Inequality has plagued responses to harmful pathogens. Take Covid-19: an unprecedented 11.9 billion doses of vaccines have been administered worldwide, helping many countries turn the tide of the pandemic. Yet more than 80% of people in Africa have not received a single dose, some 18 months after the first person was vaccinated.
As long as this gap exists, we cannot protect the world from new variants of the virus and end the acute stage of this pandemic.
Thanks to revolutionary innovations, effective vaccines have been developed to protect against Covid-19 in record time. However, at the beginning of the vaccination campaign, there was a concentration of production of vaccines and other health technologies in a few, mostly rich countries. Poorer nations found themselves at the back of the queue.
Since then, the situation has changed, with world supply exceeding world demand. The international community, led by the ACT-Accelerator and its COVAX facility, has played a crucial role towards this end, confirming that responding to scourges such as COVID-19 requires sufficient preparedness and new ways of working to protect public health.
The main challenges now are how to ensure that vaccines remain effective, increase the capacity of the national public health system to administer doses and increase vaccine uptake, and counter the pervasive winds of misinformation that fuel vaccine hesitancy.
A clear lesson from this pandemic is that we need to expand local and regional production of vaccines and other essential health products in low- and middle-income countries. This will enable both direct access to vaccines and the development of local vaccine production ecosystems. This will make supplies in the event of the next crisis more reliable and fairer, as long as global supply chains are not disrupted.
The World Health Organization (WHO), the African Union, the European Union, the governments of South Africa, Rwanda, Senegal, Germany and France and partners are working to help industry and partners scale up local vaccine production and improve global and regional cooperation for preventing and responding to future pandemics.
Collectively investing to ensure that all regions of the world have state-of-the-art manufacturing infrastructure, trained personnel, and institutional and regulatory arrangements is a valuable asset to our shared health security.
WHO supports multilateral efforts to establish and disseminate mRNA technology in developing countries.
One year ago, WHO, South Africa and the Patent Medicines Fund established an mRNA Vaccine Technology Transfer Center in Cape Town, supported by the EU, France, Germany and other local and international partners. The center’s goal is to spread this technology to developing countries by training and licensing manufacturers to produce their own vaccines for national and regional use.
With donor support, the center is already producing results. Scientists have created a new mRNA vaccine based on publicly available information. Local manufacturers from Africa, Latin America, Asia and Europe have been selected to receive the technology. Partners in the Medicines Patent Fund are ready to help license technologies. A new African Development Bank initiative, the African Pharmaceutical Technology Foundation (APTF), can also contribute.
Parts of the private sector are also stepping up. The recent groundbreaking ceremony in Rwanda for Africa’s first mRNA production facility, built by the German company BioNTech, is another example of efforts by African countries to work with partners to become more resilient in the face of pandemics. Similar facilities are planned in Senegal, in cooperation with Ghana for filling and finishing services.
mRNA technology is not just for fighting Covid-19. It can be adapted to address other diseases, such as HIV, tuberculosis, malaria and leishmaniasis, putting countries at the forefront of producing the tools needed to meet their health needs. At a recent summit in Kigali, BioNTech committed to completing its malaria vaccine program and manufacturing every licensed product in Africa. The WHO’s mRNA Hub program in South Africa already has its sights set on developing a wide range of vaccines and other products to address disease threats, such as insulin to treat diabetes, cancer drugs and, potentially, vaccines for other priority diseases such as malaria, tuberculosis and HIV.
Building a vaccine production facility is difficult, but ensuring their sustainability is even more difficult.
First, there is a need to strengthen the capacity of the workforce by providing specific training for the staff working in these facilities. WHO is bridging this gap through a biomanufacturing training center in the Republic of Korea, working within the WHO Academy based in Lyon, France, to help developing countries produce not only vaccines but also insulin, monoclonal antibodies and treatments for crab . Rwanda recently launched the African Biomanufacturing Institute (ABI), an innovative structure bringing together industrial training providers and universities to train the local workforce.
Second, the manufacturing of healthcare products requires a strong regulatory capacity to ensure quality standards and approve end products. WHO and partners are investing in strengthening regulatory authorities in Africa and beyond. The African Centers for Disease Control and Prevention (CDC) and the African Union Development Agency are working with regulators on the continent and in high-income countries to increase their capacity. And the African Medicines Agency (AMA), which will be headquartered in Rwanda, has come into force and will become Africa’s continental medicines regulator.
Stronger regulatory agencies in developing countries will also increase confidence in locally produced products and counter misinformation and the availability of dangerous counterfeit drugs.
Third, new manufacturing facilities will rely heavily on a sustainable and competitive market environment where suppliers of vaccines and other new pharmaceuticals will be willing to purchase these life-saving tools. We recognize the need for current and future African vaccine producing countries to have access to vaccine delivery platforms such as GAVI among others. Regional and continental market shaping strategies, as outlined by the Partnership for African Vaccine Production, can provide sustainability to ongoing efforts, with lead agencies and market shaping partners such as Unitaid ready to support. The G7 leaders also addressed this issue and asked the relevant international actors to work on a common strategy to shape the market.
At the recent World Health Assembly, there was consensus that building strong and sustainable productive capacity in developing countries is essential for a safer world.
WHO Member States also discussed the need for a new Pandemic Agreement, as an interconnected world requires globally agreed norms and mechanisms to ensure strong coordination during an acute health crisis.
And most importantly, governments have recognized that additional funding is urgently needed to make substantial investments in pandemic preparedness and response capacity in countries, regions and globally. In this regard, we welcome the newly established Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response, which is housed at the World Bank and with WHO playing the central technical leadership role.
We know that the next outbreak is a matter of when, not if. Time is of the essence to strengthen cooperation and promote local production and build confidence in locally produced products so that we are better prepared next time.
Paul Kagame, President, Rwanda; Emmanuel Macron, President, France; Cyril Ramaphosa, President, South Africa; Macky Saul, President, Senegal; Olaf Scholz, Chancellor, Germany; and Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO.