SAHTAC, the Coalition for Health Research and Development (CHReaD) and Pandemic Action Network (PAN) jointly hosted an official side event during the second International Conference on Public Health in Africa (CPHIA) in Kigali, Rwanda. The event was titled, Expanding local and regional production of medical countermeasures in Africa. The event was held at the Kigali Convention Centre on 12 December. The hybrid event was joined by 17 participants online and attending in person. The participants were from multiple sectors including civil society, patient groups, academia, and the private sector.
The session was held as a side event and organized by SAHTAC and The AURUM Institute. The dialogue held in a panel discussion format comprised of two substantive sections each playing an important facet to informing participants on the impetus for building better and responsive healthcare systems that can act as effective buffers for any future health threats using lessons from the COVID – 19 pandemic in the continent. The panelists together with participants from all over the globe in person and virtually engaged in the dialogue to specifically tackle challenges and leverage innovative efforts to build and grow local and regional production capabilities to strengthen healthcare systems in the continent, explore innovative ways to adequately finance preparedness and responsiveness for future health threats, explore innovations around the need to strengthen technical capacities and efforts for local manufacturing in Africa for better healthcare systems, take stock of progress made in strengthening regulatory capacity in Africa and challenges in action and the need to unlock them. The discussions in each panel were informative and action oriented with a focus on calling all stakeholders to act.
Mr. Aggrey Aluso, the African regional director of the Pandemic Action Network underscored the adverse impact Covid – 19 has had on the continent and worsened since the continent was not well prepared and heavily dependent on the global North. Unfortunately, due to the pandemic’s global reach, the Africa was left stranded with the global North having to focus inwards to protect and deal with the issues brought by the pandemic. Although we are experiencing a resurgence in recovering from the Covid – 19 pandemic, we need to not forget and reflect on lessons learned to avoid going through a vicious cycle. As such, the session and the conference comes at a good time in offering a platform allow important discussions around key issues to take place including but not limited to understanding our real ecosystem in terms of the continent’s preparedness for pandemics, what is needed for the continent’s R&D ecosystem, what partnerships are key to enabling the continent’s capabilities to sustainably handle future health threats, what level of commitment do we need in terms of financing for health and the innovative ways to do so, What key multi sectoral approaches to maintain an innovative, and responsive healthcare ecosystem, key governance approaches that will enable countries and the continent in general to sustain the resurgence momentum and how to engage with the world to affirm the continent’s voice in the global health agenda, as well as exploring dynamics in the continent’s market trends and potential to sustain production. The hope is, through such discussions, Africa will never have to find herself unprepared in any future health threats.
In his remarks, Dr. Githinji Gitahi, the group CEO for AMREF Health Africa emphasized on the currency the dialogue in the session has to sustainably transform health systems in the continent. Dr. Githinji also underscored the interconnection between the AU’s agenda 2063, particularly around building pillars of prosperity on the foundations of health. However, challenges that have continued to impede Africa’s progress calls for more efforts to launch the continent through a great escape like those experiences by Europe and others. The question is how to achieve that feat in the continent experiencing rapid population growth, poverty, and scarce resources. One thing to note, as Dr. Githinji puts it, financing pandemic preparedness and response systems are not mutually exclusive. Hence, key focus should be put to building foundations for a holistic health system for it to responsive day to day and to respond when times of crisis. The next key issue is to identify the key pillars necessary to build on. For him, the needed manpower in the healthcare ecosystem, the quality-of-service delivery, the health service, products and technology, the data to inform decisions, leadership and governance, and financing, trust which is central to bridge the interaction between the services, products etc. provided and the recipients of services and products. Without trust, then no matter the efforts put in, no outcomes will be achieved. One other issue that needs attention is that of financing taking stock of current realities whereby Africa continues to record low access to health services including health services and commodities. This boils down to the adverse outcomes of poor structures in health financing and lack of innovative financing. To overturn this, it is fundamental to start using our domestic resources in an extremely efficient manner through innovation and through devolution of decision making to the lowest level, integrate development assistance and convert it into development investment to bolster capacity building and manufacturing capacities in the continent. For Dr. Githinji, innovative financing is a shift of mindset, accountability, mutual trust to use existing resources.
On navigating different market forces that forces Africa local manufacturers to be at a competitive disadvantage, Dr. Githinji sees the current ongoing discussions to open a financing window for enabling local vaccine manufacturers which is different from GAVI replenishment approach to raise funds specifically for African manufacturing. This in turn can then help cover the price premium and allow the region to go through the phase of capital investment to the price competitive phase and achieve manufacturing distribution. On the issue of nationalism, it is important for AU to take the lead and identify areas of focus that can be distributed in different markets to avoid concentration of market power and avoid potential geopolitical issues that can have significant market implications.
Moreover, in his remarks around manufacturing capacities and current realities in Africa, Prof. Geoffrey Setswe- Managing Director – Aurum Implementation Research Division recognized the dire situation that the continent is in whereby the continent accounts for 17% of world’s population and yet bears the biggest disease burden and contributes only 3% of global drug production with high reliance on donors to access vaccines. Although, few initiatives and efforts are already being implemented including the Africa CDC’s partnership for African Vaccine Manufacturing (PAVM), African Development Bank’s African Pharmaceutical Technology Foundation, and AUDA – NEPAD’s Pharmaceutical Manufacturing Plan for Africa (PMPA). The challenges faced by the continent are far and wide with multisectoral implications including financing, access to technology and technical know-how, human resource capacity, weak regulatory systems, R&D. As such more need to be done to enable local manufacturing including investing in building the technical capacity required to support the local manufacturing agenda, adopting an incremental approach towards manufacturing among others.
In taking stock around the progress made in strengthening regulatory capacity in Africa to expand local and reginal production of medical countermeasures in the continent, Dr. Margreth Domondo, Head of the African Medicines Regulatory Harmonisation Initiative- African Union Development Agency reiterated on the progress made under the PMPA and PAVM whereby goals under the PAVM have been set to increase vaccine manufacturing on the continent (60%) of the demand by 2040 and mandated the program to develop a framework for action to execute plans. This includes the institutionalization of a continental strategy that will set the agenda and formulate 6 key functional operational pillars for its success (market design and demand intelligence, access to finance, technology transfer and IP, regulatory strengthening, R&D and talent development and infrastructure development). Moreover, more progress has been observed in the ratification of the AMA treaty, but more efforts need to be exerted to reach 100% ratification status.
Dr. Simon Agwale, CEO of Innovative Biotech Ltd echoed the previous speakers’ reflections particularly around the need to increase efforts to build manufacturing capabilities in the continent to improve the region’s readiness for any future health threats. For him, the key entrance point is to decrease dependency while investing in building local capacities through a multi sectoral approach. Through this approach, the region’s readiness and responsiveness to health threats will be bolstered.
Key Takeaways from the session
Through discussions, key takeaways in form of recommendations were propose and are as follows
- The need to invest in building manpower capacity in the healthcare ecosystem in the continent.
- More investment needs to be allocated to R&D through a multisectoral approach in the healthcare in health.
- Start building trust in our healthcare system to bridge the interaction between the services, products etc.
- Increase advocacy for development investment instead of development assistance for building and manufacturing capacities in the continent (Innovative Financing).
- Devolve institutional decision making to enable efficient utilization of resources in our health care ecosystem.
- Accelerate efforts to streamline regulatory systems that encourage domestic health products development and ensure the quality, safety, and efficacy of the products.
- Embrace technology co-creation to go beyond technology transfer in enabling local manufacturing.
- Consider adopting a regional hubs approach to cluster production of affordable and high-quality drugs.