Last call for regional health praxis? How Africans can pivot from COVID-19 clinical trial participants to vaccine and drug developers and manufacturers
|19 August, 2021||Odhiambo Gandhi, Joanes Atela, Nora Ndege, Samson Kinyanjui and Uzma Alam|
The COVID-19 pandemic, like Zika and Ebola before it, is a reminder to Africa to walk the talk on strengthening her vaccine and drug (VD) development systems.
There is a global shortage of capacity for vaccine and drug development, especially during health emergencies. Here we consider potential strategies to strengthen African capacity for vaccine and drug development coordination, regulation, and manufacturing. This blog is informed by a recent high-level discussion series on COVID-19 science and policy engagement in Africa, part of a series of “tele-convenings” of health and policy leaders from across the continent.
The tendency for individual African countries to jockey for advantage in drug research & development (R&D) hampers an efficient pandemic response. Individual nations hesitate to adopt regional partnerships due in part to sovereignty issues. Moreover, African countries and those in the ‘less developed’ world can be subject to ‘vaccine and drug apartheid,’ victims of political and economic forces that disadvantage African countries in the global competition for R&D resources during pandemics. Inevitably, bureaucratic barriers to the approval of VD R&D have adversely affected research scientists in Africa despite their desire to be full participants in the fight against COVID-19. Countries would be well-served by a deliberate and well-coordinated regional approach to developing VD clinical trial capacity, in turn creating capacity for local manufacturing. To this end, some African countries have established ethics and regulatory committees since March 2020 to oversee R&D approval. To accelerate and amplify this process, the assembled thought leadership recommended multiple pathways:
Embrace homegrown, indigenous approaches to vaccine and drug development
Multiple studies suggest that the medicinal potential of a vast diversity of indigenous plants in Africa1,2 is under-exploited. To build local capacity to respond to the COVID-19 pandemic, countries including Cameroon, Nigeria and Madagascar made deliberate attempts to ‘formalize the informal’ — indigenous and local approaches to COVID-19 treatment. Such efforts, however, are limited by requirements for clinical trials according to universally accepted safety protocols. To the extent that these inhibit the adoption of local solutions and capabilities, Africa’s capacity to respond to world health crises is weakened. Institutions must be agile in adopting cutting-edge local research, resisting the tendency to disempower and reduce the agency of local communities. This can only be achieved by the complete integration of communities whose health vulnerabilities and risks are high, and by accounting for the distinct social-economic and cultural influences of each community.
Strengthen integrative health systems and develop Africa’s capacity for local manufacture of vaccines and drugs
Africa’s contribution to VD development has been relegated historically to serving as clinical trial subjects. African nations and consortia must claim its capacity and desire to manufacture drugs and vaccines for her citizens and those around the world. In addition to the economic and equity imperative of becoming full participants in VD R&D, the participation of African nations at all stages of the development pipeline is essential to confront the history of using African people as more-expendable participants in clinical trials. For example, while the U.S. Food and Drug Administration (FDA) suspended clinical trials of Nevirapine due to the emergence of severe side effects, expectant women in ‘resource-limited areas’ of Africa continued to be subject to these trials. For African countries to reverse these trends, local systems must be integrated into designs for early detection, monitoring, management, and modeling of clinical trials.
This is particularly important given the unique convergence of multiple pandemic outbreaks in Africa, including HIV, Ebola, Zika and malaria. In some exceptional cases, this history of multiple pandemics has strengthened Africa’s health infrastructure through, for example, fast-tracking approvals in some countries. This may have contributed to the lower-than-predicted COVID-19 infection rate in Africa. It is imperative that Africa moves beyond her role as providing ‘guinea pigs’ to actively using its human capital and natural products to build the necessary health infrastructures for VD manufacturing. Governance across the continent must be modified to integrate regional R&D at all levels of the pipeline.
Leverage global synergies to enable African countries to be active prosumers in the pharma industry, not just consumers of drugs and vaccines
A report published by World Economic Forum (WEF) on how Africa can make its own medicines reveals that Africa imports nearly 90% of the drugs consumed by its 1.1 billion citizens. This not only raises her vulnerability to vaccine and drug shortages, but also erodes her leverage in global negotiations as VD manufacturers. A model for upending this norm is Ghana’s new rules on cocoa exportation, especially to Switzerland. Africa must claim her right and capacity to move beyond the role of exporter of ingredients for drugs that are manufactured elsewhere to local manufacturers. The Africa Continental Free Trade (AfCFTA) pact is a step in this direction but must be strengthened and simplified.
Africa must build her health system capacity, particularly production and supply chains. This can only be fully realized when African countries put aside nationalistic self-interest and embrace regional integration of vaccine and drug manufacturing.
Asundi, A., O’Leary, C., & Bhadelia, N. (2021). Global COVID-19 vaccine inequity: The scope, the impact, and the challenges. Cell Host & Microbe, 29(7), 1036–1039. https://doi.org/https://doi.org/10.1016/j.chom.2021.06.007
Banda, G., Wangwe, S., & Mackintosh, M. (2016). Making Medicines in Africa: An Historical Political Economy Overview. https://doi.org/10.1007/978-1-137-54647-0_2
Gakuya, D. W., Okumu, M. O., Kiama, S. G., Mbaria, J. M., Gathumbi, P. K., Mathiu, P. M., & Nguta, J. M. (2020). Traditional medicine in Kenya: Past and current status, challenges, and the way forward. Scientific African, 8, e00360. https://doi.org/https://doi.org/10.1016/j.sciaf.2020.e00360
Richey, L. A., Gissel, L. E., Kweka, O. L., Bærendtsen, P., Kragelund, P., Hambati, H. Q., & Mwamfupe, A. (2021). South-South humanitarianism: The case of Covid-organics in Tanzania. World Development, 141, 105375. https://doi.org/https://doi.org/10.1016/j.worlddev.2020.105375