A review in Vaccine X suggests that for Africa, a “high prevalence of infectious diseases” is combining with “weak healthcare systems, poor antimicrobial stewardship, and an unchecked drug supply chain” to encourage antimicrobial resistance (AMR). Describing AMR as a “brewing pandemic”, the authors identify a need for Africa to develop independence of external sources for its vaccine supply. The review searched academic databases and grey literature as well as a reports and articles to outline the threats and concerns that AMR presents to Africans.  The emphasis is on the “urgent need” for Africa to develop greater vaccine manufacturing capacity to “improve vaccine access” and better prepare for future pandemics.  

The threat of AMR 

The authors describe AMR as a “brewing pandemic” in the abstract, and this is explored in greater detail throughout the article. They note that amidst growing incidences of infectious disease, antimicrobials often provide “hope”. However, they come with the limitation of AMR. Reportedly first described in Japan in 1956, AMR is “undoubtedly the most concerning emerging public health threat”. This problem of “epidemic proportions” is expected to claim around 10 million lives and cost around $100 trillion by 2050.  

For Africa in particular, the situation “may exacerbate” due to “widespread antimicrobial misuse”, yet there is limited surveillance of AMR. 

“The paucity of quality data, particularly in Africa, is a major challenge that often leads to insufficient treatment regimens.”  

Despite the lack of data, AMR is expected to be “implicated” in over 4 million deaths in Africa by 2050, with a recent study suggesting that 24 deaths in every 100,000 in sub-Saharan Africa were a result of AMR. Alongside the human cost, the authors state that emerging economies in Africa are estimated to lose “up to 5 percent” of their Gross Domestic Product (GDP) due to AMR.  

WHO is concerned by the threat of AMR and encourages measures such as infection prevention, antimicrobial stewardship, strengthening of healthcare systems, and of course, effective use of vaccines.  

African vaccines in Africa 

Several studies that we have explored in the past have emphasised the need for local vaccines to be developed in Africa, to address sustainability and access concerns for the continent. Unfortunately, in Africa, “inequitable resource distribution” puts many children at risk of vaccine-preventable infections. Despite programmes to encourage more effective distribution and deployment, the issue can better be tackled through increased local manufacturing capacity. There is reason to be optimistic about this, as we heard from Professor Petro Terblanche in our interview at the Congress. 

We are no longer just waiting for the world to innovate for us; we are able to innovate with the world.” 

While this innovation is growing and accelerating, there are very few vaccine manufacturers in Africa, with “little upstream production”.  

“It took the pandemic to show that nearly all Africa’s vaccines are imported.” 
Barriers to vaccine growth 

The study identifies several factors that hinder the growth of developing African vaccine manufacturing capacity: 

  • High start-up and operation cost 
  • Human resources 
  • Source of raw materials 
  • Time factor 
  • Limited partnership opportunities 

The paper describes global vaccine inequity as a “dire situation”, and notes that increasing Africa’s vaccine development capability to 60% (from less than 1%) is a “project that goes beyond a quick-fix strategy”.  

Suggestions from the study 

The authors identify some areas for focus: 

  • Building strong pharmacovigilance capacity in Africa 
  • Boosting research and development of vaccine development in Africa 
  • Strong African government commitment 
  • Decisively addressing the issue of vaccine hesitancy in Africa 
  • Careful application of technological innovation and advancement 
  • Understudying case studies of successful vaccine development 

The paper concludes that “vaccines are irrefutably essential for fighting antimicrobial resistance since they reduce antimicrobials’ usage and avoid illnesses caused by resistant pathogens. Therefore, Africa must strengthen its resilience and focus on building the capacity to create its vaccines.”  

Do you agree with the suggestions made in this paper, and can you identify other barriers to vaccine development in Africa? If you know of any efforts to encourage vaccine development on the continent do get in touch, and don’t forget to subscribe for more like this! If you are interested in understanding more about the burden of AMR check out our interview with Dr Jomana Musmar.