In 2021 at the height of the COVID-19 pandemic, Aspen Pharmacare opened Africa’s first COVID-19 vaccine plant in South Africa backed by US pharmaceutical giant Johnson & Johnson. It was hailed as a trailblazer and a lifeline for Africa. Less than a year later, in 2022, the effort was abandoned.
Like Aspen Pharmacare, Moderna abandoned its mNRA manufacturing plant in Kenya after waiting for orders for two years. Likewise, South Africa’s AFRIGEN developed a COVID-19 vaccine. But no orders were received.
Many reasons were given to account for the fact that Aspen, Moderna, and AFRIGEN did not receive orders – poor African logistics, lack of skilled staff and cold chains, etc. In other words, the usual claim of lack of capacity in Africa. But the true reasons for the failure of these efforts have little to do with lack of capacity.
Aspen Pharmacare, Moderna, and AFRIGEN all responded to an outcry: as the storm of COVID-19 picked up speed in 2020-2021, African countries were at the bottom of the list for delivery of vaccines amid warnings of a continental catastrophe.
But even though by 2022 only a sixth of the population in the continent was vaccinated, African countries did not order vaccines from Aspen, Moderna or AFRIGEN. This experience was an object lesson.
African Market for Vaccines
By the late 1990s it was estimated that some 30 million children in developing countries were not fully immunized against deadly diseases, and a larger number were not immunized against any disease. The drive for universal immunization had stalled in part because low-income countries could not afford the vaccines.
Led by the Gates Foundation, a group that championed health in poor countries developed a formula to enable manufacturers to sell vaccines to lower-income countries.
The proposal offered manufacturers long-term, high-volume, and predictable demand from lower-income countries. In exchange, the manufacturers would lower their prices to make vaccines more affordable to lower-income countries. Thus, emerged Global Alliance for Vaccines and Immunization (GAVI) in 2000, under whose auspices reduced cost vaccines are provided to many African countries today through GAVI and UNICEF with most countries handling local distribution.
For example, Kenya commits to buy a certain number of vaccines each year for 5 years based on demographic projections. That gives manufacturers a predictable market and rationale for lowering the price. Kenya provides for testing, cold storage, distribution, and the logistics for vaccination but the main hurdle, buying the vaccines, is under some control though the GAVI-UNICEF arrangement.
When it was replicated across the continent, this arrangement has saved millions of Africans. It is a reliable arrangement. Indeed, some African countries rely on the GAVI-UNICEF arrangement for some aspects of testing, cold storage, distribution, and logistics in addition to receiving the vaccines.
Under current arrangements, once a country attains a gross national product per capita of US$1,820, it is no longer eligible to participate in the program. Presumably, countries that have higher gross national product per capita can afford to pay full prices for vaccines directly from manufacturers without the intermediation of GAVI. The arrangement gives African countries access to vaccines, but it also shapes the market for the manufacturers of vaccines in advanced economies. The expectation is that African countries will ‘graduate’ from this arrangement and become customers of the manufacturers in advanced countries. GAVI has arrangements with 40 African countries including Kenya.
Clearly, African countries would not override the GAVI-UNICEF arrangement even under circumstances as dire as being the last in a long line to receive vaccines amid a raging epidemic.
This is the reality that Aspen Pharmacare, Moderna, and AFRIGEN encountered before abandoning their efforts to produce COVID-19 on the African continent. Even if the African countries had opted to buy vaccines, the cost would have been higher than what the GAVI arrangement provides.
To produce vaccines in Africa, to one degree or another, all three companies depend on technology transfer and imports of the substances which are used to make vaccines. Consequently, and although the final stages of production occur in Africa, the vaccines are costly. Hence, despite having the largest concentration of vaccine manufacturers on the continent, South Africa recently made the decision to source cheaper vaccines from Cipla in India.
The next discussion will focus on the lessons that Africa could learn from India if Africa is to achieve the goal of producing vaccines on the continent.
