Imagine a continent brimming with untapped potential, yet held back by systemic hurdles that prevent it from thriving in global health— that's the stark reality confronting Africa's pharmaceutical landscape! In a candid discussion at the 2025 Conference on Public Health in Africa (CPHIA), a leading figure in the continent's drug industry laid bare the frustrating obstacles hindering local manufacturing. But here's where it gets controversial: Is the blame on outdated regulations, or are international bodies like Gavi and UNICEF dragging their feet on fair procurement? Let's dive in and unpack this eye-opening conversation, breaking down the complexities for anyone new to the world of health policy.
Held in Durban, South Africa, the conference saw Dr. Stavros Nicolaou, a top executive at Aspen Pharmacare—the largest pharmaceutical company on the continent—share some unvarnished truths with Africa's health policymakers. As both Aspen's group senior executive for strategic trade and the chairperson of the Pharmaceutical Manufacturers in South Africa, Nicolaou pointed the finger at regulatory hurdles and purchasing policies as the primary culprits behind the continent's underperforming drug manufacturing sector. For beginners, think of regulatory bottlenecks as unnecessary red tape that slows down approvals, while procurement policies refer to how governments and organizations decide what medicines to buy and from whom—these often favor cheap imports over local production.
'It is simply unacceptable that African drug makers face a grueling six-year qualification journey before they can even enter the market. We could achieve the same results in just half that time,' Nicolaou declared during a plenary session focused on boosting local manufacturing.
He challenged the common misconception that African manufacturers lack competitiveness, highlighting Aspen's impressive global footprint as a prime example. The company operates in 55 markets worldwide, serving patients across more than 150 countries, and stands as the leading provider of generic anesthetics outside the United States. This success story underscores how African firms can punch above their weight globally when given a fair shot.
Nicolaou urged a fundamental overhaul in multinational procurement practices, specifically targeting organizations like Gavi, UNICEF, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. He acknowledged the launch of the African Vaccine Manufacturing Accelerator (AVMA) last year as a promising beginning, but didn't mince words: 'It's not fit for purpose in its current state.' Established to mobilize $1.2 billion over a decade for drug manufacturers, the AVMA focuses on 'fill-and-finish' operations—a process where pre-made drug components are packaged or finalized locally. Yet, Nicolaou argued this funding is far too modest to truly catalyze sector growth. For clarity, fill-and-finish is like the final assembly line in drug production, where vials are filled and labeled, without needing to create the core ingredients from scratch.
He emphasized the need for stronger incentives to expand the entire medical products supply chain, warning that imposing solutions from outside Africa won't suffice. 'We can't let African problems be solved by external forces—it just won't work,' he stressed. Speedy establishment of pooled purchasing for vaccines, treatments, and diagnostic tools across the continent was his call to action.
Reflecting on past pledges, Nicolaou noted that over four years have slipped by since the African Union and the Africa Centres for Disease Control and Prevention (Africa CDC) set a bold goal: manufacturing 60% of the continent's vaccine needs by 2040. Despite this ambition, 'nothing has happened' to advance it. And this is the part most people miss—the COVID-19 pandemic painfully revealed Africa's near-total dependence (99%) on overseas vaccine suppliers, leaving urgent needs at the bottom of global priority lists.
Nicolaou also directly addressed remarks from South Africa's Minister of Science, Technology and Innovation, Dr. Blade Nzimande, who delivered the session's keynote. Nzimande championed building independent capabilities in research, development, science, and technology, spanning the full spectrum of health manufacturing—from treatments and diagnostics to vaccines. He hailed the 60% by 2040 target as a 'historic' milestone for safeguarding Africa's health security, outlining plans to boost capacity, enforce standards, and streamline regulations—ideas echoed by other presenters.
With a glass of water in hand at the podium, Nzimande toasted the initiative, inviting applause from the audience. 'Governments must step up by prioritizing purchases of locally made therapeutics, diagnostics, and vaccines,' he urged.
Nicolaou, however, expressed deep disappointment that Africa, burdened by the world's highest disease load, remains a perpetual importer, with its pharmaceutical trade deficit swelling annually. South Africa and Egypt lead the continent's pharmaceutical markets, and Nicolaou stressed South Africa's pivotal role in ensuring supply security. 'Charity begins at home—we must first overhaul our national procurement laws,' he insisted, pointing out that the country's market, worth about R70 billion (based on manufacturers' prices), sees over 50% of its value come from imports, amounting to around R39 billion.
Despite clear potential for domestic production, South Africa still brings in large quantities of essentials like antiretrovirals and vaccines, stalling local industry growth. 'The scales tip heavily toward importers, and the numbers don't lie,' Nicolaou said, referencing customs data, including inflows from India. As an example, South Africa hosts the world's largest HIV population—17% of the global total, with around eight million infected individuals and 6.6 million on treatment—yet imports most of its antiretrovirals. These imports are on the rise, encompassing not just HIV drugs but also vaccines, tuberculosis medications, and insulins.
Even when local firms offer competitive pricing or superior value, the preference for imports misses a golden opportunity to stimulate the economy through what economists call the multiplier effect—where money spent locally circulates and generates more growth.
To turn the tide, Nicolaou outlined a straightforward three-step plan. First, implement priority reviews and simultaneous submissions to speed up drug approvals. Instead of the regulator reviewing after the World Health Organization (WHO), they should do it concurrently, shaving off two to three years of expensive delays. Second, ramp up Gavi subsidies for domestically produced vaccines to create demand. Third, create a continent-wide procurement pool, similar to the successful model used during the COVID-19 crisis, to achieve cost efficiencies through bulk buying.
Joining the discussion, Nhlanhla Msomi, president of AfricaBio, advocated for an industry agreement to foster localized innovation. But Nicolaou cautioned that jumping straight to value chain expansion is premature. Start with supporting fill-and-finish manufacturing to build skills and scale, he advised, allowing companies to eventually invest in upstream activities like developing active drug ingredients. 'Without initial orders and success in fill-and-finish, firms won't invest backward into core development,' he explained.
Progress is lagging, Nicolaou warned, eroding momentum toward the 60% by 2040 goal. 'We have domestic challenges to resolve first, then tackle the continental level,' he added.
Dr. Serge Blaise Emaleu, a specialist in global public health and infectious diseases, chimed in during the plenary, envisioning how sustainable development could transform Africa from a disease hotspot into an innovation hub. Local manufacturing, he called the 'backbone of an independent health system,' but stressed that political will must be matched with funding, governance, and leadership—all advancing in harmony.
Emaleu outlined five key pillars for Africa's R&D independence: connecting scientific research to production; securing funding for innovation; nurturing skilled workers; developing infrastructure and tech; and establishing regulations to protect progress.
Image Credits: Africa CDC, Rwanda Ministry of Health (https://rwandafda.gov.rw/rwanda-becomes-home-of-african-medicines-agency/).
In wrapping up, one can't help but ponder: Are the criticisms of AVMA and international procurement fair, or do they overlook the complexities of global health aid? And here's a thought-provoking twist—could pushing for local manufacturing inadvertently slow down access to cheaper global supplies, potentially harming patients in the short term? What do you think? Does Africa deserve more control over its health destiny, or are these goals unrealistic given current realities? Do you side with Nicolaou's push for faster reforms, or see merit in cautious, gradual steps? Share your perspectives in the comments—we'd love to hear agreements, disagreements, and fresh ideas to fuel the debate!
