Q&A: How Africa is preparing for the next pandemic

Research and development, independent manufacturing, and health system strengthening are three elements moving forward in Africa that are critical to pandemic preparedness, said L. Muthoni Wanyeki, executive director for Africa at the Open Society Foundations, a private funder supporting the work of those tackling justice, democratic governance, and human rights.

“Drawing on the African response to COVID-19, several things became clear,” Wanyeki said, explaining the first was the value of the Africa Centres for Disease Control and Prevention "and its network of early warning and preparedness within ministries of health, but also within scientific centers across Africa.” Established under the African Union in 2016, the technical unit gained leadership status during the pandemic for its coordination efforts and is now in the process of becoming an autonomous agency.

A second lesson, according to Wanyeki, was the need to harness the emerging enthusiasm of the region’s youth — over 70% of sub-Saharan Africa’s population is under 30 — while increasing innovation around local manufacturing of vaccines, therapeutics, and diagnostics.

“The COVID-19 pandemic showed we have the agency and capacities we need to get the equipment, the regulation, the value chain into place,” she said.

Sitting down with Devex, she explained how African countries are preparing for future pandemics, the challenges they face, and the support needed to accelerate progress.

This conversation has been edited for length and clarity.

What are countries across Africa doing to prepare for future pandemics based on lessons learned from COVID-19?

One lesson was the importance of having an overarching, coordinating body — Africa CDC — to deal with national and subregional coordinating bodies on guidelines and so on. Further strengthening of Africa CDC is important. A number of things have already been done with this in mind. There's a multidonor fund set up to support Africa CDC, it's received financial autonomy from the AU, and it's worked on a division of labor with hubs and subregional surveillance hubs across the continent.

The second thing was the energies unleashed in terms of young entrepreneurs, not so much around diagnostics and therapeutics but rather the local production of masks, of personal protective equipment, and other things we needed around the response. These young entrepreneurs, together with chambers of commerce and private sector bodies, moved fast to respond to production needs.

That said, the biggest lesson was around how dependent we are on diagnostics, therapeutics, and vaccines from the outside. There is a big push under the Partnership for Vaccine Manufacturing In Africa, or PAVM, to work with African scientists, African academic institutions, and value chains from innovation all the way to manufacturing, with ambitious goals to reduce our dependence not just around COVID-19 but also neglected tropical diseases.

Local manufacturing has been touted as a way forward for Africa to prepare for future pandemics and health emergencies. Are there any particular challenges making independent manufacturing efforts difficult to achieve?

With so few manufacturers, Africa relies largely on imports. About 99% of the vaccines used in Africa are imported. The dysfunction of this system, decades in the making, had disastrous consequences during COVID-19 because Western countries gobbled vaccines up, and countries across Africa struggled to source doses for their own populations. This ‘trickle-down’ model, in which the global south relies on products and innovations developed in the global north, has now potentially cost millions of lives over the course of the pandemic.

That’s why the innovation happening around independent manufacturing on the continent is so important now and for future pandemics.

Africa CDC, working through the PAVM, has embraced a vision for a new public health order that hopes to see the continent ramp up its pharmaceutical manufacturing capability to meet 60% of its domestic vaccine demand by 2040.

The big story is the South African manufacturing effort on COVID-19. Afrigen, along with its partner Biovac, is part of the World Health Organization’s effort to develop mRNA vaccines and drugs to expand global access not only in Africa but in other low- and middle-income countries. This effort could help close the gaps in the global distribution of vaccines during future pandemics. It will develop the first African-owned COVID-19 vaccine, with a Belgium based company, Univercells, which Open Society invested in.

The Institut Pasteur, too, is one of a series of vaccine manufacturing projects launched across Africa in hopes of making the continent less dependent on vaccine shipments from abroad. Open Society supports The Pasteur Institute’s new manufacturing facility — called the Manufacturing in Africa for Disease Immunisation and Building Autonomy, or MADIBA — which could start producing COVID-19 vaccine in the coming months. When it reaches full capacity, the facility is expected to churn out 300 million doses annually, and those won’t all be for COVID-19.

In terms of challenges, there's the question of getting to market and getting to market at scale. It's not just that you need the researchers working on things, you need researchers who are able to link with companies who can make viable-to-market plans. You need the investors — whether philanthropic, overseas development assistance, or social impact investors — who are willing to take a bet on it. And you need Africa to make use of our move toward the African Continental Free Trade Agreement to invest in ourselves and invest in our own products. You need the regulation as a standard across the continent. All of those bits and pieces have to fit together; it's like a jigsaw puzzle where every piece has to work.

What other innovative approaches is the region pursuing to address the current pandemic and prepare for future pandemics?

Different governments are doing it differently. Different philanthropies and social impact investors are also doing it differently. There are also different models being put in place around the research and development and manufacturing agenda.

Even with the ambitious targets that have been set by the PAVM, we're not going to be in a situation where every country in Africa is producing its own therapeutics, diagnostics, and vaccines. So I think we need to recognize the need for regional hubs, recognize the need for division of labor, trust the regional integration agenda, and recognize the value of common procurement. And dividing up the work, that was made clear during the pandemic as well.

Additionally, we know there’s a dearth in both tests and treatments. To help demonstrate what’s possible, a “test and treat” — a pilot program called the Quickstart Consortium, of which Open Society is a funder, is working to get Paxlovid — a COVID-19 treatment — to 11 countries, including 10 countries in Africa. They just launched their very first shipments a few weeks ago to Zambia.

Where does the region stand in terms of research and development, or R&D, as a key component of pandemic preparedness?

We know that the future of the continent’s economic growth and development is inextricably linked to R&D. Africa’s position in the current global health environment is critical, but the capacity of member states to conduct Afrocentric R&D and manufacturing is underdeveloped.  

But there are interesting and promising continental initiatives. For instance, at the beginning of the COVID-19 pandemic, the African Centre of Excellence for Genomics of Infectious Disease in Ede, Nigeria, generated the first sequence of the SARS-CoV-2 on the continent — in an unprecedented speed of 72 hours. The Institut Pasteur is developing the first vaccine candidate designed and developed in Africa for a neglected, high consequence infection — Rift Valley Fever — to boost pandemic preparedness.

Additionally, the African Research Universities Alliance has a plan with three hubs working on R&D; one in Ghana, one in Uganda, and one in South Africa for west, east, and southern Africa respectively. Those hubs serve different purposes around R&D. The South African one is probably most advanced, but through the money that came in for COVID-19 responses, everyone has gotten a significant boost.

Then we have the network that's been put in place by Africa CDC, working with the plan of WHO on R&D and manufacturing. They have slightly different hubs.

The situation has given some acknowledgment to the hard slog our scientists have been doing in our universities without much recognition, public support, and so on. I feel the past two years, going on three, have given them weight of recognition, which of course translates into financing for the equipment that they need to do their work. This means there's a slight improvement compared to at the start of the pandemic.