The Key to Transforming African Health

Автор: Jayati Ghosh
Professor of Economics at the University of Massachusetts Amherst

Despite the relentless stream of bad news from around the world, there are still reasons for optimism

One notable example is the renewed push to localize pharmaceutical production in Africa, demonstrating how even catastrophic events like a pandemic can lead to positive, unforeseen outcomes.

The COVID-19 shock underscored the critical need to fund public-health systems and expand access to essential technologies and preventive and therapeutic drugs, and should have served as a wake-up call for policymakers and publics worldwide. But once the virus was brought under control, wealthy countries reverted to the policies and practices that had made the initial pandemic response so unequal.

No part of the world has suffered more from these extreme global inequalities than Africa. African countries were the last to receive COVID-19 vaccines, having been crowded out by vaccine-hoarding wealthier countries and denied access to the technologies necessary for domestic production. Although Africa accounts for 18% of the world’s population, the continent received only 3.3% of all administered vaccines by the end of 2021. By the end of 2022, its share had barely increased to 5.5%.

Even before COVID-19, Africa was already grappling with the global neglect of major epidemics such as Ebola, Zika, and monkeypox, as well as endemic diseases like sleeping sickness. One of the biggest obstacles to tackling these health crises is the continent’s dependence on imported drugs. Despite bearing one-quarter of the global disease burden, only 2% of medical research is conducted in Africa, and more than 90% of the continent’s vaccines and 70% of its medicines are imported. Moreover, of the roughly 375 pharmaceutical manufacturers operating in Africa, just 15% are locally owned, and most of these companies focus on formulations rather than the active pharmaceutical ingredients (APIs) crucial for drug production.

Fortunately, the bitter experience of COVID-19 appears to have catalyzed a much-needed policy shift. During the pandemic, the Africa Centers for Disease Control and Prevention laid the groundwork for inter-governmental cooperation by bolstering collective regional responses under extremely difficult conditions. More recently, several African governments and international organizations have launched initiatives to boost local pharmaceutical production and promote innovation across the continent.

The African Pharmaceutical Technology Foundation, backed by the African Development Bank, is a prime example. This initiative aims to bolster the continent’s technological capabilities by expanding access to knowledge, building skills, and expanding product pipelines. The Foundation has pledged to invest up to $3 billion over the next decade to develop pharmaceutical products in Africa, thereby reducing the continent’s dependence on imports.

Another example is the Medicine Patent Pool’s mRNA technology transfer program, supported by the World Health Organization and the United Nations. The goal of this initiative, which operates from its South African hub at the Cape Town-based biotechnology company Afrigen, is to develop the necessary technological capacity and technical know-how to enable 15 low- and middle-income countries to manufacture mRNA vaccines. Initially focused on COVID-19 vaccines, the program has since expanded to other diseases prevalent across Africa, as well as more affordable cancer treatments.

These initiatives face significant challenges, especially their reliance on voluntary technology transfers, which have proven to be very limited in scope. To access essential knowledge and force multinational companies (MNCs) to share their technologies, African countries must expand their use of compulsory licensing, in line with their own patent laws and the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement.

Notably, the mRNA hub in South Africa has already faced legal challenges from Moderna, itself a beneficiary of US government subsidies and patent sharing. This underscores the importance of ensuring that the ongoing negotiations for a global pandemic treaty include specific provisions addressing compulsory licensing.

That said, access to knowledge alone is not enough. Given that production processes require specialized expertise, comprehensive education programs and skills training are crucial to establishing a sustainable foundation for innovation and production in Africa. This requires a broader regional effort, which African governments appear to be considering.

Another major obstacle is competition from large pharmaceutical companies. Novartis, which has previously initiated patent disputes in countries like India, has already announced its intention to achieve a fivefold increase in patient outreach in Sub-Saharan Africa by 2025. For localization efforts to succeed, it is crucial to emphasize local ownership and ensure that the benefits are not monopolized by Big Pharma. In any case, MNCs can be unreliable partners, as is evident from Moderna’s recent decision to put on hold its planned investment in vaccine production in Kenya because reduced demand makes commercial profitability less likely.

Given that Africa’s rich genetic diversity makes it a veritable treasure trove of genomic data, the risk of knowledge and data theft is a pressing concern. While the African CDC’s Pathogen Genomics Initiative was celebrated as a major achievement when it was launched in 2019, there are now valid concerns that the pandemic treaty could make these data globally accessible, potentially benefiting large pharmaceutical companies in rich countries without ensuring fair compensation for Africa. Tellingly, foreign powers are already squabbling over who should control access to this invaluable database.

The challenges confronting African countries’ efforts to take control of their health-care destiny are immense. Their determination to localize drug and vaccine production is a promising start.

© Project Syndicate 1995-2024

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