How to lower costs in African healthcare and make it more accessible

Will local production improve Africa’s immunisation efforts?

This year has seen an extremely high incidence of measles in Western and Central Africa, with 34,105 cases reported across the DRC, Guinea, Nigeria, Chad, Cameroon and Benin, and the majority of the ill were children under the age of five. Other communicable diseases for which vaccines exist but are not rolled out extensively enough across the continent include TB, polio, rubella and rotavirus.

The issue of vaccine production and distribution has been on the agenda of African governments for a long time based on the idea that local operations could provide the answer to issues of cost, availability, and response time.

The argument for local production

At the session of Global Vaccine Action last month, which was part of the 67th World Health Assembly (WHA) in Switzerland, South Africa’s Minister of Health (MOH) Aaron Motsoaledi told the gathering: “We want the WHO and other international agencies to empower us to produce our [own] vaccines.” Motsoaledi and other domestic production advocates like Mexican MOH Juan Lopez and Kenya’s director of the Kenya Medical Research Institute Solomon Mpoke explained their case by pointing to the following issues when relying on international suppliers:

  • lengthy supply chains that can mean delivery delays and protracted outbreak response times;
  • frequent supply shortages, particularly when it comes to vaccines that target developing world diseases and so aren’t manufactured as pervasively; and
  • high purchase costs, especially of certain vaccines (e.g. polio, rotavirus, inactivated human papillomavirus, and pneumococcus).

The representatives asked for technical assistance in establishing national self-reliance in terms of vaccination production. “We want to be able to make all our own vaccines to ensure we are self-reliant and able to meet our requirements at all times,” Mpoke told SciDev.Net.

Programme leader for the WHO Technology Transfer Initiative Martin Friede said that his organisation supports regional and local vaccine development. He referenced the H1N1 influenza outbreak and said that those countries with their own vaccine supplies were able to react quickly, while those without (and/or without an advanced purchase arrangement) struggled to lay hands on the necessary supplies. Countries with a domestic supply are therefore better positioned to respond to outbreaks, and those on the level of pandemic can be a matter of national security.

WHO has committed itself to helping 14 developing nations build their technological expertise in the field of vaccinations.

The obstacles to overcome in local production

Friede did however caution governments that there are difficulties involved in establishing local vaccine production. “Since vaccine production benefits from economy of scale, the products from small or medium-sized production facilities may cost more than those currently procured on the global market,” he said. This could be taken as an argument for choosing a regional production scheme.

Other impediments that would need resolving in order for domestic vaccine plans to succeed are:

  • vaccine production requires substantial capital investment;
  • a national regulatory system needs to be established; and
  • in order for local production to remain viable governments may have to intervene in terms of pricing and supply.

Technology

Possibly the most exciting application of technology to  the healthcare industry lies in the field of ‘telemedicine’, which usually refers to the use of telecommunications to allow healthcare workers in out-of-the-way places to remotely diagnose patients in conference with specialists. As part of the Pan-African e-Network Project, a co-operation between the government of India and the AU, doctors in India are helping to remotely diagnose patients in 53 hospitals in Africa. The same project makes it possible for African students to study medicine under lecturers at seven universities in India.

Technology can also provide more orthodox solutions to bureaucratic issues that can sometimes be overlooked by actors in the healthcare space with a propensity to look for the dramatic fix. Carego Livewell, the Nairobi-based healthcare company, specialises in providing healthcare facilities with software to simplify their clinical and business processes and for regional and national healthcare organisations and governmental departments to co-ordinate better.

On the other hand, and more positively, there are signs that the private sector will be willing to compensate for much of the funding lost as governments cut back. The rise in popularity of corporate social responsibility (CSR) and ‘double bottom line’ or ‘triple bottom line’ accounting, in which corporations keep track of social and environmental achievements alongside their financial performances, will mean that many large international corporations may be happy to participate in helping to improve the state of the healthcare industry in Africa.

David Okwara

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