Nii Lantey Bortey
Humanity has endured several notable pandemics, including the Spanish Flu, which swept the globe in the early 1918s, infecting an estimated half a billion people with over 50 million fatalities. The rapidly growing global interconnectedness, urbanization, overdependence on natural ecosystems, among others, have facilitated the spread of pathogens among countries and increased the likelihood of future pandemics. The legacy of these previous pandemics has led to the emergence of key public health institutions and the reorientation of significant policy attention to focus on the establishment of global surveillance networks, increasing international cooperation and preparedness, and most notably, advancing vaccine technologies to counter future pandemics. Most vaccines deployed today to prevent various infectious diseases were developed through the attenuation of live organisms and the injection of immunogenic components to improve the presentation of antigens to the immune system. These classic techniques were adapted to modern vaccine technology in the early 1950s, and subsequently led to the development of vaccines for hepatitis B virus, rotavirus, and the HPV in the United States (McCullers et al, 2008).
The COVID-19 pandemic somewhat caught the world by surprise, but recent advances in vaccine technology in North America, Europe, and other parts of the world, which stem from the application of genetic engineering spurred by the industrial revolutions, ensured the swift development of highly effective vaccines that mitigated the severity of the pandemic. In the West, the pandemic spurred massive private and public sector investments towards vaccine research and development. For instance, in the first few months of the pandemic, North America and Europe spent over US$4.3 billion on emergency funding to advance vaccine development (Peterson Institute for International Economics (PIIE), 2021). This enormous investment, coupled with the remarkable political will and the coordination of the academic, private and public sectors, consequently led to the testing and approval of several vaccines for COVID-19 in less than a year. According the PIIE, this has been an extraordinary achievement, especially with the success of vaccines based on the new synthetic messenger RNA (mRNA) technology utilized by Pfizer/BioNTech and Moderna, which are considered potential game changers for targeting emerging diseases where rapidly designing, constructing and manufacturing vaccines are crucial.
East Asia’s response to the COVID-19 pandemic has also been relatively exceptional so far. This has been attributed to the lessons learnt and innovations derived from the region’s decade-long battle with novel pathogens, such as the 1957 and 1968 Asian and Hong Kong influenza pandemics, respectively, and most recently, the 2002-03 SARS epidemic. After the SARS epidemic caused the most severe socio-political crisis in the Chinese leadership, the government invested billions of dollars into research preparedness and construction of a three-tiered network of disease control and prevention system (Huang, 2004). These significant investments and other public health initiatives led to the advancements in viral diagnostics methods, immunogenicity testing, and bioinformatics capabilities, among others. Understandably, Chinese researchers were among the first to begin vaccine development against the COVID-19. The Sinopharm (inactivated) vaccine, for instance, developed by the Chinese state-owned firm, has been approved by the W.H.O for emergency use worldwide.
Africa is no stranger to epidemics. The trypanosomiasis epidemic that originated from the Busoga region in Uganda in the early 20th century killed more than 250,000 people. More recently, the HIV/AIDS pandemic and Ebola virus disease (EVD) are the two of Africa’s instructive epidemics that have had devastating socio economic effects and fatalities. The delayed containment of the EVD as a result of the weak surveillance capacity, coupled with the region’s poor healthcare systems and the associated high EVD-related mortality, led the W.H.O to warn that Africa could be the next COVID-19 epicenter (Afolabi et al, 2020). Even though the continent’s COVID-19 mortality rate is, ironically, lower than that of more advanced nations, it significantly lags behind in the doses of vaccines administered, which has proved so critical in controlling COVID-19. Out of the 526.8 million vaccines administered worldwide, only about 4.5 percent have been administered in Africa, according to Africa CDC. Would this inequity in vaccine distribution be avoided if a vaccine was developed in Africa?
