EDITORIALS
African Vaccine Delivery Alliance,
Maitama, Abuja, Nigeria
aoa@ayoadealakija.com
Cite this as: BMJ 2023;381:p908
http://dx.doi.org/10.1136/bmj.p908
Published: 10 May 2023
the bmj | BMJ 2023;381:p908 | doi: 10.1136/bmj.p908
Vaccine manufacturing in Africa
Investing in self-sufficiency is crucial for global health security
Ayoade Alakija chair
Globally, vaccine manufacturing requires radical
reconfiguration. Its current extreme geographical
skew must change to ensure health security for all.
Africa produces only 0.1% of the world’s total vaccine
supply,1 but self-sufficiency would make its health
systems more resilient and better prepared for public
health emergencies, promote social cohesion and
economic progress, and insulate countries from
external actions.
Africa continues to be left behind in access to
countermeasures in the ongoing covid-19 pandemic.2
It is the continent with the lowest vaccination levels:
just 30% of people have received a complete initial
protocol.3 Covax, established to guarantee equitable
global access to vaccines,4 was disrupted by funding
shortfalls, “vaccine nationalism,” and hoarding by
richer countries.5 6
Lack of local vaccine manufacturing impedes polio
elimination and leaves populations vulnerable to
outbreaks of measles, malaria,7 human
papillomavirus disease, and Ebola.8 A more evenly
distributed system of manufacturing and stockpiling,
informed by regional needs, could be more responsive
to regional public health emergencies, including
those driven by climate change events such as
Cyclone Freddy in east Africa, where lack of cholera
vaccines is a current concern.9
Political and financial commitment
African leaders, the private sector, and partners must
commit to, and plan for, long term medical
self-sufficiency. In 2021 the Africa Centres for Disease
Control and Prevention published the Partnerships
for African Vaccine Manufacturing framework for
action, calling for 60% of vaccines required by African
populations to be made in Africa by 2040—up to 1.7
billion doses annually.10 The framework also
considers research and development, regulation,
pooled procurement, technology transfer, intellectual
property, and financing. Political and financial
commitment are essential for the systemic changes
needed to create an enabling ecosystem.
To establish a sustainable market, and in return for
longer term health security, African countries will
initially have to pay more to cover higher local
manufacturing costs,11 underscoring the urgency of
fully implementing the 2001 Abuja declaration12 to
contribute 15% of gross domestic product to health.
Covid-19 accelerated the African vaccine
manufacturing efforts of companies, including Aspen,
Biovac, and the Institut Pasteur de Dakar.13 These
efforts are mainly filling and packaging vials with
vaccines made elsewhere (fill and finish); end-to-end
production remains an aspiration. However, Africa’s
pharmaceutical regulatory ecosystem is fragmented,
BMJ: first published as 10.1136/bmj.p908 on 10 May 2023. Downloaded from http://www.bmj.com/ on 11 May 2023 by guest. Protected by copyright.
and until countries operationalise the fledgling
African Medicines Agency the benefits of regulatory
harmonisation and coordinated licensing by national
regulators remain remote.14 15
The Developing Country Vaccine Manufacturing
Network16 has made substantial strides in supporting
low and middle income countries, but further
public-private sector collaboration is needed to
improve vaccine access and affordability in these
regions.17 Development costs for vaccine
manufacturing can range from $500m to $1bn,
depending on scale.18 To mobilise funds,
governments and stakeholders must seek creative
solutions and engage with global and regional
financial institutions, including private capital. The
African Export-Import Bank19 and the African
Development Bank have initiatives supporting
financing for vaccine manufacturing,20 with the
development bank establishing the African
Pharmaceutical Technology Foundation.21 Africa
must invest in itself if others are to follow.
Partnerships in the global south
Africa can learn from sustainable production in
similar settings—for example, the Serum Institute of
India,22 the world’s largest vaccines manufacturer.
India offers a blueprint for creating the physical
infrastructure and enabling environment (rule of law,
fair tax regimes, low corruption), that African leaders
must prioritise to assure investors. African
manufacturers will need to engage across 55
independent countries to achieve the same market
share, however.
Knowledge and know-how from India could be
exploited through collaborations among countries
of the global south to build local capacity.23
Expanding African scientific and technological
know-how is vital, through indigenous innovation,
licence waivers, technology transfer, or licensing.24
The partnership between BioNtech and Rwanda and
Senegal to provide modular vaccine manufacturing
is innovative but not sufficient to create a truly
domestic manufacturing industry.25 Africa could
develop its own technology through strategic
collaborations among low and middle income
countries.
Collaboration, not competition, is necessary to
overcome the many challenges on the journey to
self-sufficiency. The African Union’s African Vaccine
Delivery Alliance, which has evolved into the African
Countermeasures and Readiness and Response
Alliance, enables such discussions.23 Similar
arguments apply to diagnostics, therapeutics, and
the other medical supplies needed in pandemics.
1
 EDITORIALS

