Shortage of Cholera Vaccines Spurs Africa CDC’s Quest for Local Manufacturing of Medical Products
Medicines & Vaccines 20/02/2024 •
Cholera
Floods and heavy summer rainfall have increased the risk of cholera outbreaks, exacerbated by climate change.

The Democratic Republic of Congo (DRC) needs at least five million cholera vaccines to address the worst outbreak of the disease on the African continent – but it has received none so far.

Meanwhile, Zambia has received half the cholera vaccines it needs and less than a third of Zimbabwe’s vaccine needs have been met, Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa-CDC), told Health Policy Watch on Tuesday.

Cholera is “aggressive and more protracted in multiple countries”, with almost 253,000 cases and 4,187 deaths reported 19 countries between January 2023 and January 2024, according to Africa CDC.

Six African countries are currently categorised as being in an “acute cholera crisis” – the DRC, Ethiopia, Mozambique, Tanzania, Zambia, and Zimbabwe, which account for three-quarters of cases, according to the latest Africa CDC cholera report.

Between the beginning of the year and 11 February 2024, 34 511 cholera cases and 869 deaths (with a case fatality ratio of 2.5%), have been reported to the WHO Africa region.

Access to cholera vaccines is a “key priority”, said Kaseya, who has made improving access to vaccines and medicines one of the cornerstones of his tenure as Director-General of Africa CDC since his appointment a year ago.

“There is a shortage of cholera vaccines in the world, but a manufacturer in Africa has already had a Phase One clinical trial of a cholera vaccine. They just need $15 million to accelerate from Phase Two to Phase Three. If they can manufacture this vaccine, it will be a game changer for cholera,” said Kaseya, who has been leading fundraising efforts for the trial to be completed.

As part of this quest, the African Union summit agreed over the past weekend to set up a pooled procurement mechanism to enable African countries to come together to buy medical products, ensuring lower prices in what is potentially a $50 billion market. 

The Africa CDC will manage the procurement fund, forecasting what products are needed, selecting medicines and monitoring demand, said Kaseya.

He outlines three reasons for pooled procurement: many African countries struggle to get access to quality-assured medicines;  countries pay high prices for medicines because they go to manufacturers individually, and there is a proliferation of poor quality medicines and a lack of local suppliers of high quality medicines.

Some countries will use their own money to pay for products, but others may need to get financing – including from the African Export–Import Bank known as Afreximbank.

“We want all Africans to have access to quality medicines, and we are putting in place some financial mechanism for them. It means we are very open and we are offering a large  number of options for countries,” says Kaseya.

As part of this quest, the African Union summit agreed this week to set up a pooled procurement mechanism to enable African countries to come together to buy medical products, ensuring lower prices in what is potentially a $50 billion market. 

The Africa CDC will manage the procurement fund, forecasting what products are needed, selecting medicines and monitoring demand, said Kaseya.

He outlines three reasons for pooled procurement: many African countries struggle to get access to quality-assured medicines;  countries pay high prices for medicines because they go to manufacturers individually, and there is a proliferation of poor quality medicines and a lack of local suppliers of high quality medicines.

Some countries will use their own money to pay for products, but others may need to get financing – including from the African Export–Import Bank known as Afreximbank.

“We want all Africans to have access to quality medicines, and we are putting in place some financial mechanism for them. It means we are very open and we are offering a large  number of options for countries,” says Kaseya.

‘Operationalise the African Medicines Agency’

The pooled procurement mechanism will dovetail with the African Medicines Agency (AMA), which is to be the regulatory body of Africa that assesses the quality of all the medical products used. 

“During the AU meeting, Africa CDC advocated for the operationalising of AMA. While we are waiting for AMA to to be operationalised, we are putting national regulatory authorities into regional bodies that can be the regional regulatory body. So SAHPRA [South Africa Health Products Regulatory Authority] in South Africa will lead the regulatory aspect in southern Africa.”

Gavi’s African Vaccine Manufacturing Accelerator (AVMA), aimed at catalysing the growth of vaccine manufacturing, is another initiative to boost the continent’s access to medicine. It will by making up to $1 billion available over the next 10 years to support the growth of Africa’s medicines and vaccines manufacturing base, according to Gavi, whose board approved the initiative late last year.

“I attended the Gavi board meeting in Ghana where AVMA was approved, and I had to engage Gavi board members, for them to support it,” said Kaseya, adding that Africa CDC will be involved in AVMA’s operations.

“In June 2024, Africa, CDC will co-host the launch of AVMA in France,” he added.

The AU Summit also appointed Kenya’s President William Ruto to champion local manufacturing of all medical countermeasures – diagnostics, medicines, vaccines and other supplies.

Ruto joins South Africa’s President Cyril Ramaphosa, formerly the continent’s COVID-19 champion who is now Africa’s pandemic prevention, preparedness and response champion.

Pandemic agreement negotiations

The AU summit also discussed the current pandemic agreement negotiations at the World Health Organization (WHO), endorsing the Africa region’s position on pathogen access benefit-sharing (PABS), said Kaseya. 

The continent believes countries should be compensated if they share the genomic sequencing and biological material of pathogens with commercial companies who go on to make medical countermeasures such as vaccines and medicines.

“We are working on a large number of vaccines targeting African diseases, but importantly, we want to bring back to Africa research and development and clinical trials. We want to know what exactly is affecting Africa, and we want to be part of the development of vaccines to get what we call benefit-sharing. If others have access to our pathogens, we need also to sell benefits.”

However, PABS is one of the most contested aspects of the pandemic agreement and Kaseya conceded that all aspects of it were still being negotiated.

“Two weeks ago, I was with AU ambassadors to see how we can facilitate the negotiations,” said Kaseya, 

“For me, there are only two words summarising this pandemic treaty. The first one is equity. The second one is respect. I think these are the two words that are really driving Africans who are negotiating. When we talk about financing, when we talk about pathogen access and sharing, everything is towards respect and equity.”

 

Image Credits: World Health Organization (WHO).

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