Grace Ashiru
By Michael Mynhardt, Co-founder and CEO of MMH & Partners Africa
The African continent, rich in resources and human capital, remains woefully underprepared for the next global pandemic. Most African states were left scrambling for access to life-saving vaccines following the outbreak of COVID-19 as the continent does not produce or manufacture its own healthcare products. According to the latest estimates from the United Nations Economic Commission for Africa ( UNECA), Africa imports close to 94% of its pharmaceutical and medicinal needs at an annual cost of US$16 billion.
The equitable distribution of medicine in Africa has since come under sharp scrutiny by local government leaders, private donor funders, and other key political organisations, including the African Union and the African Centres for Disease Control and Prevention (Africa CDC). While the Partnerships for African Vaccine Manufacturing (PAVM) Framework was established in 2021 to help amplify key diagnostic findings on the current vaccine manufacturing environment, much more needs to be done to strengthen regional healthcare systems against several public health threats facing Africa today.
The rise in Antimicrobial resistance (AMR) remains at the top of that list.
It is estimated that, in 2019, 1.27 million people’s deaths worldwide are related to AMR and that this figure can reach 10 million deaths by 2050. This bears significant consequences for African populations, where, annually, 27 deaths per 100,000 are as a result of AMR, solidifying Africa’s position as the continent with the highest mortality rate from this growing problem.
AMR describes a situation where medicines that were previously effective for the treatment of common conditions are no longer effective. This describes resistance to antibiotics, antivirals (for treating viral infections), and antifungals (for treating fungal infections).
AMR occurs when bacteria, viruses, fungi, and parasites change over time and no longer effectively respond to medicines. This resistance makes infections more challenging to treat and increases the risk of disease, severe illness, and death. With antibiotics, some bacteria may die – however, resistant bacteria can survive and even multiply. Any life-threatening infection that fails to respond to medicine can result in organ failure and a range of secondary or tertiary infections, making AMR a deadly, silent pandemic.
The rise in AMR is caused by multiple factors, including the misuse and/or overuse of antibiotics in human medicine, livestock treatment, and agriculture. It has also been fuelled by the emergence of substandard and falsified antibiotics. Other factors include the lack of access to clean water, sanitation, and hygiene; poor infection prevention and control in healthcare facilities; poor access to quality-assured medicines (including new and existing essential antimicrobials), vaccines, and diagnostics; a lack of awareness and knowledge; and a lack of enforcement of concerning legislation.
Sadly, this means that AMR disproportionately affects low- and middle-income countries (LMICs), where access to healthcare and quality medication remains restricted and in short supply.
Counterfeit antibiotics, which remain particularly prevalent in LMICs, pose a significant risk in our fight against AMR. In Africa, up to 500,000 deaths are attributed to fake medicine, 169,271 of which are linked to falsified and substandard antibiotics used to treat severe pneumonia in children
Thankfully, AMR is wholly preventable. By eradicating counterfeit medicine and providing a consistent, appropriate basket of beta-lactams and cephalosporins through new, locally-based antimicrobial facilities, we can begin to develop an effective, regional response to this pernicious threat. This would need to include the construction of new laboratory testing facilities for the detection of AMR in Africa, to be built in partnership with international donor funders committed to a collective, global response to this crisis
This approach would also need to be supported by a pan-African educational campaign that communicates the dangers of misusing drugs in a manner that causes resistance to the medication provided. Limiting self-medication, ensuring medicine is being stored appropriately, and preventing the sharing of medicines between people who have not been prescribed that medication will remain essential
The Africa CDC plays an instrumental role here as well. In October 2017, it launched the Framework for Antimicrobial Resistance Control with a task force that subsequently drafted the AU Framework for AMR Control 2020-2025. This five-year plan aims to improve surveillance of AMR organisms among humans, animals, and plants; delay AMR emergence; limit AMR transmission; and mitigate harm among patients infected with organisms that are resistant to treatment
Over the last six years, several external role players have positioned themselves effectively with the best-in-class experts required to develop a regional response to this growing public health threat. The team at Atlantic Life Sciences (ALS) in Accra have built a premier sterile pharmaceutical manufacturing plant that specializes in various dosage forms, including large volumes of parenterals, vaccines, and biological products. Established under Ghana’s “One-District, One-Factory” programme, ALS – commissioned in 2022 – remains a critical provider of affordable, high-quality healthcare products in the region and holds membership in the Pharmaceutical Manufacturers Association of Ghana and the African Vaccine Manufacturing Initiative.
At present, approximately 30% of Ghana’s essential medicine needs are met through local manufacturing, with the remainder supplemented by imports. Sadly, the magnitude of these imports creates an ideal environment for several illegal activities, including the importation of fake, counterfeit, and substandard medicines and antibiotics.
Industry experts at ALS have recommended a comprehensive strategy to effectively address these conditions, with a proposal that encompasses legal regulations, surveillance, education, and supply chain strengthening to combat AMR in West Africa. The company’s objectives include commissioning a new antimicrobial facility, expanding vaccine production, and developing laboratory testing facilities.
In the larger context, ALS’ initiatives align with global efforts to combat AMR, contribute to pharmaceutical innovation, and ensure the production of high-quality medicines, making significant strides in addressing critical healthcare challenges in Africa.
By improving Africa’s laboratory and testing capacities in the fight against AMR, we can equally prepare West Africa with the facilities required to aid in the preventative efforts against other diseases, with additional capacity to produce and manufacture vaccines.
This strategy also aids in improving access to treatment in the region, as any additional Beta-Lactams manufacturing facility will help create quality medicine that is not counterfeit, ensuring that the appropriate medicine is available to different population groups across Africa.
Improving AMR research in settings where resources are limited but capacity has improved will offer a noteworthy blueprint for a uniquely pan-African response to this crisis.
