STAVROS NICOLAOU: Game changer for equality in African healthcare

A historical decision was made last week that could truly change the future of Africa. The “great tragedy” of African vaccine inequality was potentially eradicated by a game-changing decision by global vaccine alliance Gavi, which approved the establishment of the African Vaccine Manufacturing Accelerator (Avma), a financing instrument that supports sustainable vaccine manufacturing in Africa up to a $1bn cap.

Gavi supports vaccines against 17 infectious diseases, currently vaccinating more than half the world’s children, which gives it significant negotiation power.

Access to basic healthcare is crucial to Africa’s development agenda, and having an accessible supply of vaccines is a critical success factor to continental health security. For Africa, with some of the poorest countries in the world, it is imperative to deal with the issues that have prevented African manufacture of vaccines.

Admittedly, the number of manufacturers supplying pre-qualified Gavi-supported vaccines has grown, from five in 2001 to 19 in 2022 (with more than half based in low-middle-income countries). But none is from Africa — until now.

The Gavi decision last week about the launch of the financial instrument comes at the end of a series of decisions over the last year that will, in effect, help lower-income countries tackle the “backsliding” after the Covid-19 pandemic and allow Africa to be better prepared to respond to current and future health emergencies.

During a May 2022 meeting, the Bureau of the Assembly of AU Heads of State extended access by the African vaccine manufacturing countries to the international purchasing and distribution platforms. French president Emmanuel Macron, in his capacity as chair of the Council of the EU, was also in attendance.

Heads of state expressed strong concern that global vaccine purchasing players like Gavi had been slow to support the continent to develop its own vaccine manufacturing capacity, using only manufacturing hubs outside Africa for vaccines meant for Africa.

There was a clear call for organisations and agencies responsible for bulk purchasing of vaccines, such as the Covax facility, Gavi, Unicef and African governments, to prioritise procuring vaccines for Africa from African producers. The bureau called for Gavi and other partners to offtake at least 30% of all vaccines produced by the continent for global consumption.

The May 2022 meeting was followed by a Gavi board meeting decision on December 8 2022 to approve the development of a regionally diversified vaccine manufacturing ecosystem “based on three pillars; support for strategic antigen selection by manufacturers/countries, market shaping and demand creation, the initiative represents a major step forward in addressing one of the critical challenges faced during the pandemic: how to ensure all regions of the world have the ability to manufacture vaccines.

“The initiative, supported by the AU, Africa CDC, G7 and other stakeholders, also envisages the possibility of a fourth pillar, the design of a new financial instrument in the form of an advance market commitment for African vaccine manufacturing. This will be developed over the coming year, for potential approval and launch in 2023.”

A year later, almost to the date, this commitment has now been delivered on by the Gavi board in the December meeting last week. But, what does this all mean?

We have always underscored the need for Africa to have a united position on ensuring multilateral agencies and philanthropists that are providing vaccines to Africa, should procure them from African producers, hence guaranteeing Africa’s position in the vaccine manufacturing sector for the benefit of Africans in terms of access to healthcare, through cost and availability. Who can forget the promises to Africa for Covid-19 vaccines that were never fulfilled?

In May 2022, we agreed that a few things needed to happen for Africa to secure its position in the global vaccine manufacturing ecosystem:

• Establish a working group of vaccine manufacturers in Africa, co-ordinated by the Africa CDC as part of the Partnership for Africa Vaccine Manufacturing, inclusive of those countries aspiring to produce vaccines.
• Set up procurement mechanisms, through AVAT/T, Africa CDC and Common African Pooled Procurement System (CAPPS) for public health products, to ensure certainty of demand for African manufactured vaccines and other relevant pharmaceutical products by the end of the year. This is a critical aspect of securing offtake agreements for the vaccines and essential medicines and health products.
• Set up a mechanism to support manufacturers with business case development.
• Engage in high-level advocacy with Gavi, Covax, African governments and other stakeholders to encourage support for the emerging African vaccine manufacturing industry.
• Lastly, but most importantly, united political will and commitment is required, led by the bureau to increase the demand for vaccines in Africa for us to reach the two vaccination targets of the AU’s 2040 60% localised manufacturing and the 70% target set by the WHO.

Commitments were made by the bureau of heads of state on each of the above, and there has been measured progress on all of the five action items above, but with last week’s decision by the Gavi board one thing has become very clear, and that is the need to accelerate actions and reaffirm commitments.

The immediate next steps are for Unicef, the procurement arm of Gavi, to onboard the African manufacturers, which need to be accredited and licensed by the WHO. These manufacturers then go into a Unicef tender process, which should result in orders being placed according to the financial instrument.

We can’t stress enough the importance of advocacy and political will of our heads of state to support this historical decision by Gavi, because history will only be made if our own member states procure from Africa, for Africans.

To this end, the timing of living in the era of the African Continental Free Trade Agreement (AfCFTA) means this decision creates an opportunity to accelerate the operationalisation of the AfCFTA, especially because Africans become the beneficiaries of access to healthcare, at a lower cost, and widespread availability.

We have all the components for success, but that success is dependent on closing the circle with political will, actualised procurement and creating a framework and infrastructure for optimised intra-Africa trade. All of those things are up to us.

Never again shall “the great African vaccine tragedy” of Covid-19 be repeated. Africa’s future history lies in our own hands.

• Nicolaou is group senior executive at Aspen Pharmacare.