While August is recognized as National Immunization Awareness Month in countries such as the US and Canada, February 2025 has already made its mark in this respect with no less than three high-level meetings focused on African vaccine manufacturing. Recently two of these took place in Cairo, Egypt. The first one, on February 4, led to the signing of a Memorandum of Understanding (MoU) among Africa’s WHO Maturity Level 3 National Regulatory Authorities (NRAs). On February 05, the 2nd Vaccine and Other Health Products Manufacturing Forum was held in the same city of Cairo, with many stakeholders involved. By the way, on the sidelines of this event, a few encouraging landmark vaccine deals were also  announced, signaling Africa’s willingness to shift to local manufacturing.

But over to the third event  which I attended in person. Titled ‘Sustainable Access to Vaccines: Strengthening Regulatory Frameworks, Building Production Capacity, and the Importance of Partnerships in Achieving AU Priorities’, this meeting took place in Addis Ababa on the sidelines of the 38th Ordinary Session of the African Union Assembly, on 16 February.  In this article, I’ll provide some key messages from this meeting.

But first some necessary background to get us all on the same page.

Why do we need vaccines? Why is vaccine production becoming a vital necessity in Africa?

As the Covid-19 pandemic made painfully clear, regional vaccine manufacturing has become indispensable – as well as urgent. It’s a key priority of Africa CDC’s  New Public Health Order since a few years, and for good reason.

In geopolitically tricky times, with multilateralism under major pressure, regional vaccine manufacturing is even more relevant. And nowhere more so than on a continent where new and emerging infectious diseases are prevalent, with 52 outbreaks on average per year. Over 200 diseases outbreaks were reported on the continent last year.  In short, we definitely need context-based vaccine production.

Speaking of which, last year, I was deployed to the Somali regional state of Ethiopia as part of the African Volunteer Health Corps (AVoHC) in response to a cholera outbreak.  During a meeting with the regional health leaders, I heard that the region requested hundreds of thousands of Oral Cholera Vaccines (OCV), but less than 15,000 were promised, and those were not even delivered on time (i.e. during the time of the outbreak). Imagine if we had the capacity to manufacture these vaccines locally, how many lives we could save and how many illnesses we could prevent!

While no African country has yet taken the lead on cholera vaccine production, Zambia’s historic decision  (October 2024) to sign an MoU with China to establish Africa’s first-ever cholera vaccine plant could be a game-changer. And in 2022, the International Vaccine Institute    (IVI) and Biovac, a biopharmaceutical company based in South Africa, already  signed a groundbreaking licensing and technology transfer agreement  to manufacture oral cholera vaccine in Africa for African and worldwide usage. So some promising initiatives seem on the way.

An image taken at Kabribayah cholera treatment center, Somali, Ethiopia, 2024.

(Frontliner, Representative from the Ethiopian Public Health Institute (me), Center Director, and Representative from the Ministry of Health, Ethiopia (left to right).)

With the rise in cholera outbreaks on the continent lately ( and elsewhere), it only makes sense that regional manufacturing of cholera vaccines is firmly on Africa CDC’s radar now, just like vaccines for Mpox, Marburg, measles and others.

Then there’s Antimicrobial resistance (AMR)  – and for the purpose of this article, the important role of vaccines in  reducing AMR.  Antimicrobial resistance is rapidly becoming one of the most pressing global health challenges, with Africa a key battlefield. Projections indicate that by 2050, AMR could be responsible for a staggering 1.91 million deaths annually according to IHME. However, there is hope: vaccines play a crucial role in reducing the use of antimicrobials, offering a powerful weapon in the fight against AMR.  Africa needs stronger public health policies to combat AMR, integrating vaccine development, local manufacturing, and efficient delivery systems.

The Addis event

The event I attended in Addis was hosted by the Rwandan Ministry of Health, the African Medicines Agency (AMA), and the International Vaccine institute.  The latter played a key role in facilitating the program, with its Director General, Jerome Kim also present.

As I proudly receive the lapel pin from the Director-General of IVI, it symbolizes my official induction as a WHO/TDR Fellow for 2025, marking the exciting start of my journey with IVI

During the program, interim WHO-AFRO director Dr. Chikwe Ihekweazu delivered his remarks, marking his first public address since stepping into his new role. He mainly talked about vaccine sustainability and enhancing of the local workforce. He appreciated the bio manufacturing training provided by IVI, for healthcare workers globally and in Africa.

