Ramping up Africa’s vaccine manufacturing capability is good for everyone. Here’s why

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Seth Berkley, Chief Executive Officer, Gavi, the Vaccine Alliance

• Africa only produces about 0.1% of the global supply of vaccines – a market failure which has cost lives and needs urgent attention.
• Creating greater vaccine supply resilience for Africa through domestic production requires creating a multi-million industry almost from scratch.
• With the support of governments of both donor and recipient countries and manufacturers, expanding production is in everyone’s interest.

Today, Africa only produces about 0.1% of the global supply of vaccines. This is a market failure which has cost lives and urgently needs to be fixed. More than 11 billion doses of COVID-19 vaccine were produced last year, in theory enough to protect everyone.

But because of vaccine hoarding and export restrictions combined with the lack of regional vaccine supply across the continent, Africans died because of delays in access to doses. If left unchecked this represents a serious threat to global health security.

If Africa’s limited vaccine industry were to be significantly expanded, this kind of market failure could be avoided. Not only should it improve global pandemic preparedness, which ultimately benefits everyone, but in periods between pandemics it should also help to create greater vaccine supply resilience for African nations for a wide range of vaccine-preventable diseases. However, realising that means the creation of a sustainable, multi-billion-dollar industry practically from scratch.

Vaccine manufacturing initiatives under way

As daunting as this massive expansion may seem, that process has already begun, with more than 30 vaccine manufacturing initiatives now under way across the continent. The African Union has set a goal for the region to develop, produce and supply more than 60% of the vaccine doses required on the continent by 2040.

Whether or not this ambitious target can be reached, it is supported by an implementation plan led by the African Centres for Disease Control and Prevention Partnership for African Vaccine Manufacturing (PAVM) and by G7 nations and EU leaders, as well as the Pandemic Pact spearheaded by the German government, so it should be possible.

The big question is not whether Africa should have more vaccine manufacturing capacity, but how. Vaccine markets can be precarious , and “build it and they will come” approaches rarely work, if ever. Without careful planning and coordination, the danger is that even with significant capital investment many of these initiatives will not survive in the long-term, and those that do could have unintended negative impacts on existing vaccine markets. So, for any venture to succeed, a new comprehensive approach is needed.

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Large, fixed overhead costs, the need for highly trained skilled labour, intense quality assurance and control, and the challenges of reliably producing vaccine of sufficient and consistent quality, all present costs and risks that make vaccine manufacturing inherently expensive, compared say to drug production.

These high costs have to be reflected in the price of the product if the facility is to remain viable and sustainable. Usually, the only way to bring prices down and become globally competitive is by producing large volumes, but this often takes years, which can be make or break for a manufacturer. Even multinationals struggle with this.

Gavi, the Vaccine Alliance, the organization I run, is all too familiar with such scenarios and the kind of challenges that vaccine market failures can pose. For more than two decades, we have helped shape vaccine markets to lower prices and improve access, protecting over a billion of the poorest and most vulnerable children, and preventing more than 16 million deaths in the process.

For example, the 11 vaccines that WHO recommends for every country cost an equivalent of about $1,300 in the United States, but less than $28 for Gavi eligible countries. When Gavi was first founded, it had just five suppliers, which were mostly based in Europe or North America, whereas today it works with 18 manufacturers, only seven of which are European or North American.

COVID-19 highlighted need for new approach

But, while this model normally works extremely well, COVID has demonstrated a need for a new approach, one where the expansion of vaccine manufacturing across Africa could help boost both the regional and global supply of routine vaccines and in the process create greater supply resilience for future pandemic vaccines. As the world’s largest purchaser of vaccines, and the biggest supplier to African nations, Gavi has a central role to play here.

That is why we are proposing a four-point plan to support regional manufacturing in Africa, to reduce its reliance on vaccine imports and ultimately help realise the African Union and the Africa Centres for Disease Control and Prevention’s New Public Health Order vision.

Part of that will involve engagement with industry, providing analysis of existing markets, playing a coordinating role to advise on vaccine markets to be explored, to avoid over-crowding markets and encourage sustainability, as well as ensuring that there is suitable regulatory benchmarking in place. Indeed, Gavi has already identified a number of key markets where new suppliers could have a valuable role to play in boosting global production and improving product profiles.

Gavi is also proposing to adapt its existing market shaping and procurement policies, in line with its strategy of promoting supply diversity, to take into consideration geographic concentration of the supply base, which currently isn’t the case.

And while the Gavi model has country choice at its core, it is proposed to work closely with Gavi-supported countries in Africa and beyond, to help provide new continental suppliers with increased demand assurances over the vaccines that countries intend to select through Gavi. The supply to African countries represents significant investment in vaccines by 2030, and so will ultimately create greater demand certainty.

But arguably the biggest challenge new suppliers will face, and one that Gavi cannot solve by itself, will be finding ways to bridge the price gap. New suppliers will likely need to find a way to cover their higher start-up costs to be competitive with low-cost incumbents and win business.

How to accelerate vaccine manufacturing in Africa

One way to address this is through an Advance Market Commitment. This kind of financial instrument has already proved successful in accelerating the market for pneumococcal vaccines and was key to the COVID-19 global pandemic response, enabling COVAX to provide more than 1.6 billion doses so far to lower-income countries, preventing more than half a billion deaths in the process.

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What is Gavi?

Gavi is an Alliance launched at the World Economic Forum Annual Meeting in 2000. It has contributed to the immunization of nearly 700 million children, saving an estimated 10 million lives worldwide in less than 20 years.

Gavi was launched with an initial pledge of $750 million from the Bill and Melinda Gates Foundation.

The aim of Gavi is to make vaccines more accessible and affordable for all children, wherever they live. It brings together the best efforts of UN agencies, governments, the vaccines industry and civil society to improve childhood immunization in developing countries and accelerate access to new vaccines.

Gavi works closely with our System Initiative on Shaping the Future of Health and Healthcare. Contact us to help improve the state of healthcare globally.

For African vaccine manufacturers to have the long-term and sustainable impact that is needed, a targeted and time-limited financial mechanism such as this could be key. But it can only work with the support of the governments of both donor and recipient countries and manufacturers.

Expanding vaccine manufacturing in Africa represents a huge opportunity to improve health security across the continent. But it also represents a potentially even larger opportunity, not just to protect African citizens from a wide range of infectious diseases, including those that particularly affect the region, but also to establish African vaccine manufacturers as important global suppliers. That is in everyone’s interest.