Gavi, the global vaccine alliance, has undertaken to adapt its approach to procuring vaccines in order to support African vaccine manufacturing.

In a plan released on Thursday, Gavi has committed to placing “a higher value on the benefits of diversification to supply security, with a focus on Africa”.

The 10-point plan, developed in consultation with the African Union and other key partners, also allocates responsibilities to other key players – G7 Development Ministers, African countries, international partners including development financial institutions, and the private sector – to support sustainable African manufacturing capacity.

However, Gavi will drive and coordinate the plan, given its enormous clout as the world’s biggest buyer of vaccines.

“For 22 years, as the largest buyer of vaccines in the world, Gavi has worked closely with African countries and manufacturers to favourably shape the market for essential routine and outbreak vaccines,” said Gavi CEO Dr Seth Berkley. 

“Gavi is committed to contributing to the AU’s vision. The plan published today provides a pathway to ensuring vaccine supply security for Africa during pandemics and expanding access to other life-saving vaccines at sustainable, affordable prices.”

The COVID-19 pandemic exposed Africa’s vulnerability when the entire continent was unable to get vaccines for months as wealthy countries had bought up all the doses made by Pfizer and Moderna and India stopped the export of generic vaccines made by the Serum Institute of India destined for the continent.

Stung by the COVID-19 experience, the AU has set a target to produce and supply more than 60% of its vaccine doses on the continent by 2040 – it currently supplies 1%. 

Although Africa consumes vaccines valued at over $1 billion every year, the cost of much of this is carried by Gavi, UNICEF and donors.

At present, Gavi chooses vaccine suppliers on price, and “does not systematically permit the accommodation of higher prices in the name of geographical diversity and supply security”, it acknowledged. 

“New accommodations in the way Gavi assesses products against supply security as a new market health objective, could have a substantial impact,” it acknowledges. 

The risk of supporting more expensive African-made vaccines could be mitigated by countries committing upfront to vaccines which would enable “predictable pooled procurement volumes”. 

African countries themselves also need to “send clear demand signals to the market on willingness to select and procure from African suppliers”.

“In the last 18 months alone, more than 30 new African manufacturing projects have been announced and estimates indicate that the African vaccine market across all existing and projected novel products could range between US$ 2.8 billion and US$ 5.6 billion by 2040, demonstrating the potential for a thriving regional industry to emerge,” according to Gavi.

However, the report also acknowledges that “a disorderly expansion risks unhealthy competition, potentially undermining the impact of market-shaping initiatives that have delivered low vaccine prices to lower-income nations, while also failing to realise Africa’s manufacturing aspirations”. 

It calls for a  “business model” that “actively shapes markets in support of the AU’s vision: meeting the mutually reinforcing objectives of continued global market health, and a sustainable regional manufacturing sector”.

Nonetheless, the price of setting up new manufacturing facilities in Africa may mean that their products are way too expensive to be viable.

“Modelling indicates that price differentials for new entrants may be in excess of levels that could be accommodated during standard Gavi/UNICEF competitive tenders, without impact on programme coverage,” Gavi warns.

“Ways must be found to support new entrants, whilst at the same time, avoiding a situation in which incumbent manufacturers increase their prices for vaccines due to lost volumes. This carries a potential risk of increasing the costs of immunisation worldwide.”

To address the high cost for new entrants, the plan proposes “a time-limited financial instrument that can help mitigate the high cost of vaccine production at market entry”. 

It also advocates that this financial instrument supports African manufacturers to make the most commercially viable antigen-based vaccines – starting with cholera and Ebola.

For their part, African countries are tasked with accelerating investment in the enabling environment, including “strong regulatory authorities, robust supply chains, skilled human capital, reduced trade barriers and empowered regional coordination”.

Image Credits: Gavi/Karel Prinsloo 2017.