What is a sustainable vaccine manufacturing footprint for Africa?
Vaccine Insights 2023; 2(11), 443–446
Clinton Health Access Initiative
The COVID-19 pandemic highlighted the importance of local manufacturing to ensure vaccine supplies during times of emergency. Export restrictions, hoarding, and nationalism meant that even relatively wealthy countries struggled to procure COVID-19 vaccine doses from outside their borders.
African nations were some of the last to receive sufficient COVID-19 vaccine doses. Less than 1% of all the routine vaccine doses administered in Africa in any given year are manufactured on the continent, leaving African countries in a vulnerable position in terms of pandemic preparedness. To mitigate these risks and spur economic growth, the African Union and The Africa Centres for Disease Control and Prevention (Africa CDC), through the Partnership for African Vaccine Manufacturing initiative, have set an ambitious target for 60% of vaccine doses administered in Africa to be manufactured on the continent by 2040.
There has been significant support for boosting vaccine manufacturing capacity on the continent. Over US$4.5 billion, including some soft commitments and existing lending ceilings, has been pledged by stakeholders, while the Gavi Alliance, the region’s largest vaccine financer, has updated its global healthy market criteria to put more consideration into regional supply. Around 30 new vaccine manufacturing projects have been commissioned on the continent, with a total capacity of close to 2 billion doses already installed or ordered, and a planned capacity of up to 4 billion doses.
However, while momentum for change is welcome, it is critical to ensure that progress is sustainable and meets the needs of Africa (and the world) in the long term.
With funding from the Bill & Melinda Gates Foundation, the United States Agency for International Development, and support from Africa CDC, the Clinton Health Access Initiative set out to define a sustainable, fit-for-purpose target pathway for African vaccine manufacturing and identify the most effective interventions to achieve that goal. We hope that the resulting white paper  will act as a roadmap for all stakeholders.
What is a sustainable target for African vaccine manufacturing?
By speaking with a wide range of stakeholders, we identified three key goals for African vaccine manufacturing:
- Pandemic preparedness and response;
- Healthy global vaccine markets; for example, markets that sustainably ensure access to quality-assured affordable vaccines without supply disruptions;
- Long-term commercial viability.
There is a need for compromise between these goals; for example, if considering only pandemic preparedness, the target would be to develop end-to-end vaccine manufacturing capacity for enough doses to vaccinate all of Africa. However, this would be commercially unsustainable and not consider the market at large. From a global health perspective, the ultimate goal is to have a sustainable supply of affordable vaccines.
We found that a balanced target by 2030 would be approximately 170 million doses of end-to-end manufacturing capacity, plus approximately 460 million doses of antigen-agnostic drug product capacity, giving a combined output of 630 million doses. This represents close to 40% of vaccine doses administered in Africa (and aligns with the Partnership for African Vaccine Manufacturing target of 60% by 2040).
The sustainable target capacity outlined is well below the 2 billion (mostly drug product) dose capacity installed or ordered, leading to overcapacity and a risk of unsustainable ‘white elephant’ projects. Drug substance capacity, meanwhile, remains low. In addition, more than 60% of the installed drug product capacity lacks the technology transfer partnerships essential for commercialization.
Based on this target, we estimate that the continent can support a maximum of three to five geographically dispersed manufacturers with a diversified portfolio of antigens.
These manufacturers will face a number of challenges, including structural cost disadvantages compared with manufacturers in other developing countries, particularly India. To compete, a regional market approach will be needed, with African governments committing to preferentially buy vaccines from manufacturers across the continent (not just domestically). In addition, many national regulatory bodies in the region lack the capacity to regulate vaccine production, preventing timely market access.
How can we achieve the target?
We identified five key areas for intervention to help achieve a meaningful target of approximately 630 million doses produced in Africa by 2030. First, if stakeholders with an interest in African vaccine manufacturing can align investments and support towards a common target, the chances of achieving a sustainable African vaccine manufacturing footprint can be maximized.
Second, funding from the Gavi African Vaccine Manufacturing Accelerator and other initiatives should be used to offer financial incentives to enhance manufacturers’ cost competitiveness.
Third, technology transfer partnerships between African manufacturers and originators must be prioritized since they are vital to making use of existing drug product capacity and expanding drug substance capacity longer-term.
Fourth, while challenging, it is critical to enact a collaborative procurement policy to ensure demand from African governments for African-made vaccines, which is currently being championed by Africa CDC.
Finally, an appropriate enabling environment must be created by investing in policy, education, and regulatory capacity to support vaccine manufacturing.
We believe that these interventions are best placed to balance the immediate need for rapid capacity-building in Africa with the long-term need to maintain commercial stability and deliver sustained access to affordable immunization products. It is heartening to see that many of these efforts are already underway, and the target pathway can serve as a ‘north star’ for stakeholders to align their existing and planned initiatives for further development of the African vaccine manufacturing ecosystem.
Given the energy, intention, and funds being directed to the space, there is potential for a thriving vaccine industry in Africa, particularly in the areas of Africa-endemic diseases and new vaccine platforms, where African manufacturers can carve out a unique niche. We hope the insights presented in our white paper will help guide stakeholders toward that bright future.
Finally, there are valuable lessons to be learned from how India and China have built their vaccine manufacturing ecosystems over the past 20 years. Our next white paper will take a deep dive into the critical factors behind the success of these LMIC manufacturing ecosystems, and how these learnings could be applied in Africa.
Clinton Health Access Initiative, Inc. Continental Market-shaping Strategy for a Sustainable Vaccine Manufacturing Footprint in Africa, Nov 2023. Crossref
Philip Dorrell leads the work of the Clinton Health Access Initiative to support African Vaccine Manufacturing with market-shaping initiatives to create a sustainable vaccine manufacturing ecosystem. He studied at the Universities of Oxford and Cambridge, with a focus on the philosophy of medicine and African politics, and has subsequently worked on solving strategic health problems in the public and private sector in the UK, India, and South Africa.
Rishabh D Jhol is a Technical Advisor at the Clinton Health Access Initiative, where he focuses on supporting African Vaccine Manufacturing through market-shaping initiatives to establish a sustainable vaccine manufacturing ecosystem. He studied social impact strategy at the University of Pennsylvania and has a background in founding and leading non-governmental organizations in the public policy and public health space.
Clinton Health Access Initiative
Rishabh D Jhol
Clinton Health Access Initiative
Authorship & Conflict of Interest
Contributions: Jenna Conway, Kenneth Akwue, Khanyisa Mtombeni were contributors to this article. All named authors take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Acknowledgements: This work was made possible by the support of the American people through the United States Agency for International Development (USAID) and by funding from the Bill & Melinda Gates Foundation. We would also like to thank the partners and individuals who have contributed to this paper, either by commenting on the draft, reflecting on the data collected, or by sharing their own thought leadership in this field. We extend our sincere appreciation to Africa CDC, GAVI, PATH, CEPI, among others.
Disclosure and potential conflicts of interest: The authors have no conflicts of interest.
Funding declaration: The author received no financial support for the research, authorship and/or publication of this article.
Article & copyright information
Copyright: Published by Vaccine Insights under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.
Attribution: Copyright © 2023 Dorrell P, Jhol R D. Published by Vaccine Insights under Creative Commons License Deed CC BY NC ND 4.0.
Article source: Invited.
Revised manuscript received: Nov 22, 2023; Publication date: Dec 6, 2023.