The Covid-19 pandemic not only exposed the weaknesses in our healthcare system but also revealed the deep-seated issues that remain prevalent with pharmaceutical companies responsible for developing lifesaving technology. The deep-seated issues pertaining to access to medical resources in third-world countries, where many countries are often left behind in the process of accessing lifesaving technology.
“If the local manufacturers would have been given the technology to allow them to make vaccines, we would have been in a better position but there wasn’t enough permission for local manufacturers to produce the vaccines. They (pharmaceuticals) are refusing to share and insist on keeping their exclusive rights while we lose lives,” said founder and director of Health Justice Initiative (HJI) Fatima Hassan at a roundtable discussion organised in partnership with the South African Health Technologies Advocacy Coalition (SAHTAC).
“The reason we are here today is to take stock of where South Africa is with its 2% commitment to health research and development,” said Executive Director at Bhekisisa Centre for Health Journalism Mia Malan, who facilitated the panel which included the HJI’s Hassan, director of international business development for the South African Medical Research Council, Professor Richard Gordon and chief executive officer at Biovac, Dr Morena Makhoana.
“Even if we get all the funding as part of the 2% commitment, what is the point if the research is going to benefit the first world country? We are being used. We were last in line for vaccines after taking part in the clinical trials. It is the community who are driving the clinical trials and yet they are not getting priority and sometimes they don’t get any access at all to these vaccines,” said Hassan. If there is an investment in using public participation then the product has to be a public product, but that’s not what is happening, she added.
Hassan insists medicine and lifesaving technology have to come with a recognition of being a public good, beyond commercial gains that hamper progress for everyone else. “Stop supporting and participating in clinical trials where institutions do not want to share the intellectual property (IP) for the greater good of all,” she added. If things are to change, then these IP issues and systematic access are the priority — otherwise, we will not resolve the issue of access and exploitation.
“There is a hidden danger in the terms and conditions about licensing that we do not have access to,” said Hassan. Governments need to legislate public health research to make sure that it’s not just a matter of philanthropists having too much power.
“The danger with these international agencies is that they can determine the research needs with their funding. We must not only determine our funding, but we must also determine our own research needs. It’s not just the funding and research, but it is about what happens to the knowledge after the research,” added Hassan.
“It is sexy to do research in Africa because of the black bodies that are ‘disposable’,” said Yvette Raphael. The Executive Director Advocate for the prevention of HIV in Africa went on to say that research must commit to transformation — “Where are the black researchers in these conversations?”
There is finally a conversation about racism and decolonisation in medical research particularly as they concern the clinical trial design, Hassan responded. It is the community and civil society who create confidence in science, but if you do not explain to them what is happening, and you leave them out, then people will be losing faith in the potential of science and research to change people’s lives for the better.
Someone in the audience echoed the “we are being used sentiment” and went on to say that South Africa needs to have a public health research agenda with key identified areas that the government aims to fund.
Gordon said that South Africa needs to prioritise producing research because currently “about 75 % of research in South Africa is for other countries”.
According to Malan, the “G-Finder” report published by Policy Cures Research in 2019 revealed South Africa continues to make the list of top funders globally of research and development (R&D) for neglected diseases, which include HIV, tuberculosis and malaria. South Africa ranks at number 12 on the list of top funders, behind high-income countries such as the US, Germany and the UK.
“The warning of the pandemic is that public funding does not mean that the public will get access. The CEO of Moderna said our IP will be recognised on all future vaccines for all diseases. The potential to commercialise is a severe risk because unless you have those patents and the freedom to operate, then it is Moderna who decides what, who and when the work benefits,” emphasised Hassan.
It’s complicated to get to a number of how much the government is spending on its health research and development because of the variety of funding streams between the Medical Research Council, the department of health, higher education, the National Research Fund and other institutions.
“The money is put into so many pots that it is difficult to track, that’s the first issue in tracking our goal for 2%. It needs to come as a government goal to align funding with this objective” said Gordon, who noted that the Medical Research Council accounts for just over R1 billion per year of funds spent by the department of health. “We can do more research but that doesn’t guarantee that we will get more products made because it is expensive to produce medicines locally,” he added.
“Nearly half of our [South Africa’s] budget goes towards buying medicine that we are unable to produce ourselves. Producing the vaccines is not just a matter of setting up the site and finding the expensive raw material, it is also about complying with international clinical standards. The products have to meet these standards and still be affordable enough to be a viable option in a competitive market,” said Gordon.
The changing variants of the virus also add complexities to the R&D phase that make it more costly for small companies to survive against pharmaceuticals, explained Makhoana.
Among others, there were two key Covid-19 diagnostics projects that have come out of South Africa, said Gordon. The first is the Network for Genomic Surveillance in South Africa (NGS-SA) which included various institutions working together to track the various strands, leading to the discovery of the Omicron variant. The second is the mRNA Technology Transfer Hub with the objective to transfer mRNA technology to South Africa and to advance vaccine development and manufacturing in South Africa and beyond the continent. These initiatives rely heavily on the collaboration of various institutions and scholars sharing ideas and resources.
“It is difficult to get into research because research is expensive. However, the dream is to become an end-to-end manufacturer of our own vaccines. We want to produce the product and own the intellectual property for the developed products,” said Makhoana.
He went on to explain that most pharmaceutical companies generate income from their existing products, and use the revenues generated from other wings of their business to R&D and developing vaccines, which are often costly to manufacture with little returns. Setting up a vaccine development company means you have to have at least R500 million annually for a few years before there are any returns, he said.
Partnering with multinational companies that have the technology to develop the vaccines seems to be South Africa’s best bet towards creating our own lifesaving technology.
“We need to partner with those who have the technology. However, those partnerships do not result in revenue for a while, and the question is always how to keep the ship afloat for the development process,” said Makhoana who remains optimistic that we can develop our vaccines. He announced that the mRNA Technology Hub will likely be going to clinical trials next year and that it is only around 2025-2026 that we might start to have vaccines that are produced locally. “Even if we might be out of the pandemic, the product will still be helpful to make sure we can produce our medicine locally,” said Makhoana.
All of these hopes can only be realised with leadership and clarity of vision from the national department of health, who panelists agreed, were always missing from these conversations.