Why Africa needs homegrown health solutions
It’s increasingly unclear when exactly Africa will receive Covid-19 vaccine. But if history is to serve as a benchmark, continent will have to wait a little longer.
It’s not lost on us that it took two decades for the hepatitis B vaccine to become affordable and accessible in Africa.
It also took two decades of incredible AIDS activism and generic production for the cost of anti-retroviral treatment (ART) per patient annually to decrease.
Now imagine how many such infections and deaths could we have prevented over those two decades?
Yet nearly every global health technology goes through this excruciatingly painful process — research and development (R&D) typically happens in high-income countries (HICs), and the product is usually not affordable in low- and middle-income countries (LMICs) when launched.
It takes herculean efforts—including extensive advocacy campaigns, product buy-downs, compulsory licensing, patent challenges, efforts to create competition, advanced market commitments, creation of alliances, such as, Gavi, Global Drug Facility, creation of non-profit R&D groups — over many years to make new technologies accessible in LMICs.
But even so, many products are still not accessible to folks who need it the most.
And although advocacy groups are currently running campaigns to lower prices of bedaquiline for TB, insulin, TB molecular test, pneumonia vaccine, among more general efforts to curb outrageous drug prices, the answer to the question, “for how long?” remains a matter of conjecture.
While the decades-long delays can be attributed to a number of encumbrances, including drug regulations for local registration might take time in LMICs, high cost of innovative products vs. limited budgets set obstacles in LMICs, and knowledge transfer needed for the local health professionals, it now exposes inadequacies of global health, the prominent one being an excessive reliance on ‘trickle down’ model, where products and innovations are developed in the Global North, and after a decade or two, slowly trickle down to the Global South, where the biggest needs are, and where technologies often have the greatest impact.
Evidently, this approach mostly exclude scientists, development experts and innovation hubs in LMICs.
It also does not factor in the peculiar health needs of LMICs that could be addressed at primary healthcare. Thus time has come for Africa to consider an alternative: home-grown innovations.
Globally, home-grown innovations have better odds of success than standard trickle-down model.
First, when innovations emerge from LMICs, governments are often key stakeholders and funders.
They are, thus, more willing to include them in national policies for scale-up. Second, home-grown products often receive faster regulatory approval, since trials are done locally.
Domestic use does not necessarily require external policy endorsement; for example, WHO endorsement or pre-qualification is not required.
Third, it takes less effort to convince policy makers, experts, and healthcare workers. Such innovations are not received with skepticism, unlike foreign products which are often seen as being ‘pushed by external donors.’
Fourth, cost of goods are lower, as are labour and manufacturing costs. Fewer distributors and intermediaries are needed.
Manufacturing can leverage generic companies and economies of scale.
Fifth, technologies developed in LMICs have additional benefit of going through a shorter supply chain and are usually designed with local conditions and end-users in mind. — The writer is Global Impact Fellow at Moving Worlds Institute