To protect public health, African states must work together to reshape vaccine access and promote self-sufficiency, write Akhona Tshangela and Jean Kaseya ahead of the Third International Conference on Public Health in Africa.
[ADDIS ABABA] Africa's vaccine procurement draws on support from Gavi, UNICEF and others to access vaccines for developing countries.
The COVID-19 pandemic, however, brought to light critical gaps in this system. Delayed rollouts and unequal distribution contributed to significant case spikes, greater vulnerability to new virus strains, and vaccine hesitancy.
As several low-income countries anticipate transitioning away from external support due to economic growth, there is an urgent need for an independent African solution to ensure continued access to affordable vaccines and other health products to be adequately prepared for future public health threats in line with pandemic preparedness, prevention and response measures.
In 2021, the African Union (AU) established the Partnerships for African Vaccine Manufacturing (PAVM), hosted by the Africa Centres for Disease Control and Prevention.
PAVM has been collaborating with various stakeholders to advocate for a pooled procurement mechanism for vaccines across the continent. This means different buying authorities combine their financial and other resources to achieve greater purchasing power and efficiency.
Drawing on the AU's prior experiences in setting up procurement mechanisms like the Africa Medical Supplies Platform and the African Vaccine Acquisition Trust for COVID-19 vaccines, the Partnerships for African Vaccine Manufacturing has developed a comprehensive roadmap to achieve this goal.
Why pooled procurement?
The vaccine value chain is typically interlinked, and limitations in one area can impact others. For example, local manufacturers need guaranteed demand to invest in manufacturing facilities, while purchasing countries need affordable rates to meet their demand requirements.
Pooled procurement mechanisms allow for demand consolidation, enabling collective bargaining power and better negotiation with vaccine manufacturers.
This leads to reduced fixed costs per unit as the number of doses produced increases. For instance, South Africa achieved a 68 per cent cut in HIV treatment costs between 2011 and 2019 by pooling demand across nine provinces, offering three-year contracts, and prioritising local and new suppliers.
By 2021, it had achieved some of the lowest costs for HIV medication per unit globally, outperforming even major pooled procurement mechanisms such as the Global Fund.5
So-called "offtake" agreements help manufacturers reach scale by predicting production trends and allowing them to invest in vaccine manufacturing capabilities. For example, Bio Farma, an Indonesian state-owned vaccine manufacturer, established long-term supply agreements with UNICEF, ensuring future demand and economic stability.
This contributed to Bio Farma's growth, enabling them to supply over 130 countries and receive WHO prequalification for ten vaccines.
Additionally, local vaccine manufacturing benefits from offtake certainty as it is still in its early stages and susceptible to fluctuations in activity levels. A lack of demand in 2022 led to the closure of Aspen Pharma's COVID-19 vaccine plant in Gqeberha, South Africa.
Cutting costs
A review of pooled procurement of medicines and vaccines published last year found that efficient and streamlined procurement processes are crucial to saving time and cost while ensuring continued access to medicines. UNICEF and the Pan American Health Organization have achieved substantial discounts by centralising their negotiating and contracting.
By consolidating demand, these agencies have been able to control over 70 per cent of the global vaccine market by volume, despite representing only 7.5 per cent by value, primarily due to their ability to bring high volumes to negotiations.
The African Vaccine Manufacturing Accelerator mechanism currently being designed by Gavi intends to ensure the continent's health security by guaranteeing a steady vaccine supply to low-income countries.
Africa reducing its reliance on other countries for vaccine manufacturing is crucial in repositioning itself within the global health architecture and aligns perfectly with the theme for the Third International Conference on Public Health in Africa (CPHIA 2023) in Lusaka, Zambia later this month (27 to 30 November).
First, pool procurement methods in Africa require ongoing commitment and an enabling environment. In scenarios with high upfront costs and uncertain demand, push-pull financing techniques are essential to maximise impact and get intervention to end-users.
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Second, AU member states, health and finance ministries, and other stakeholders including manufacturers, must commit to developing a legal instrument and securing buy-in and technical support to guide participation in pooled procurement mechanisms.
Lastly, robust analytics infrastructure is needed for technical design, and a clear business case and plan are needed for full design and implementation. This includes the scope of the product and purchases, the countries that will be involved, the supplier strategy, governance, financing, regulatory standards, pricing and negotiations, logistics and distribution, and pricing and negotiations.
These steps to implement the pooled procurement mechanism to address market needs collectively pave the way for the ambitious transformation of the vaccine landscape on the continent, a topic of utmost importance to be explored at CPHIA 2023.
Jean Kaseya is the director-general of the Africa Centres for Disease Control and Prevention.
Akhona Tshangela is the programme coordinator for Partnerships for African Vaccine Manufacturing.
This piece was produced by SciDev.Net's Sub-Saharan Africa English desk.
