CAPE TOWN — It was a blustery January day in Cape Town, at a five-star hotel near the city’s harbour. The occasion was a Saturday breakfast press briefing, and the European health commissioner, Stella Kyriakides, sat alongside South Africa’s deputy health minister, Sibongiseni Dhlomo, and diplomats from Germany, France and Belgium.The day was a proverbial victory tour for the partnership between South Africa and so-called Team Europe, which is pumping around €1 billion in European funds into vaccines and medicines manufacturing in Africa. It’s the public cornerstone of Europe’s global health response, and an attempt to right one of the wrongs of the COVID pandemic, which is that without the ability to produce their own vaccines — and with Western countries going to vaccine manufacturers armed with significantly deeper pockets — African countries were left at the back of the queue.
On the agenda was a visit to two recipients of Team Europe’s money: the World Health Organization’s mRNA hub at Afrigen, which is working to produce its own COVID-19 vaccine based on publicly available information about Moderna’s jab, and a visit to Biovac, a public-private partnership with the South African government that has secured manufacturing deals with international vaccine-makers.
But the smiling photo ops from Saturday morning belie the difficult reality — it’s going to be an uphill battle from here.
With demand for COVID-19 vaccines receding, new facilities will need to turn to routine vaccinations and keep production lines warm by producing jabs for the many other pressing health needs that plague the continent. That’s if they can secure the technology and know-how to produce those vaccines. Once produced, their national drug regulator needs to be able to actually approve the vaccines.
And then there’s perhaps the most critical problem — finding buyers willing to pay more simply because the vaccine was made in Africa.
“How are we going to get out of that stalemate situation?” asked Patrick Tippoo, head of science and innovation at Biovac and executive director of the African Vaccine Manufacturing Initiative. “I think that there is no way that this can get out of the starting blocks without appreciation that [there] is going to be a cost.”
Buy local
Looming over the meeting was the shadow of a failure that illustrates some of the difficulties that lie ahead. In 2022, a production line of Johnson & Johnson COVID-19 vaccines at South African generics manufacturer Aspen had to be shut down because there were no buyers.
It’s a situation no one wants to repeat.
But lessons need to be learnt, Tanja Werheit, Germany’s consul general in Cape Town, said — particularly the “importance of creating demand.” And the demand for vaccines produced on the continent needs to come from local governments, she said.
A “critical success factor” for Biovac is the South African government, which committed to purchase the vaccines that Biovac was supplying for the country’s national immunization program, explained Tippoo. “If the market is guaranteed the rest flows in quite easily,” he said.
But, if African facilities want to produce a vaccine from start to finish, it’s likely going to be significantly more expensive than one produced by experienced facilities in India that are churning out hundreds of millions of doses.
That’s where the largest purchaser of vaccines on behalf of lower income countries comes in. Gavi, the Vaccine Alliance, has the ability to shape markets with the vaccines it buys and now it’s trying to come up a new financial mechanism to help solve the stalemate in Africa.
The plan is to develop an advance market commitment, backed by donor funds, for the purchase and manufacturing of vaccine doses. The idea is to give African manufacturers time-limited financial support (a previous scheme for a pneumococcal vaccine lasted 10 years) to help them build their competitiveness for global tenders. Gavi’s Director of Development Finance David Kinder and his colleagues have been working with the Africa CDC and the Partnership for African Vaccine Manufacturing to figure out what exactly this mechanism will look like.
As always, the big question is where the cash will come from. It can’t come from Gavi’s core budget, said Kinder. “We [are] looking to raise additional finance to support the mechanism,” he said, pointing to existing Gavi donors such as sovereign countries and private philanthropy.
Olympic-level hurdles
But a new financing stream won’t be a silver bullet.
There also needs to be a strong ecosystem, said Mmboneni Muofhe, deputy director-general at South Africa’s science and innovation department. You can’t “just do the one thing and hope that other things fall together,” he said.
These other things include having qualified staff, a strong national regulatory agency and know-how to produce the vaccine. These are no small tasks and each can take many painstaking years to get right. “There are so many challenges that are still lying ahead,” said Muofhe at the breakfast in Cape Town.
One of these is whether the private sector is willing to play ball. In a 2023 report, Wellcome identified a lack of confidence as a barrier to deals. “It seems that [multinational corporations] are often wary of partnering with African manufacturers, owing to the perceived inexperience or lack of maturity of the local regulators, or to concerns over the economic viability of such partnerships.”
While Pfizer and Sanofi have signed rare deals with Biovac to locally produce an anti-pneumonia vaccine and a six-in-one shot for diseases including diptheria and tetanus, Moderna refused to share its COVID vaccine technology with the mRNA hub, instead opting to set up its own production facility in Kenya.
BioNTech has also chosen to go it alone, setting up so-called “BioNTainers” in Rwanda, rather than doing a technology transfer deal with a local manufacturer.
What needs to be done is to “sit down with pharma and address their concerns,” which can usually be answered clearly, said Charles Gore, executive director of the Medicines Patent Pool, which is deeply involved in the mRNA hub. He knows what he’s talking about, having secured the voluntary license deal for the COVID-19 antiviral Paxlovid from Pfizer, a company that typically doesn’t agree such licensing deals.
It’s an issue that was also front and center for a delegation of European lawmakers who visited South Africa and Ethiopia in February to understand the EU’s role in African countries overcoming the pandemic.
“The problem of intellectual property … has been a barrier to local vaccine production,” said MEP Pierrette Gabrielle Herzberger-Fofana, member of the Greens and vice chair of the development committee, who was part of the delegation.
As of March this year, around €980 million of Team Europe’s commitment was already “approved and under implementation.” But Herzberger-Fofana said the impression among parliamentarians in South Africa is that Europe is willing to give money, but unwilling to share intellectual property rights.
“They don’t want charity, [what they want] is the ability to produce themselves their own vaccine,” said Herzberger-Fofana.