Uganda’s long road to manufacturing vaccines

Until Covid-19 pandemic reared its ugly head, most, if not all countries in the Global South – Uganda being one of them, didn’t think of a time when they will be at the bottom end of the pecking order at their most hour of need.
  
Before thinking of countries in Africa, the Global North countries—wealthier and developed economies, first made sure that their population receive even booster Covid-19 vaccines shots, before donating the surplus, some of which were due for expiry, to countries with no say on access, majority of which are in Africa.    

While six billion vaccine doses were preordered by higher-income countries during the Covid-19 pandemic, the World Health Organisation reports that less than 1 per cent of the produced vaccines were distributed to developing countries such as Uganda. 

“The rush by most countries to hoard drugs and other medical products during the Covid-19 pandemic exposed the Africa’s vulnerability to the caprices of global medical supply systems,” reveals an expert analysis authored by Southern and Eastern Africa Trade Information and Negotiations Institute (SEATINI) Uganda and Afya na Haki. 

The report titled: “Advancing Regional Vaccine Manufacturing and Access in Africa (ARMA)”, further notes: “The unequal global distribution of vaccines against the deadly Covid-19 virus shone a spotlight on the lack of access to vaccines on the African continent and the vulnerability that such a lack places on both the economies of African nations and the health of their people.”

As a result, currently SEATINI Uganda and Afya na Haki together with other partners are implementing a project towards, “Advancing Regional Vaccine Manufacturing and Access in Africa (ARMA), with the consortium partners from various African countries including Uganda, Nigeria, Rwanda, Tanzania, South Africa, Kenya, Senegal and Zimbabwe.

Reawakening 
Although government working with local scientists have made progress in research and development of animal vaccines, with Kukustar vaccine - a remedy for Newcastle disease, being one of the most obvious development over the years, the same tenacity hasn’t been geared towards developing human vaccines.
 
 This, according to the Minister of Science, Technology and Innovation, Dr Monica Musenero, is not because of lack of proof of concept – far from it, but due to lack of necessity and belief. 
“We didn’t think this is something we needed to do. There were some confidence issues.  Some thought it was sophisticated. It was until Covid-19 struck that government really put in serious money in vaccine research,” Dr Musenero said while discussing the viability of vaccine manufacturing in the country.

She revealed that investment in vaccines – in this case human vaccines, is possible in Uganda and the continent in general, but, “not without government funding.”
For Uganda’s case, the bureaucratic nature in which things are subjected to is impacting the development of the human vaccines as there are bureaucrats who don’t believe in the steps leading to the development of a vaccine. 

Dr Musenero believes private sector can play a role, although it should be at the tail end, considering the cost associated with resources (money) and time involved can better be managed by government. Indeed in Global North, according to health sector analysts spoken to, say much of the investment is offset by the government before the private sector is handed over the project.

As long as the government consistently funds research and development, human vaccine development will happen in Uganda, beginning with the Covid-19 vaccine possibly sometime next year – 2024. 

Already, the plan is to complete a plant in Matuga, an urban centre in central region, to pilot production of smaller amounts of vaccines for clinical trials. The animal vaccine manufacturing line being completed at Namanve industrial park will also be utilised for human vaccines if World Health Organisation gives a green light.  

If all the aforementioned go as planned, Uganda could, according to Dr Musenero, become a vaccine hub in the region as well as the continent. This will include doing what she describes as fill and finish – akin to assembling vehicles or phones made elsewhere, but in the pharmaceutical industry, is the process of filling vials with vaccine, something Egypt and South Africa are currently doing. 

For Uganda fill and finish will be particularly for early childhood vaccines such as polio, tetanus and measles among others as research and development for diseases that are a threat to the continent is deepening, a shift from modus operandi – where most research and development were done outside the continent although the impact is here.      

Chocking realities 
But Pharmaceutical companies, also known as “Big Pharma”, have been restricting access to patent rights and have control over prices of their drugs and medical products to widen their profit margins, resulting in their inaccessibility to many who depend on them. 

The aforementioned expert analysis singles out Pfizer, BioNTech, Moderna, and Sinovac who made an extraordinary $90 billion in profits on their Covid-19 vaccines and medicines in 2021 and 2022 through, among other things, restricting access. 

Given the disparity in access to vaccines especially during the Covid-19 pandemic, many developing countries called on the international community to waive Trade-Related Aspects of Intellectual Property Rights (TRIPS) Intellectual Property (IP) protections for Covid-19 vaccines, based on the notion that allowing any company to manufacture the vaccines will boost production and vaccinations.

Often, international trade and investment agreements include IP provisions that protect the interests of multinational pharmaceutical companies, which can make it difficult for local manufacturers to compete.

“Despite having the highest incidence of mortality caused by infectious diseases, less than 1 per cent of Africa’s vaccine needs are met by products manufactured on the continent,” said Dr Denis Kibira, a pharmaceutical policy analyst and health systems researcher. 

Although the African Union targets a 60 per cent local vaccine manufacturing capacity in Africa by 2040, something Dr Musenero believes can happen with consistent government funding in vaccine research and development, this target is still out of reach in comparison to the current production rate estimated at 1 per cent of all vaccines administered in Africa. 

Despite the growing demand for vaccines in the continent, Africa has a long journey to topple the leading vaccine producing regions estimated at 34 percent, 28 percent and 20 percent for Americas, West Pacific region and Europe respectively. 

According to sector analysts, the inability of the continent to produce vaccines to meet its growing demand has not only promoted vaccine inequality but also rendered the continent vaccine dependent on other vaccine producing regions. This discrepancy highlights the injustices Africa still faces in vaccine access. 

Uganda and the continent in general, shoulders a heavy disease burden yet the world scientific output focused on African countries remains largely small estimated at less than 1 per cent.
According to a report published by the WHO-Afro in 2018, 76 per cent (36/47) member states in Africa had an alarming total of 96 new disease outbreaks of public health importance.  Such findings underscore the need to pandemic preparedness which predominately lacks within the continent. 

 Way forward 
Currently, there has been a new paradigm shift in the vaccine landscape in the last two years for Africa, where several African countries, including Uganda, Egypt, Kenya, Morocco, Senegal, South Africa, and most recently Rwanda have taken concrete steps towards manufacturing vaccines on the continent. 
This has caused countries like South Africa, Ghana, Nigeria, Tanzania and Egypt attaining the Maturity Level 3 (ML3) for vaccine status under pillar 3 of the New Public Health Order for Africa launched in 2021 strategically focusing on the expansion of manufacturing of vaccines, diagnostics and therapeutics.

According to executive director, SEATINI Uganda Ms Jane Nalunga, unlocking East Africa and by extension Africa’s potential to locally manufacture vaccines will require a review of some trade and investment policies. 

She said: “The Investment policies should provide for joint ventures, technology transfer and skilling. The trade policies especially the regional trade policies should also encourage regional value chains.”

She continued: “A regional approach is important to provide for needed finances, technology and market. Additionally, there is need to review the Common External Tariff (CET) and tariff schedules to ensure that they promote local vaccine manufacturing.”

Ms Nalunga says intellectual property laws have various provisions therefore it is critical to build capacity to use the flexibilities within the Intellectual Property laws to promote local vaccine manufacturing.

“There is need to review the existing investment, trade and industrial policies at national, regional and continental levels to enable countries to incentivise local vaccine manufacturing,” said Ms Nalunga, a trade, treaty and investment expert.