African countries should unite for drug development
African nations must pool resources to promote local pharmaceutical innovation, say Ibrahim Assane Mayaki and Carel IJsselmuiden.
Africa bears a quarter of the world's disease burden, yet accounts for less than one per cent of global expenditure on health.
About half of the continent's population lacks access to essential medicines and the few drugs that are available often come from outside — Sub-Saharan Africa imports nearly 90 per cent of its medicines.
A lack of pharmaceutical innovation and access to essential medicines within Africa is severely hampering the continent's ability both to discover and develop medicines that meet local public health needs, as well as to deliver drugs in a timely manner, at an affordable cost.
To invest in national pharmaceutical innovation, countries can focus on generating long-term economic benefits by strengthening their science and technology sectors and adjacent sectors, such as drug delivery infrastructure. Or they can focus on improving universal access to essential medicines.
Both approaches are viable and countries often mix the two objectives when considering innovation strategies. In the end, decision makers must be clear on the balance they want to achieve and craft a strategy that meets their goals — economic development, improved access, or both.
In either case, investing in pharmaceutical innovation would enable the continent to target drug development at diseases specifically affecting local populations, and to explore and use its wealth of traditional medicines.
Hints of promise
There are signs that African leaders are waking up to the need for local pharmaceutical innovation and production.
Thirty-seven countries on the continent now engage in some form of medicine production. Egypt and Tunisia, for example, have been particularly successful, meeting 60–95 per cent of their own drug needs.
But capacity for local production elsewhere in Africa is generally low and most 'production' consists simply of packaging, or reformulating existing active ingredients. South Africa is the only country to produce new active pharmaceutical ingredients.
The global health community — including multilateral health programmes, donors and UN agencies — has proved critical in providing affordable medicines to fight diseases neglected by profit-driven pharmaceutical manufacturers.
For example, the Onchocerciasis Control Programme (OCP) has significantly reduced river blindness in the past 40 years, and various initiatives to develop antiretrovirals for HIV/AIDS have dramatically increased the number of people treated in the past five years.
But for too long, international players have set the African agenda for health research and drug development.
It is imperative that countries be allowed to set their own priorities and formulate their own strategies to meet the needs of their people.
Several African countries are now working to make this a reality. Kenya, Nigeria, South Africa and Tanzania, among others, have policies to guide investment in developing, producing and delivering medicines for their populations. These include Tanzania's national drug regulatory authority and the traditional medicines policies of Nigeria and South Africa.
Local pharmaceutical innovation is a principle agreed across the continent. All 55 members of the African Union (AU) have signed the Gaborone and Abuja Declarations supporting the development of an African pharmaceutical innovation plan.
And a recent initiative led by the New Partnership for Africa's Development (NEPAD), Strengthening Pharmaceutical Innovation in Africa, marks the first attempt to put African pharmaceutical innovation into practice.
At a February meeting convened by the AU and the Council on Health Research for Development in Pretoria, South Africa, African research, political and industry leaders approved an action plan to build countries' expertise in pharmaceutical innovation (see Africa plans leap into drug R&D).
At its meeting in March, the African Ministerial Council on Science and Technology (AMCOST) recognised this initiative as a key ingredient in implementing the AU's Pharmaceutical Manufacturing Plan for Africa.
It will also prove indispensable in implementing the WHO's Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, which will be discussed next month by representatives of 193 countries at the World Health Assembly.
But limited infrastructure and skills mean that the prospect of lab-to-patient innovation systems remains a distant dream for many African countries.
Much quicker progress could be achieved by pooling resources across regions. Working through 'Regional Economic Committees', individual countries could decide which skills to develop and craft strategies to attract investment to the region, calling on international expertise as needed.
Opportunities for regional cooperation include sharing medicines registration, quality control, clinical trials, education and professional training for pharmacists. This would reduce investment costs and create economies of scale in innovation and production.
Last month's endorsement by AMCOST of the Strengthening Pharmaceutical Innovation in Africa initiative opens the way for joint action — between policymakers, pharmaceutical producers and development partners — to make country-driven pharmaceutical strategies a reality for Africa.
It marks the beginning of a real movement to create a new cadre of African research and innovation managers to take on the challenge of developing pharmaceutical innovation on the continent.
Ibrahim Assane Mayaki is chief executive officer of the New Partnership for Africa's Development (NEPAD).
Carel IJsselmuiden is director of the Council on Health Research for Development (COHRED).