Combating AMR and infectious diseases in Africa: The urgency of building vaccine ecosystems

When antibiotics were introduced, they were a game-changer in the treatment of infectious diseases which had previously overwhelmed health systems and claimed innumerable lives.

Today, antibiotics and other antimicrobial drugs are still important concerns in the health sector, but not for the right reasons. After years of use, overuse, and misuse of antimicrobial drugs globally, many bacteria have developed resistance to one or more antimicrobial drugs. This has given rise to the problem of antimicrobial resistance, or AMR – now among the top 10 global public health concerns, according to the World Health Organisation. If the progress of AMR is not interrupted, we might regress to a scenario in which some infectious diseases will become incurable once again, claiming hundreds of thousands of lives annually.

Vaccines to the rescue

A review published in the journal Vaccine X in 2023 highlighted the significant benefits of using vaccines to tackle the scourge of antimicrobial resistance.

Using vaccines is one of the most effective ways to interrupt the worsening of the AMR situation. This strategy has already proven useful in the past. For instance, when the pneumococcal conjugate vaccine (PCV) was introduced, a reduction of resistant Streptococcus pneumonia was observed in the vaccinated population. The mass vaccination had conferred herd immunity to the general population. As is expected with other infectious diseases as well, lower infection rates resulted in lower antibiotic consumption, which was associated with a diminishing threat of resistant bacteria.

In addition to reducing the need for antibiotics, vaccines are an effective option also because they don’t have the same vulnerabilities as antimicrobial drugs. Pathogens don’t acquire resistance to vaccines as easily. This means that the same vaccine can be deployed for years on end without becoming outdated.

AMR and infectious diseases in Africa

Historically and even today, Africa is home to a disproportionate share of the global infectious disease burden. A study published in The Lancet Global Health in 2023 revealed that the WHO African region also has a high AMR burden for many bacterial pathogens and pathogen-drug combinations. This region also sees high mortality rates associated with these pathogens.

An earlier study revealed that while antimicrobial resistance is very much a global problem, low- and middle-income countries (LMICs) bear a disproportionate AMR burden. Specifically in Africa, in 2019, 1.05 million deaths were associated with bacterial AMR while 250,000 deaths were attributable to bacterial AMR. The greatest burden of AMR fatalities was attributed to lower respiratory and thorax infections, followed by bloodstream infections, intra-abdominal infections, and tuberculosis. 7 pathogens were cumulatively responsible for 821,000 resistance-linked deaths. Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus took the cake, each causing over 100,000 deaths.

LMICs, including those in sub-Saharan Africa, often have these high disease numbers because they face distinct challenges in managing their infectious disease and AMR burdens. These challenges also extend to AMR surveillance programmes which suffer from a dearth of national action plans, limited investment, inadequate human resources, insufficient infrastructure, low utilisation of data, and poor information dissemination.

While there is certainly a need to plug gaps in data, antimicrobial stewardship, policy and infrastructure to manage AMR in Africa, building a robust vaccine manufacturing and distribution ecosystem is non-negotiable. Producing vaccines and achieving high coverage levels is an efficient solution to multiple problems: a well-distributed and efficient vaccine ecosystem can lower infectious disease spread, decrease mortality rates, and minimise the AMR burden.

AMR has made even minor infections tougher to treat. This means that patients with resistant infections often spend longer in hospital before they begin to recover. Investing in a strong vaccine ecosystem can help prevent these monetary and human resource losses. Overall, eliminating the scourge of AMR has many public health, social, and economic benefits – well worth the investment in vaccines.

Africa’s vaccine manufacturing ecosystem

Africa’s vaccine manufacturing ecosystem has a long way to go to meet the continental population’s needs. Of the roughly 10 vaccine manufacturers on the continent, most are concentrated in a few countries like Egypt, Morocco, Senegal, South Africa, and Tunisia. To make matters worse, most of them are focused on downstream processes like fill-and-finish, packaging, and labelling of imported products. The low presence of African manufacturers in upstream processes like R&D and active pharmaceutical ingredient (API) production marks a major drawback.

Pan-African organisations recognise these limitations in their vaccine infrastructure and have set ambitious goals to overcome them. As part of the Partnerships for African Vaccine Manufacturing (PAVM) initiative, the African Union (AU) and the Africa Centres for Disease Control and Prevention (Africa CDC) aim to produce 60% of all vaccines used in Africa domestically by 2040. The African Medicines Agency (AMA) is aiming for regulatory harmonisation across the continent to simplify and streamline pharmaceutical access, including access to vaccines. The mRNA vaccine hub in Africa shows promise for the future of novel vaccine delivery mechanisms.

In November 2023, the Clinton Health Access Initiative (CHAI) released a “Continental Market-shaping Strategy for a Sustainable Vaccine Manufacturing Footprint in Africa”. The strategy targets achieving a balance between improved pandemic preparedness and response, global market health, and commercial viability for manufacturers. To meet the strategy’s identified targets, Africa’s manufacturing footprint should cover an end-to-end production capacity of about 170 million doses annually across 8 specified antigens and an additional 460 million doses of antigen-agnostic drug product capacity.

There are risks to achieving this vision – high initial costs, imbalances in production capacity, inadequate tech transfers, ineffective procurement policies, and a regulatory environment which still needs to upgrade its capacity and harmonise across borders. But there are also pathways outlined to overcome these challenges – stakeholder alignment in favour of realistic targets, financial incentives for manufacturers, tech transfer partnerships, demand-generating policy provisions, and the development of an enabling environment.

No stone must be left unturned in the fight against infectious diseases and AMR in Africa. Developing a robust vaccine manufacturing and distribution ecosystem is an indispensable part of this fight.

PodTech™ is committed to helping African countries develop their biopharma infrastructure not only with prefabricated factory systems but also tech transfers. With PodTech™, African countries can combat AMR on a war footing. With PodTech™, they can make building vaccine factories child’s play.