I agree with what he said, and that workforce development is crucial for strengthening capacity. However, we are behind the target. According to Prof. John Gyapong, President of the African Research Universities Alliance, Africa requires over 10,000 PhDs annually, but is currently producing fewer than 3,000 per year. The AU plans to train 12,000 people in order to achieve this goal. But we don’t just need more PhDs, we also need  a diversified workforce, as local manufacturing will only work if you have manufacturing, quality assurance, market shaping, pharmacovigilance, an intellectual property environment that does not block knowledge sharing, ….   Training of qualified staff for all these areas is thus key.  Investing in both short-term programs like ClinOps and Bio Ventures for Global Health, as well as long-term training like the MSc Clinical Trials at CDT-Africa, Addis Ababa University, sets an exemplary standard.

Sadly, Africa is still losing much of its educated workforce for several reasons, so we need to continue training and invest in manpower to scale vaccine production by Africans.  And address some of the root causes of the brain drain.  

During the meeting, I made an effort to capture some key numbers, because, as we all know, numbers speak volumes. However, I can’t deny that some of these African figures are far from acceptable:

25 active vaccine manufacturing initiatives (as of June 2024)

375pharmaceutical manufacturers (most in North Africa)

25% of consumers of globally produced vaccines

8 countries’ national regulatory authorities reached ML3 (but only 2 countries -Egypt and South Africa- reached ML3 for local vaccine production)

>80% of countries with ML1 or ML2—that’s why we still need WHO prequalification

99 % of vaccines is still imported

1.2 Billion USD is available for the African Vaccine Manufacturing Accelerator

AU target of producing 60% of vaccines needed by 2040…with a population of 2 billion people   by then

It is crucial for partners to collaborate with the “appropriate key individuals” in governments. Support from government leadership is also necessary to bolster regulatory agencies and engage local leadership. A prime example of this is Kenyan President Ruto, who serves as the African Union Champion for domestic manufacturing.

Funding is available through collaborative efforts and innovative financing that can support end-to-end research.  Manufacturers are often not aware about the various available financing structures in the continent. Later this year, a financial structure platform will become available, according to a representative from the African Export-Import Bank, so that those who want to access financing can get the information they need.

Key messages from the event

Several other messages from the various sessions I attended resonated with me:

• WHO must fast-track WHO pre-qualification for African-made vaccines by establishing a dedicated Africa-specific support program to provide on-site regulatory guidance to already existing manufacturers, and help train African regulatory staff.
• UNICEF, GAVI and others must commit to sourcing any pre-qualified vaccine manufactured in Africa directly from African manufacturers – because this is the only way to incentivize manufacturers.
• Currently, efforts are too fragmented, with various initiatives funded differently, operating on various timelines, and driven by different levels of urgency. So what we need now is connecting the dots and align these efforts under a single cohesive vision and roadmap that drives coordinated progress.
• A task force needs to be established comprising key personnel and accountable to drive rapid, coordinated progress. The taskforce can be led by Africa CDC, to create a unified roadmap for developing the continent’s capabilities.
• Talent development should be strengthened to get to the 14,000 highly trained employees in vaccine manufacturing & research roles, which Jean Kaseya (Africa CDC) deems necessary to achieve the 2040 goal. But mitigating the brain drain should also get priority.
• Innovative financing models for filling the vaccine funding gap are required.
• The African Medicines Agency will conduct its director’s election on February 26 – the selected individual should be a dedicated advocate for vaccine manufacturing.
  
  

Throughout the insightful discussions and fruitful sessions organized at the event, I saw a lot of partnerships, a lot of collaborations, and a lot of MoUs. In addition, there are also plenty of frameworks and roadmaps in the vaccine manufacturing industry. How do we find overlap and synergies between all these? And more importantly even, how do we get straight to the point and deliver?

Perhaps clear medium-term targets can help. In fact, they already exist. The first one (10 % by 2025) is clearly impossible, but member states and other actors should be encouraged to expedite efforts to get to ‘30% by 2030’. 

It won’t be easy. But regardless, the time has come to move beyond words and start taking bold, decisive action.