An adequate supply of quality assured health products is essential for a strong health system capable of ensuring access to essential medicines and treatments.

Already before the pandemic, central pharmaceutical stores in many African countries were far from being able to adequately supply health facilities with health products of assured quality; the COVID-19 pandemic exacerbated this situation and led to massive disruptions in global supply chains, including Africa.

The Journal of Pharmaceutical Policy Practices has recently published two articles examining the challenges of COVID-19 pandemic in pharmaceutical supply in Nigeria and Rwanda respectively.

In Nigeria, about 70 per cent of the drug supply is imported, contributing to create a growing disparity between the declining supply and the rapidly increasing demand following the pandemic. The shortage of medicines is due to a combination of several factors, including:

– the delays of world trade,

– the delays of manufacturing,

– the slowdown of the local economy, especially in the informal sector,

– the lack of buffer stocks of health products,

– the insecurity and the poor financing of the health system.

In Rwanda, country that is part of the East African Community’s programme to harmonise pharmaceutical regulation, the pharmaceutical sector is also heavily dependent on imports; shortages are mainly due to the limited importation of goods from abroad and the practice of compulsive drug purchasing by worried clients and by some health actors who wanted to build up stocks in response to the pandemic.

The parallel conclusions of these two articles are that in times of pandemic, there is a greater need than ever to secure and strengthen national drug procurement and supply systems in all their aspects, for example:

– planning and monitoring,

– financing,

– regulation of the safety, efficacy and quality of medicines,

– price control,

– the distribution channels, etc.

It is also suggested by some stakeholders that more investment should be made in the local production of medicines in order to achieve self-sufficiency. In this respect, we feel it is important to stress that this would be a long-term solution, which must be preceded by the strengthening of regulatory authorities. Furthermore, regional collaboration (i.e. “regional” rather than “local” production) should be envisaged to allow, in the long term, the creation of production units for quality products that can be competitive on the market.

Although local production of medical equipment has increased in Africa since the beginning of the pandemic, it is far from meeting current needs and responding in the long term to rapid population growth. In Kampala (Ouganda), Joint Medical Store, a laboratory with collaborations in the North, has successfully launched production lines for surgical gloves, disinfectant and protective equipment approved by the national authorities that have been delivered locally and to neighbouring countries, including Kenya.

What about vaccines?

Until the third quarter of 2020, most African countries seemed to be less affected by the successive waves of the pandemic in Europe and America. However, since October 2020, African countries have been increasingly affected and their under-equipped health facilities have been increasingly stretched. Worldwide, vaccination against Covid-19 has so far involved barely fifty countries. Ten high-income countries alone account for 75% of doses of anti-Covid-19 vaccine production, with Israel and the United Kingdom leading the way. It is considered that seventy lower-income countries will be able to vaccinate only 10 percent of their population by 2021. The Covax Initiative enabled the delivery of a first batch of vaccines to Africa on 24 February (in Ghana). China and Russia are also delivering vaccine to Africa: this is “vaccine diplomacy”; their vaccine is better adapted to the African situation than the more heat-sensitive vaccines that are administered in Europe and North America.

AEFJN’s position :

It is important to ensure equal access to vaccination for African populations. This is a question of equity but also of safety, because the longer the virus continues to circulate, the more it will mutate with the possibility of new variants that are pathogenic to humans.

Rich countries should give the Covax Initiative the needed means to achieve its objectives.

The moratorium on intellectual property rights (TRIPS) on vaccines is being blocked by rich countries at the WTO, even though this would be an excellent way to bring down the price of vaccines through competition between manufacturers. A change in trade policy is needed in the name of the humanitarian emergency that this pandemic represents.

Sign the following People Health Movement petition on a waiver for TRIPS:

Christian Roberti