additional costs or fees associated with the manufacturing of healthcare products in Africa.

Research and development, intellectual property rights, clinical trials and the registration of products will immediately add to these figures. The actual manufacture, distribution and education associated with the product compounds the final amount. Medical devices, pharmaceutical products and biologics must each have their own production facility as well — with a number of strict controls to prevent the contamination of the products being manufactured.

At this point, imports begin to look more favourable — and one could almost forgive national governments for choosing to outsource such costly manufacturing processes.

Improving standards of healthcare

So why invest? Because the African continent, and the people who live here, deserve access to improved vaccine-supply security. Citizens across Africa should rest assured that we have strengthened our pandemic preparedness and improved our ability to tackle endemic diseases.

This undertaking is already being led by the Partnerships for African Vaccine Manufacturing Framework For Action (PAVM FFA), which, with our continued support, could result in success. The PAVM has set itself an ambitious goal, towards ensuring that 60% of Africa’s vaccine demand is supplied by Africa’s own vaccine-manufacturing industry by 2040.

Vertical over horizontal integration is key

If we are to meaningfully tackle the expansion of our manufacturing capabilities, we cannot ignore the need to ensure vertical integration in the healthcare manufacturing sector. If we are not able to control the entire manufacturing process, then all we will achieve is a number of fill and finish facilities. This means we need to empower players in the sector with the regulatory and financial support they require to become innovators, with their own research and development, to ensure they have sole control of the intellectual property of their products ahead of clinical trials.

This support must remain in effect across all four stages of clinical trials, until there is a proven claim regarding the efficacy of the product being manufactured. Once manufacturers reach the regulatory space, we need to ensure the local authorities (for example SAHPRA) create an enabling environment with quick turnaround times for the registration of pharmaceuticals and biologics. If entities like SAHPRA can expedite the licensing of plants and product registrations in a manner that is efficient and timeous, local manufacturers will decrease their time to market and citizens will have improved access to health care, faster than ever before. 

Case studies for success

The world-renowned Afrigen Biologics mRNA hub in Cape Town already aims to contribute significantly to our continental independence, by working on the development of new vaccines for diseases that are rampant in lower and middle-income countries. The first vials should be making their way to the market by 2024. What makes Afrigen a particularly valuable case study, is that they’re willing to transfer their knowledge to a number of selected manufacturers in Africa as well. Afrigen’s pan-Africanist approach to decreasing Africa’s reliance on imports will help put SA at the forefront of this remarkable undertaking over the next five to 10 years.

Support from government: critical

Support from local government structures will remain critical if we are to improve our healthcare systems with an expanded capacity to manufacture our own vaccines. The public sector should offer preferential treatment to local manufacturers in their public contracts and tenders, and should consider duties on imports — perhaps restricting them altogether.

Government should also consider offering exclusive rights to local manufacturers, based on the economic multiplier effect. This is a long-term plan, which cannot be implemented if we get stuck on the costs in the short-term. Price preference must be weighed equally against the opportunity for job creation, skills development, improved health outcomes, investment and overall economic growth.

Our national government would also have to support local manufacturers with subsidies and sound offtake agreements, in an environment that is defined by a stable political economy to create the right climate for continued investment. Providing private sector players with equity in exchange for their years of expertise and business acumen would contribute significantly to improving the operating environment of any healthcare manufacturer in Africa as well.

Let ubuntu define the trajectory

Pan-Africanism, underpinned by the principles of ubuntu, will have to play a central role in every step we take if we are to reach the PAVM’s targets, with just 17 years on the clock.

Thankfully, the momentum is beginning to build. Last month, the Africa Health Business Symposium, together with the Africa Centres for Disease Control and Prevention launched a memorandum of understanding with the US Pharmacopeia Convention to expand our access to quality-assured medical products, by increasing regional manufacturing, strengthening enabling regulatory and market environments while bolstering clinical and public health laboratory networks.

It will take a concerted effort between public and private industry players to decrease Africa’s reliance on imports — but it is possible, if we work together to become more self-sufficient instead.

*Michael Mynhardt is group executive and business strategist and Nicaise Ndembi PhD MPH is chief science adviser, office of the director-general of the Africa Centre for Disease Control and Prevention