African leaders must prioritise investment in vaccine manufacturing,

21 African Development Bank Group. African Development Bank's board approves landmark
distribution, and delivery to ensure universal coverage and institution: establishment of African Pharmaceutical Technology Foundation to transform Africa's
pandemic preparedness. They must replace aid reliance with pharmaceutical industry. 2022. https://www.afdb.org/en/news-and-events/press-releases/african-
investment in regulatory frameworks, health systems, supply chain development-banks-board-approves-landmark-institution-establishment-african-pharmaceutical-

management, and sustainable financing mechanisms, especially
where countermeasures cannot be produced locally. The transition
to self-sufficiency will require difficult decisions, but the prize is a
more equitable future for Africa.
Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial
companies. The author declares the following other interests: I am WHO special envoy and co-chair
of Access to COVID-19 Tools Accelerator; chair of the board of directors of the non-profit FIND, the
global alliance for diagnostics; and founder of Nigeria’s Emergency Coordination Centre.
BMJ: first published as 10.1136/bmj.p908 on 10 May 2023. Downloaded from http://www.bmj.com/ on 11 May 2023 by guest. Protected by copyright.
technology-foundation-transform-africas-pharmaceutical-industry-52727
22 Serum Institute. https://www.seruminstitute.com/
23 Alakija A. Past time for a PACTT for humanity. Lancet 2023;401:-6.
doi: 10.1016/S0140-6736(23)00500-7. pmid: 36907193
24 European Public Health Alliance. Advocate sharing of patents, know-how and technology to
maximize vaccine production. 2021. https://epha.org/advocate-sharing-of-patents-know-how-
and-technology-to-maximize-vaccine-production/
25 Republic of Rwanda. Rwanda receives first biontainer for African-based mRNA manufacturing
facility. Press release, 13 Mar 2023. https://www.gov.rw/blog-detail/rwanda-receives-the-first-
biontainer-for-african-based-mrna-manufacturing-facility

Provenance and peer review: Commissioned; externally peer reviewed.

1 Gavi. Expanding sustainable vaccine manufacturing in Africa. 2022.

https://www.gavi.org/sites/default/files/document/2022/Gavi-Expanding-Sustainable-Vaccine-
Manufacturing-in-Africa-2022.pdf
2 Alakija A. Africa is being punished by richer nations in the Covid battle. Financial Times 2021 Dec
8. https://www.ft.com/content/12924b55-679d-4b31-b2d4-596f16dd6f4a
3 Share of people vaccinated against covid-19. Our World In Data, 29 Mar 2023. https://ourworldin-
data.org/covid-vaccinations
4 Usher AD. A beautiful idea: how COVAX has fallen short. Lancet 2021;397:-5.
doi: 10.1016/S0140-6736(21)01367-2 pmid: 34147145
5 Hafner M, Yerushalmi E, Fays C, Dufresne E, Van Stolk C. Covid-19 and the cost of vaccine
nationalism. Rand Health Q 2022;9:.pmid: 36238007
6 Bell D, Brown GW, Oyibo WA, etal. COVAX—Time to reconsider the strategy and its target. Health
Policy OPEN, 2023, doi: 10.1016/j.hpopen.2023.100096.
7 Joi P. Five things you need to know about the new R21 malaria vaccine, Gavi, the Vaccine Alliance.
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vaccine
8 Georgieva K. Support for Africa's vaccine production is good for the world. IMF blog, 12 Mar 2022.
https://www.imf.org/en/Blogs/Articles/2022/01/12/blog011322-support-for-africas-vaccine-pro-
duction-is-good-for-the-world
9 Kaveri M. As cholera cases spike, there is no short-term solution to vaccine shortage. Health
Policy Watch, 23 Mar 2023. https://healthpolicy-watch.news/cholera-vaccine-shortage
10 Partnerships for African Vaccine Manufacturing. Framework for action.
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for-action/
11 Paun C. To fight inequity, Africa wants to produce its own vaccines. First it needs to find buyers.
Politico 2022. https://www.politico.com/news/2022/07/20/to-fight-inequity-africa-wants-to-
produce-its-own-vaccines-first-it-needs-to-find-buyers-00046550
12 Abuja Declaration on HIV/AIDS. Tuberculosis and other related infectious diseases, African Summit
on HIV/AIDS, tuberculosis and other related infections diseases, Abuja, Nigeria 24-28 April 2001.
https://au.int/sites/default/files/pages/32894-file-2001-abuja-declaration.pdf
13 International Finance Corporation. IFC and Institut Pasteur de Dakar deepen their partnership to
build covid-19 vaccine manufacturing facility Press release, 23 Mar 2022. https://press-
room.ifc.org/all/pages/PressDetail.aspx?ID=26887
14 Jerving S. Rwanda chosen to host the African Medicines Agency. Devex 18 Jul 2022.
https://www.devex.com/news/rwanda-chosen-to-host-the-african-medicines-agency-103653
15 Pincombe M, Guzman J. A defining moment for medicines regulation in Africa: the establishment
of the African Medicines Agency. Centre for Global Development blog, 3 Feb 2022.
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medicines-agency
16 Developing Country Vaccine Manufacturing Network. https://dcvmn.org/who-we-are-what-we-
do/#
17 Luter N, Kumar R, Hozumi D, etal. An updated methodology to review developing-country vaccine
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18 Kazaz B, Webster S, Yadav P. Incentivising COVID-19 vaccine developers to expand manufacturing
capacity. CDG Note, Mar 2021. https://www.cgdev.org/sites/default/files/incentivizing-covid-19-
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19 Afrexim Bank. Afreximbank strengthens support for Coalition for Dialogue on Africa to consolidate
collaboration on continental vaccine manufacturing, AfCFTA and other key programmes. Press
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afcfta-and-other-key-programmes/
20 AFRICA CDC hosts lead partners of Partnerships for African Vaccine Manufacturing (PAVM) for
review of vaccine manufacturing ecosystem in Africa. African Development Bank Group blog, 15
Mar 2023. https://www.afdb.org/en/news-and-events/press-releases/africa-cdc-hosts-lead-
partners-partnerships-african-vaccine-manufacturing-pavm-review-vaccine-manufacturing-
ecosystem-africa-59784

2 the bmj | BMJ 2023;381:p908 | doi: 10.1136/bmj.p908