Despite the fact that proliferation of biomedicine in Africa took place in an oppressive colonial context, one would expect the sociological and physiological imprints left by the continent’s past epidemics to cumulatively build a strong political will and unleash an extraordinary outpouring of research and development supported by public and private investments towards vaccine development. The question that however remains is, would this latest pandemic finally spur the continent’s vaccine revolution, and boost its resilience and preparedness for future pandemics?
Africa has the highest incidence of mortality caused by infectious diseases in the world. Nevertheless, it produces only 1 percent of the vaccines it administers (Nature, 2020) and just 2 percent of the global scientific knowledge (Kasprowicz et al., 2020). Additionally, it allocates only 0.5 percent of its GDP to research and development, compared to the global average at 2.2 percent.
For Africa to reduce its double burden of infectious and chronic diseases, improve life expectancy, build its scientific capacity, and guarantee its health and economic security, it should look beyond vaccine manufacturing through transfer of vaccine technologies. Instead, it should focus on building its capacity to develop and patent its own vaccine and production technologies. Simply sharing technologies and production processes is dangerously inadequate in building the continent’s own research base.
To successfully do that, it would at least four core ingredients: a strong political will; expansion of its scientific capacity through increased investment in research and development; build collaborative networks and strengthen south-south collaboration; and establishment of regulatory bodies that meet W.H.O’s regulatory standards.
The political will to create more vaccine research and innovation projects, and boost local manufacturing capacities is rising, particularly in Africa, in the wake of the COVID-19 pandemic. The presumed ‘vaccine nationalism’ and ‘vaccine apartheid’ which have, undoubtedly, impeded the vaccination of a critical mass of the world’s population implies that when crises hit, countries prioritize the needs of their own first. Africa is taking note. In an effort to ameliorate its resilience and pandemic preparedness and achieve public health security, the continent leaders have embarked on several policy agendas, including the Partnership for African Vaccine Manufacturing (PAVM) and the recent global conference held by the African Union (AU), which aims to expand Africa’s vaccine manufacturing for health security and fast-track vaccine development, respectively. Although these are steps in the right direction, Africa’s leaders’ lack of political will to fight corruption, which is strongly correlated to poor levels of scientific innovations (Global Risk Profile), has been one of the major hurdles to its vaccine revolution. Transparency international, for instance, regards political will as the most important variable ‘for ensuring the effective implementation of a comprehensive anti-corruption strategy’.
Gross mismanagement, fraud, and systematic embezzlement have been the strategic essence of governance in most of Africa’s political regimes. This has not only exacerbated the region’s burden of poverty and health inequities, but more importantly, it has considerably reduced the incentives for investment in research and development.
Devising innovative mechanisms to improve government accountability and transparency is an important requisite to building and reinforcing the political will to survive this quagmire. The general consensus among the anti-corruption regime is that Africa ought to move beyond the traditional accountability approaches; reporting, auditing, setting up offices, etc., to ‘pragmatism and action’. According to the UNDP, anti-corruption initiatives must be an integral aspect of national developmental goals, and should also include governance innovations, such as open data systems and social accountability tools. These innovative strategies would allow citizens and stakeholders to use their own observations and data to hold governments accountable and summon authorities to action.
Research studies on scientific capacity building provide compelling evidence on the impacts on scientific research on public health advancements. For example, recent studies conducted by Science and Society emphasized that ‘Strengthening research capacity in developing countries is one of the most effective and sustainable ways of advancing health and development, and helping correct the 10/90 Gap in health research’ which is essential in scientific innovations. As noted earlier, although the continent bears a disproportionately high burden of infectious diseases globally, it produces a mere 2 percent of the global scientific knowledge, and allocates only 0.5 percent of its GDP to research and development. Additionally, Africa has just 79 scientists per million inhabitants, compared to the 656 and 4,500 in Brazil and United States, respectively (The guardian, 2019). This relatively low research capacity has been attributed to factors ranging from limited material and financing resources, weak progression pathways for scientific careers to poor physical and communication infrastructure and lack of critical mass of researchers, among other impediments.
