COVID-19 exposed Africa’s vulnerabilities and its urgent need for local innovation and drug development. Leading African scientist KELLY CHIBALE discusses some of the key challenges.

Improving scientific skills in Africa and stemming the continent’s brain drain weigh heavily on Professor Kelly Chibale’s mind, particularly as COVID-19 pandemic has damaged fragile health systems and reversed hard-fought gains against a range of infectious diseases.

Professor of organic chemistry at the University of Cape Town, Chibale runs one of the continent’s most innovative medicine discovery and development laboratories, the Holistic Drug Discovery and Development Centre – H3D. But there are many barriers to success – ranging from a lack of skills and resources to antiquated regulatory requirements, and Afro-pessimism.

Major global supply chain disruptions during the first two years of the COVID-19 pandemic exposed the dearth of African innovation and how some initiatives from the global North were unsuited to the South – such as vaccines that needed ultra-cold storage.

Lack of opportunities

“It’s really important to tap into local innovators to get homegrown solutions,” says Chibale.  “But the Achilles heel of the continent is a lack of skills. 

“You can have technology transferred from a pharmaceutical company today, but it’s a new technology, which means you have to upskill people and we don’t have a critical mass of people that are skilled. It’s really painful because every single African country, after gaining independence, quite rightly invested heavily in training nationals but today, we are still talking about a critical shortage of skills.”

The “brain drain” of skilled Africans is driven by a range of issues, he contends, but at its heart is a lack of opportunities.

Chibale favours on-the-job training so that people can put into practice what they are learning, but adds that this also requires the capacity to absorb newly trained people – and this is often where the wheels fall off.

He gives the example of international clinical trials that require a high level of skills and organisation. But once they are over, everything is simply packed away.

“There is no pipeline of projects coming through, which means you’re going to lose the skills that you’ve gained. You’re going to lose continuity, you’re going to lose the infrastructure, you’re going to lose the technologies and you’re going to lose the people.”

Stemming these losses requires African organisations and governments to step up as partners, not mere participants.

“Skills development programmes have to be locally led. If they’re driven from New York or Geneva or wherever often these will end up being in silos and duplicating other programmes.”

Stepping up as partners

If African institutions and governments step up as partners and “co-create” projects with funders, these will have a better chance of success.

African governments could, for example, have policies that mandate that products need to have locally manufactured components and give incentives to local manufacturers and prioritise ordering from them.

In addition, African countries could require clinical data about how effective medical products are on local populations, as Japan and China do, before they approve medical products.

“Tremendous credit to the government of South Africa, for example, for the way they’ve come to the party with all in all our partnerships,” says Chibale.  “For every dollar we get from the Bill Melinda Gates Foundation, we get a dollar from the South African government.

“But it’s not all about the money. You can incentivise business by having an attractive regulatory framework where companies know that if they submit data, they’ll get a yes or no within a predictable period.”

However, Chibale concedes that some African countries simply lack the infrastructure to do some of the work, while fostering and retaining scientific talent is not the only factor in the equation.

 “In South Africa, we’ve developed infrastructure to a point where we can order reagents and chemicals very quickly to do drug discovery. But we worked with colleagues in other parts of Africa, and had to order the reagents for them. But then we couldn’t even ship the reagents because their customs make it so hard to even receive a donation. We are sometimes our own worst enemies with assistance.”

African Medicines Agency game-changer

Chibale is enthusiastic about the African Medicines Agency (AMA), which is due to be headquartered in Rwanda, according to the announcement made just this week.

African Union Selects Rwanda to Host African Medicines Agency, Grants Africa CDC Autonomous Status

As a former board member of South Africa’s regulatory authority, Chibale understands how important a strong and nimble regulator is to R&D.

“COVID has really highlighted the importance of having a competent regulatory authority in Africa that can facilitate regulatory harmonisation, and timely approve and monitor products.

“Having the African Medicines Agency will be a significant step forward. What bedevilled access to vaccines on the continent is that we didn’t really have a harmonised regulatory environment or even procurement at the continental level. This is really going to increase access to products because we have a unified way of doing things.”

AMA will also be crucial in managing continental clinical trials.

“If you don’t approve clinical trials quick enough, your population is not going to benefit from participating in trials that will make sure that the vaccines or therapeutics are optimised for your population,” says Chibale. 

“There’s also a business case to be made. Clinical trials create jobs, and research and development can be promoted across the whole value chain when we know that we can harmonise the environment.  Some Phase 3 trials have to be done in multiple countries. If you don’t have a harmonised regulatory environment, each country is going to do its own thing and hold up the other countries.”

Afro-pessimism

One of the hardest barriers to local innovation is Afro-pessimism:

“This might sound like I’m being funny, but it really is true. People almost don’t trust if the innovation is made in Africa. We need to take pride in what is locally produced and be deliberately supportive of local producers. People almost want to trust something that’s come from overseas and yet many of those products are not really tested on a bigger population in Africa.”

Image Credits: Kerry Cullinan, E Fletcher/HP-Watch.