As apparent during the COVID-19 pandemic, long-existing health inequalities mean that a location’s experience of public health threats varies widely. For Africa in particular, the pandemic highlighted the need for independent innovation and development in response to neglect from other nations. Public health leaders in Africa, among them newly established Director General of Africa CDC Dr Jean Kaseya, have called for a continentwide effort to localise development and manufacture of vaccines. This would equip the most vulnerable nations against often localised threats and more international health challenges.  

However, as a recent study in Vaccine X highlights, localisation “has not gained much attention” in the vaccine sphere. The study defines localisation of vaccine production as the “process of producing vaccines within a particular country or region, rather than importing them from other countries”. Here we take a closer look at the study’s investigation into whether Africans will support African-made vaccines, and why.  

COVID-19 and mpox  

Over the past couple of years, we have heard great discussion about the inequality of vaccine distribution during the COVID-19 pandemic response. Despite a concerted global effort, many areas suffered the consequences of vaccine nationalism and self-interest. This is not the first, and will sadly not be the last, time that lower resource areas experience delayed or disrupted public health necessities.  

Just last year, mpox entered the global awareness, and vaccines were scrambled during efforts to curb a potential pandemic. However, as Dr Ahmed Ogwell Ouma, acting director of Africa CDC at the time commented, the “source” of the problem should have been addressed earlier. Africa was once again an afterthought, despite its experience with mpox.  

Independence from the ‘global north’ 

The study suggests that during COVID-19 “most developing nations looked to advanced countries in the global north for assistance”. When the “laudable initiative” of COVAX was implemented, the authors indicate that “structural weaknesses” and “ill-readiness to confront pandemics” were exposed. They identify a need to understand the “mechanisms” through which African countries can “break the shackles bounding vaccine production and access among their citizens”.  

“Localisation is seen as a solution to timely access to preventative medicine for import-dependent nations by shortening the supply chains.” 

Furthermore, it provides the additional benefits of “increased efficiency” and “reduced environmental footprints”. Other possibilities include opening doors to “greater diversification of supply chains, stronger partnerships, and private investment”.  

“It could also tackle the unmet need for discoveries in diagnostics and therapeutics in developing countries.”  

The African Union aims high 

Aware of Africa’s “huge” dependence on imported vaccines, and associated “vulnerability”, the African Union is aspiring to produce the continent’s most needed vaccines by 2040. African leaders have pledged to increase the percentage of home-produced vaccines from 1% to 60%. As much as this is a leadership issue, it also requires “commitment” from African citizens, suggest the authors.  

“While Africa is left behind in almost all facets regarding vaccine development and uptake, significant evidence of apathy towards homemade products and services abounds.”  

The study acknowledges that “increasing vaccine hesitancy” would worsen in the continent if “citizens’ support for locally produced vaccines is not well understood and leveraged”. So, what can be done about this? The authors believe that research in this area is “dominated” by “opinion pieces and conceptual studies”. Lacking empirical evidence, they set out to explore the scale of citizens’ support for African-made vaccines.  

Context to the study 

The authors suggest that Africans have “long been noted” for “negative attitudes towards locally made products and services”. Due to a “perceived superiority of foreign substitutes, consumption of these products is interpreted as a “symbol of high social status”.  

The WHO has indicated that the greatest obstacle is the structure of vaccine markets. The study claims that “without intentional commitment and support” to consume the products, it will be a consistent challenge to build a “sustainable industry”. However, the focus of the study is on the “end-market”: the “willingness to accept and take” these vaccines. Considering the significance of the consumer, the researchers explore Ghanaian support for African-made vaccines. 

Through 8 hypotheses, “formulated and tested based on the theories of nationalism and import substitution industrialisation”, the study aims to provide evidence on the mechanisms of public support for African-made vaccines. This can be used for “guided public health action”.  

Predictors of support and the 8 hypotheses  

The researchers state that the potential predictors of support investigated are self-reliance, enhanced access, import substitution, safety and efficacy of vaccines, and trust in local expertise.  

“These issues revolve around gains, losses, rationale and emotions, all of which have been noted as the fundamental psychological cues underlying attitudes and behaviours.”  