To bridge this gap and build its own research base, there is a need for domestically sustained and long-term investment in research and capacity building, particularly in vaccine research and development. Admittedly, there has been a gradual increase in research and capacity building investments in Africa, and this has increased its scientific capacity in areas such as epidemiology and research ethics strengthening. Most of these efforts, however, have been financially supported and driven from outside the continent. These foreign investments do not bode well for the development of sustainable African-led knowledge production pipelines that are important requisites for economic development and building its own research base (Kasprowicz, 2020). Any partnership initiatives should focus on building local capacities and empowering the continent’s own researchers. Furthermore, research and other health innovative efforts geared towards the prevention of infectious and chronic diseases endemic to Africa, including malaria and Ebola, should be led by African scientists and pioneered in Africa. This would not only ensure that study findings are communicated in a manner that is culturally congruent, but more critically it would improve the scientific knowledge and strengthen African institutions, ultimately providing a platform for scientific innovations.
The other main challenge pertains to the funds needed to steer innovative ideas to fruition. Africa still depends on the West for most of its research and development funds, and, while it can continue to thrive on this arrangement in the initial stages, there is a need for a more sustainable financing mechanism to spur growth in the research and development of the ‘African’ vaccine. The creation and strengthening of a robust south-south collaborative mechanism complete with a joint funding basket arrangement can help Africa to gain the economic muscle that it badly needs to advance its own capacity to develop vaccines. Africa must and should be seen to act as one trading block if it has to win the attention of the global market. The African Development Bank can be one strong pillar to provide the funding needed to support these initiatives, along with ongoing capacity strengthening from the Global North through technology transfer among other initiatives.
Finally, one of challenges associated with vaccine production in Africa is the need for a robust National Regulatory Authority (NRA). All vaccines need to be subjected to appropriate regulatory control from process development to use, in order to ensure their safety, effectiveness, and that they are of high quality. A recent study on the state of the continent’s vaccine regulation by the University of Western Cape indicate that these regulatory authorities ‘range in quality form robust and functioning to offering regulation that is virtually non-existent’ (Irwin, 2021). A similar assessment of 26 regulatory systems in Sub-Saharan Africa by the W.H.O found that they all had critical weaknesses, including severe lack of human resources.
Since NRAs tend to be in the spotlight during public health emergencies, they should have the capacity to effectively and efficiently regulate medical products to boost people’s confidence in vaccines, which is critical in reducing deaths and severe illness.
Conversely, countries with weak NRAs lacks the capacity to control manufacturing, marketing, and use of pharmaceutical products, consequently, hindering the achievement of optimal health outcomes.
The World Health Organization has made significant progress in strengthening national regulatory authorities in parts of Africa. Although most regulatory bodies have become functional as a result, they are usually for oversight of pharmaceuticals, rather than for biopharmaceuticals like vaccines. The COVID-19 pandemic has prompted several calls to fast-track efforts to establish an African Medicine Agency (AMA), similar to the European Medicine Agency (EMA), which would provide national African regulators with regulatory guidance on new medicines (Nature, 2021). This proposal, according to Nature, is being led by the African Union (AU) and the Africa CDC, and would cost an estimated $100 million to establish. This initiative seems propitious and if successful, will catalyze the continent’s efforts for a homegrown vaccine development.
Africa’s ambitions for its own vaccine development and production are not far-fetched. For this to be a reality however, an end to end approach is needed along any potential vaccine value chain – from the development and testing of new vaccine technologies to the vaccination of its population. A successful vaccine development in Africa would significantly reduce its double burden of infectious and chronic diseases, guarantee its health and economic security, and more importantly, boost its resilience and preparedness for future pandemics.
Cite this article
Bortey, Nii Lantey. Africa's Elusive Vaccine Revolution: Surviving The Quagmire. CenRID, (2021). https://www.cenrid.org/research/africa-elusive-vaccine-revolution
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