PREVIEW
Trade and production deals may help the region’s vaccination drive in the short term more than lobbying for changes to the IP and patent laws
The challenge to access vaccines against Covid-19 is not just an African problem, it is a global battle. But it has shone a spotlight on the complexities that Africa faces when it is competing for commodities it doesn't produce.
The situation has led to calls for Ngozi Okonjo-Iweala, the World Trade Organization's new head, to make her first action an initiative to set aside Intellectual Property patent laws to allow for greater production of Covid-19 vaccines 'for the common good' (AC Dispatches, Rich countries slowly accept the pitfalls of vaccine nationalism & Despite denials, vaccine nationalism is rampant). Knowing she was fresh from heading up Gavi, the Vaccine Alliance, half a mile down the road from WTO HQ in Geneva, 'Big Pharma' reacted quickly with a high-level lobbying initiative directed to United States President Joe Biden, and signed by all the leading manufacturers. In summary they warned 'don't relax the law or you won't get the investment that has brought us to where we are today with a number of vaccines available in record time'.
The reality is that both the calls and the rebuttals miss the point. When the IP and patent issue last hit the headlines in the 1980s and 1990s, it was over the pricing of HIV drugs that were off the scale for African governments or individuals to afford. Today, the issue is the physical availability of vaccines, and as Europe has witnessed, the scrap to get supplies can get quite nasty. The problem is capacity, as demand far outweighs supply.
As John Nkengasong, Director of the Africa Centres for Disease Control and Prevention, has said repeatedly, the continent must not find itself in this position again. Contacted by Africa Confidential this week, he cited factories in South Africa, Egypt, Senegal and Morocco as having the potential to manufacture, although he conceded that 'these will need to be expanded and strengthened'.
Tech transfer
Producing complex biological products to scale requires extraordinary infrastructure and processes, cell lines and bacteria, all managed within hugely onerous regulatory requirements to ensure every batch adheres to strict good manufacturing practice rules. John-Arne Rottingen, Chair of the World Health Organization Solidarity Trial of Covid-19 Treatments asserts that a patent waiver is simply 'the wrong approach' given the complexities of production. Instead, he urges for technology transfer, in which he includes non-exclusive licences such as AstraZeneca has struck with the Serum Institute of India and Fiocruz in Brazil for the manufacture of its vaccine.
Establishing vaccine production facilities needs to become a priority for Africa, but it is not going to happen during this phase of the pandemic. Whether split across three or four sites, or from one central site, it is going to need to be carefully planned. Africa's pharma sector has been constantly frustrated by its inability to achieve economies of scale with output that can compete with the big producers of India and China. In part, the problem has been the regulatory red tape of dealing with 54 countries, and cross-border impediments. The nascent Africa Medicines Agency, currently being piloted through the African Union by its Development Agency (AUDA-NEPAD) should significantly speed up drug and vaccine registration procedure but while its legal instruments have been adopted by member states, as ever for implementation, the devil is in the detail. At a recent high-level meeting of the implementation steering group, a senior WHO consultant cautioned delegates that 'setting up the European Medicines Agency (EMA) took 30 years'. It is going to take time.
Bottlenecks
On cross-border issues, the challenge will be the effectiveness of the African Continental Free Trade Area (AfCFTA). If trade bottlenecks continue, Africa's ability to manage its own problems will remain significantly impaired.
The Serum Institute of India is already the biggest global vaccine manufacturer and its CEO, Adar Poonawalla is challenging anyone to beat his company on price. This is the dilemma. If Africa spends big money on quality home-spun vaccine production it has to be sure that its output prices are internationally competitive. If they fail, then the business will fail.
The impact of Covid-19 on Africa has been much lighter than originally feared, with official figures indicating only about 4% of global coronavirus deaths occurred on the continent. But as a third wave of the Covid-19 virus hits countries like Kenya, amid speculation about the effects on them of neighbouring Tanzania's rogue Covid-19 status, there is no room for complacency (AC Vol 61 No 10, The Magufuli experiment).
Experts including luminaries such as Donald Kaberuka, ex-head of the African Development Bank, and Trevor Manuel, ex-Minister of Finance from South Africa, were among 23 signatories of a recent open letter to the Group of 20 calling for a series of financial and economic measures to enable equitable vaccine roll-out across Africa, and to stabilise the economic fall-out of the pandemic. Traction in these areas is where energy needs to be focused.
Already one significant viral mutation has emerged from Africa, and others will no doubt crop up so long as the virus is uncontained on the continent. The global cost of this could be many more times than the cost of assistance now.
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