The study sets out 8 hypotheses to test: 

  1. Trust in local expertise has a significant positive effect on support for African-made vaccines. 
  2. Localisation leading to a perceived improvement in the safety of vaccines would significantly and positively lead to support for African-made vaccines.  
  3. Localisation leading to a perceived improvement in the efficacy of vaccines would significantly and positively lead to support for African-made vaccines.  
  4. Localisation of vaccine production leading to perceived self-reliance would significantly affect residents’ support for African-made vaccines. 
  5. Trust in local expertise has a significant positive effect on support for African-made vaccines. 
  6. Localisation leading to import substitution would significantly and positively explain support for African-made vaccines. 
  7. Localisation leading to job creation and expansion of the local economy would significantly and positively explain support for African-made vaccines.  
  8. Localisation leading to timely access to vaccines would significantly and positively lead to support for African-made vaccines.  

To understand the structure and methods of the study we encourage you to read it here! 

A masked vaccinator puts her thumb up

What does the study find? 

Through a mixed-methods research design the study authors found evidence that “vaccine uptake ethnocentrism exists” among Ghanaians. The authors labelled three different groups according to indicated support: 

  • Afrocentric-ethnocentrics – indicated support for made-in-Africa vaccines 
  • Apathetic-Afrocentrics – unsupportive of these vaccines 
  • Afrocentric-Fence Sitters – uncertain  

The article features quotations from study participants to outline the reasons for their attitudes. For example, Kwesi remarked that “It is about time we Africans stood up because we have the knowledge required to produce drugs that will liberate us”.  

Some participants recognise that Africa is a host of “herbs for pharmaceutical formulations” and has “always made superior drugs”. Additionally, climate conditions and immune variations can be “easily understood by local scientists”. Therefore, the only problem is a lack of “systems for formalisation and large-scale production”. Mawuko commented that “Africa has intelligent scientists and health experts who better understand their fellow Africans and the continent’s health challenges.” He believes “Africans should take charge of our vaccine production”.  

‘Ghana beyond aid’ 

The authors refer to a “renaissance among developing countries and their populations to reduce their dependence on donor support”. This has been dubbed “Ghana beyond aid” in Ghana.  

“Respondents regarded support for African-made vaccines as a pathway for undoing the colonial mentality of vaccine aid and dependency and the old tradition of master-servant relationships forged for self-reliance, independence, and autonomy from the global north.”   

Fear about the quality of foreign products also play into this quest for independence. The authors describe the possibility of local vaccines as a “magical bullet against dumping activities by foreign pharmaceutical companies and their financiers”. Adjoa does “not trust foreign vaccines”. She believes that “foreigners have no good intentions for Africans”.  

This concern is echoed by Kwame, who agreed that “a stranger can’t be trusted as much as your own people”. Kwame suggests that “our own fellow scientists will aim at making their citizens healthy”.  

However, some participants expressed a lack of trust in the scientific capability of African scientists. The authors suggest that this is like a previous study conducted in Italy, where the subjects expressed “lack of trust in the scientific community”. For example, Kojo thinks the “technology and know-how” in Africa are “currently weak”.  

Recommendations to public health figures 

The study highlights an “important gap in knowledge regarding citizens’ support for African-made vaccines”. The authors suggest the need to understand this to address vaccine hesitancy. Despite the varied responses quoted, the conclusion is that “vaccine ethnocentric tendencies are prevalent” for most Ghanaians, with a “strong preference for African-made vaccines”.  

“The study recommends that public health practitioners and ministries of health in Africa should use these factors as the basis for campaigns promoting home-made vaccines to alter how Africans accepts vaccines and minimise hesitancy.”  

These findings represent a “major leap forward”, the authors suggest, nonetheless acknowledging that they “do not have and consequently did not provide all the answers to vaccine production location decisions”. Furthermore, they encourage research into the role of culture in moderating vaccine beliefs, as well as a broader view of more African countries.  

What benefits might this study provide to health leaders, and how can the results be used to encourage greater trust and acceptance of African-made vaccines? Alternatively, what must be done to promote localised production as it is being established? 

To read the study in full, click here.