Left Behind in Pandemic, Africa Aims for Vaccine Self-Reliance

(Bloomberg) -- After the Ebola crisis ended in West Africa in 2016, Amadou Sall received a painting as a gift from his wife and children. On one side is a family shrouded in darkness, threatened by a looming virus. The other is filled with bright light, a symbol of the science that will save them.

The work by a Senegalese artist hangs on the wall of Sall’s office at the Institut Pasteur of Dakar, the biomedical research center he leads in the nation’s capital.

“It’s a reminder of why I do this job,” said Sall, a veteran infectious disease expert.

The institute is a partner in a $200 million vaccine manufacturing project, part of a broader effort to strengthen Africa’s defenses against Covid-19, malaria and a range of deadly pathogens that could strike in the coming years. The continent imports about 99% of all the shots it needs. The goal is to slash that to 40% over the next two decades. 

“This isn’t a project only about making a vaccine,” said Sall, whose facility has made yellow fever inoculations for many years. “It’s a great opportunity to build a future.”

After the coronavirus emerged, many developing nations turned to Covax, the global distribution program. But the initiative has struggled to access doses, hobbled by production delays and export bans. While Covax was counting on India’s manufacturing muscle, the government prioritized its own citizens when a lethal wave of infections hit earlier this year.

A new plant, under construction on the edge of Dakar and expected to begin production in 2022, could help Africa avert a replay of the past year’s lopsided vaccine rollout. Manufacturing has been concentrated in just a handful of countries, and wealthy governments have secured most doses, leaving Africa and other regions far behind. Of the more than 8 billion doses given around the world, just 3% have gone to people in Africa, the World Health Organization estimates.

The fast-spreading omicron variant underscores the need to distribute supplies and technologies more widely. As the virus continues to rampage, the risk additional variants of concern will emerge and evade protection from vaccines increases, posing a threat to both rich countries and poor.

“We see very clearly today that whenever you have a variant, it becomes a problem for everybody,” Sall said.

The project, backed by European countries, the U.S., the World Bank and others, aims to produce 300 million doses a year targeting Covid and other diseases, helping to ensure Africa is better equipped when the next contagion comes. Institut Pasteur has teamed with Germany’s BioNTech SE and is talking with other potential partners, Sall said.

Yet even reaching those ambitious goals would leave Africa far short of the vaccine supplies needed to give two doses to each of its more than 700 million adults. And Africa’s wider plan will depend on raising additional funds, strengthening regulation and expanding distribution efforts and training, potentially taking years to deliver.

“We cannot afford to fail,” said Cheikh Oumar Seydi, who leads the Bill & Melinda Gates Foundation’s work on the continent.

The plan in Dakar is to produce shots using different technologies, in case one is less successful, said Sall, who is working with other companies including Belgium’s Univercells. The project could also pay dividends in other ways, spurring more investment, building trust in health systems and leaving the next generations in a better spot, he said.

Under pressure to help narrow the vaccine divide, a number of companies are stepping up two years into the pandemic. BioNTech, working with the governments of Senegal and Rwanda, sees a network that could eventually supply hundreds of millions of doses to the continent. The company will produce messenger RNA vaccines, harnessing the novel technology BioNTech and its U.S. partner Pfizer Inc. used successfully to make a Covid shot. 

BioNTech and Pfizer also plan to produce their Covid vaccine at the Biovac Institute in Cape Town. That’s expected to start in the third quarter of 2022, manufacturing at a rate of 100 million doses annually, according to Biovac Chief Executive Officer Morena Makhoana. The facility will focus on filling vials and packaging.

In another development, Moderna Inc., whose Covid shot has yet to reach vast parts of the world, plans to spend as much as $500 million to build a factory in Africa that could make half a billion mRNA vaccine doses a year. (Health advocates have said that sharing knowledge and technologies such as mRNA is crucial to expand production, and have urged Moderna to support a WHO initiative already underway rather than pursue its own project.)

“All of us realize that we need to do something about building capacity in Africa,” Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers & Associations, the industry group, said on a recent panel.

But as more vaccine makers jump in, there are worries about whether they will follow through on their promises, according to Petro Terblanche, managing director of Cape Town-based biotech company Afrigen Biologics and Vaccines.

“That’s one of the biggest risks to the strategy,” said Terblanche, whose company is working with the WHO and others on an mRNA hub to produce new shots and train people from other countries to make them.

Afrigen and its partners are pressing ahead with plans to reproduce the Moderna vaccine, even as the company seeks a license and answers to technical questions, she said.

“We’re not sitting and waiting,” she said.

Research highlighted by Human Rights Watch this month showed production of mRNA vaccines is possible outside the U.S. and Europe, with more than 100 companies globally – eight in Africa – potentially able to make them.

“The biggest lesson for us is that we cannot rely on the rest of the world to provide us with health security when the rest of the world is in a pandemic,” Terblanche said. “There’s a rude awakening that this cannot be repeated, ever.”

The wide gap in access between rich and poor has motivated scientists, health officials and companies to try build up the region’s autonomy.

At least five African countries are involved in vaccine manufacturing, some just focused on filling vials and finishing the process. Building on the expertise of the main players, like the Institut Pasteur in Dakar, will be vital.

“There is so much goodwill, so much commitment to ensure we turn this around that I think we are going to get it right,” Terblanche said. “Despite the disruption of Covid, Africa will in the long term come out of this in a better position.”

During the height of the pandemic, Sall’s family gave him another painting of two wrestlers sparring, a message that he needs to be strategic in the fight against new adversaries.

“We may have other Covids -- they may not be necessarily Covid, but they may be influenza or another new disease, and the world should be prepared for that,” Sall said. “Epidemics may be our way of life. We have to deal with them.”

©2021 Bloomberg L.P.