Opinion: Trump aid shock underscores need for more made-in-Africa medicine

Global health has been rocked by huge cuts to U.S. aid and U.S. President Donald Trump’s decision to quit the World Health Organization. Taken together, these moves represent an unprecedented disinvestment from tried-and-tested mechanisms that have provided care for billions of people around the world. Nowhere will the costs be higher than in Africa, where vulnerable health care systems are being hit especially hard by the closure of U.S.-backed health initiatives and research projects. Despite a limited U.S. waiver that some treatment can continue under the President’s Emergency Plan for AIDS Relief, or PEPFAR, lifesaving programs for tuberculosis, malaria, HIV, and other diseases have been disrupted drastically and now face long-term uncertainty. The shock actions by the Trump administration coincide with rising health care nationalism in other countries, driven by an inward-looking mantra to “serve your own before helping others.” The result has been a slew of cuts to aid budgets, the reallocation of development finance to domestic immigration issues, and the negotiation of exclusive deals to ensure priority supplies of medicines for home populations. This harsh new geopolitical reality is a wake-up call for African states. It is now clear that they will have to cut their dependence on outside help while doing far more to strengthen domestic financing and investment in essential health care. Building more local manufacturing capacity for medicines and vaccines — which would strengthen health care systems throughout Africa — should form a key plank of this strategy. Africa has historically imported around 80% of its medicines. This high level of dependency leaves a continent of over 1.5 billion people chronically susceptible to shortages — whether due to a crisis such as the COVID-19 pandemic, when Africa was relegated to the back of the queue for vaccines or as a result of a political whim by a single donor, as with the current U.S. cuts. The stark reality today is that lives are being lost as medicines fail to reach villages where they are needed due to disruption caused by the dismantling of the U.S. Agency for International Development. We’ve heard of pharmacies and clinics across Africa saving what little product they have, unsure as to when the next batches will arrive. Patients tell tales of traveling for days to pick up courses of treatment, only to be sent away with far less than they need — or, in one case, just a single pill. The global health ecosystem has relied on development aid and imported medical supplies for a very long time. This cannot be reversed overnight, but there are ways to improve the situation by building national and regional manufacturing centers to expand the local availability of medicines — an approach that should both lower costs and increase resilience. The task is formidable, not least because Africa lags so far behind other regions in pharmaceutical production. The continent has roughly 375 drugmakers, most of them in North Africa, while India and China, each with populations of around 1.4 billion, have approximately 10,000 and 5,000 manufacturers, respectively. Nonetheless, there are opportunities for change. Africa already has a handful of high-quality local manufacturers, supplying essential medicines for HIV, TB, malaria, and other common diseases. Some of these companies are now expanding their portfolios and have the capacity to produce at scale active ingredients, oral solid tablets, and sterile injectable products, including vaccines. A few manufacturers in Africa are even starting to make complex medicines such as biologics and messenger RNA-based products. There are also steps to align regulation, exemplified by a recent landmark agreement by seven regulators across Africa to streamline the medicines approval process and ensure that all products meet international standards for safety, efficacy, and quality. This initiative should not only help foster the development of a high-standard market for local production but also help tackle the proliferation of fake and substandard medicines that currently cost many African lives. Such efforts are badly needed at a time when multinational corporations show limited engagement, with several Big Pharma companies having exited African markets in recent years. Today, 70% of the top world’s 20 manufacturers tracked by the Access to Medicine Index do not operate commercially in sub-Saharan Africa. Large pharmaceutical organizations also fall short when it comes to signing technology transfer deals with Africa-based companies for innovative treatments, even though this is a tried-and-tested catalyst for increasing local production. Clearly, there are significant challenges in getting Africa to make a larger proportion of its own medicines. For one thing, the global market is highly competitive and if African governments do not provide adequate incentives, such as tax breaks and offtake agreements, it will be hard for domestic suppliers to compete with low-cost rivals, notably those based in India. At the same time, Africa faces steeply rising demand. The volume of medicines consumed on the continent is rapidly growing and is expected to double in the next decade. But while reducing dependence on imports will not be easy, there is a major opportunity here to boost economies and increase skilled workforces, while improving health security. Health care in Africa is at a crossroads. Faced with a new era of U.S. disengagement that jeopardizes decades of progress, it is time to redesign systems and increase regional production of medicines to instill resilience and protect the health of hundreds of millions of people.