Kenya must invest more in R&D to promote vaccine manufacturing

The effects of the Covid-19 pandemic remain formidable. To date, the pandemic embodies the greatest threat to global public health and economies in the 21st century, with the crisis laying bare stark weaknesses in almost every healthcare system.

This is compounded by the effects of other health challenges masked by the continued dominance of Covid-19 in our lives. While no country has been spared, the situation is worse in low- and middle-income countries where already vulnerable and marginalised populations bear a disproportionate burden of infections.

The rollout of Covid-19 vaccines, however, brings hope in the fight against the pandemic despite being surrounded by the challenges of equity, especially in Africa and other LMICs.

Issues of accessibility and affordability, fuelled by vaccine nationalism and hoarding by higher-income countries, have revealed deeply entrenched inequalities in global health security that continue to threaten the attainment of Universal Health Coverage.

Vaccine nationalism and bilateral deals made by more affluent countries are driving up prices as well as limiting the number of doses available for purchase.

According to the World Health Organization, less than two per cent of the world’s Covid-19 vaccines had been administered in Africa as at April 8. Countries therefore, have a huge task of making sure the vaccine is available and accessible to at least 60 per cent of Africa’s 1.3 billion people to achieve continent-wide herd immunity. But with infection cases continuously surging, governments are scrambling to secure the much-needed supplies.

One of the greatest lessons that vaccine nationalism has taught us is the need for Africa to invest in developing its own capacity to manufacture and distribute domestically produced health tools– vaccines, pharmaceutical products and diagnostics.

Africa should not solely rely on donations and importation of essential medical supplies. This makes it difficult to respond to pandemics in a timely manner - leaving citizens exposed to supply chain challenges and public health risks as manifested by Africa’s current struggles to access Covid-19 vaccines.

We should make it an urgent assignment to set up resilient structures to not only help counter the current pandemic but also make us better prepared to prevent and respond to future pandemics.

The Africa CDC reports that the continent consumes approximately one-quarter of global vaccines by volume. Conversely, it manufactures less than one per cent of its routine vaccines.

So far, there are less than 10 African manufacturers with vaccine production capacity based in five countries – Egypt, Morocco, Senegal, South Africa and Tunisia. This presents a very limited upstream production as most of the local companies only engage in labelling and packaging, and occasionally fill and finish steps. Production capacity scale-up and expansion to other countries should be treated with utmost urgency.

These current challenges grant a great opportunity to strengthen ongoing conversations and proposals into actionable steps spearheaded by the African Union and regional bodies to promote vaccine manufacturing on the continent.

Great steps have been taken towards strengthening ties between  organisations for enhanced health research, development and vaccine manufacturing in Africa.

They include the historic Covid-19 vaccine procurement agreement signed on March 28 this year between Johnson & Johnson and AU member states, through the African Vaccine Acquisition Task Team. And there's the MoU signed between the Coalition for Epidemic Preparedness Innovations, the African Union Commission and the Africa Center for Disease Control on April 13.

These efforts were boosted by the conference hosted by the Africa CDC on April 12 and 13 to discuss Africa’s vaccine manufacturing — which is one of the pillars in the AU and Africa CDC proposed New Public Health Order. It seeks to safeguard the health and economic security of the continent as it strives to meet the aspirations of its Agenda 2063 and react to future pandemics.

Scaling-up local manufacturing and access to resources and technologies should remain critical priority areas for African governments. Covid-19 presents a unique challenge for health financing because of the size and scale of its impact on the health sector. It also has significant economic ramifications at national, regional, continental and global levels.

Nonetheless, it has underscored the need for sustained fiscal investment in health research and development.

The speed and scale of vaccine development efforts, the proliferation of diagnostic tools and the development of several proven and promising therapeutic agents from other continents are all evidence of where  global science has triumphed. They reflect decades of investments in biomedical research that could rapidly be brought forth in the face of the new threat.

Sadly, for Africa, only a small fraction of fiscal investments is made in health research. Policymakers must now be cognizant of the cost of inaction during national budgeting.

Kenya’s budget-making process is currently underway, and as we await the acclimatization of the process in June, all eyes are on the policymakers to see the portion of the budget that will be allocated to health research and development.

This should be in the spirit of the Health Act 2017 that sets the premise for health R&D in Kenya by giving the National Research Fund the mandate to allocate not less than 30 per cent of its funds to health R&D.

By increasing the allocation, Kenya is poised to show leadership to other African countries by adhering to the African Union Pledge of 2007 that calls upon member states to empower local research institutions by increasing the allocation of local funding for research and innovation to at least one per cent of the national GDP.

It is worth noting that the continental average currently stands at 0.5. per cent, compared to a world average of 2.2 per cent.

The World Immunization Week is celebrated from April 24 to 30. This year’s theme is ‘Vaccines bring us closer'. This event should be a wake-up call to all sector players who must now move beyond glamorous rhetoric and act.

Governments must invest in public-private partnerships by leveraging capital, resource capacity, and know-how, and potentially providing offtake guarantees or other preferential incentives to local manufacturers.

Academia should move beyond publishing papers and translate them into innovative health products and policy recommendations for the advancement of R&D.

Civil society and advocacy networks such as the Coalition for Health Research and Development must double their efforts to rally different sector players in transforming the fiscal and policy ecosystem for health products, such as the Covid-19 vaccines.

The reality is that the economic costs of a pandemic are huge, far surpassing investments in health research and prevention. It’s therefore imperative to have more billions of dollars of investment in research, innovation, vaccines, and therapeutics as the only way to avert trillions of dollars in economic damages, loss of life and livelihoods for millions of people all over the world.

Dr Bernard Kipkoech Langat, Programme Director – Amref/CHReaD

(Edited by V. Graham)