pharmaceutical manufacturing plan for africa business plan

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PHARMACEUTICAL MANUFACTURING PLAN FOR AFRICA

This Business Plan addresses a complex industry and covers a diverse range of contexts across our 54 member states. Strengthening our ability to produce high quality, affordable pharmaceuticals across all essential medicines will contribute to improved health outcomes and the realization of direct and indirect economic bene!ts. This is the vision of the Pharmaceutical Manufacturing Plan for Africa (PMPA) endorsed by our Heads of State and Government at the summit in Accra in 2007. This Business Plan outlines a recommended approach for achieving these aims.

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This Business Plan addresses a complex industry and covers a diverse range of contexts across our 54 member states. Strengthening our ability to produce high quality, affordable pharmaceuticals across all essential medicines will contribute to improved health outcomes and the realization of direct and indirect economic bene!ts. This is the vision of the Pharmaceutical Manufacturing Plan for Africa (PMPA) endorsed by our Heads of State and Government at the summit in Accra in 2007. This Business Plan outlines a recommended approach for achieving these aims.

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How Africa can manufacture to meet its own pharmaceutical needs

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Why can’t Africa manufacture the medicines it needs?

The COVID-19 pandemic exposed Africa’s inadequate capabilities and capacity to manufacture and supply essential drugs and personal protective equipment (PPEs) needed to curb the disease. 

Although pharmaceutical products are currently manufactured in countries such as South Africa, Kenya, Morocco and Egypt, as a whole Africa currently imports more than 80 per cent of its pharmaceutical and medical consumables. It is unsustainable.

But as far back as 2007, the New Partnership for Africa’s Development (now the African Union Development Agency, AUDA-NEPAD) sought to address Africa’s overreliance on imports of pharmaceutical products when it developed  the Pharmaceutical Manufacturing Plan for Africa (PMPA) , as mandated in the Assembly of AU heads of state decision of 2005.

In 2012, the Assembly of Heads of State endorsed a PMPA business plan which consists of a package of technical solutions to some of the critical challenges confronting the continent’s pharmaceutical industry.

Some of the proposed solutions include strengthening the regulatory systems and establishing a one-stop-shop for information, data and business intelligence for industry players—governments, the private sector, Regional Economic Communities and so on. 

To boost local pharmaceutical production and in turn improve public health outcomes, the PMPA business plan strongly encourages the procurement of medical products from Africa-based companies.  

In addition to strengthening the procurement and supply chain management systems, the plan recommends the use of pooled procurement as a mechanism to incentivize local manufacturers to address maternal, new-born and child health. 

Improved access, quality, availability and affordability of pharmaceutical products, as well as increased economic benefits through sustainability, competitiveness, and self-reliance of the industry, are some of the objectives of the business plan.

The PMPA business plan underscores the urgency in addressing the challenges facing the industry. One such challenge is a lack of affordable financing and modern technology, which hampers business expansion.

Other challenges are Africa’s small fragmented markets and weak regulatory frameworks.

Inadequate human resource capacity also impedes the growth of Africa’s pharmaceutical sector as do poor procurement and supply chain systems and policy incoherencies in countries’ trade, industry, health, and finance departments.

Due to a lack of financial capacity, companies make little or no investments in research and development and in protecting intellectual property. 

No single company, government department or organization can by itself address these challenges; it is precisely why the PMPA business plan advocates for multisectoral and multi-stakeholder collaboration. 

The good news is that some opportunities are available to be explored. 

For example, the African Continental Free Trade Area (AfCFTA) , if successfully implemented, will address the challenge of small fragmented markets that have for a long time disincentivized pharmaceutical manufacturing investors. 

African manufacturers, currently operating in small fragmented markets, cannot compete with their Asian counterparts that operate in vastly larger markets and therefore enjoy economies of scale. Economies of scale help businesses save money due to higher production volumes. 

When all African countries ratify the AfCFTA, it will integrate a market of 1.3 billion people and potentially 2.2 billion people by 2050. African manufacturers can be expected to enjoy significant economies of scale and scope. Free trade under the AfCFTA should begin in January 2021. 

A pooled procurement mechanism will encourage leading global generic pharmaceutical manufacturers to build plants in Africa or partner with African pharmaceutical companies to manufacture generic products. There is a need for this form of strategic support for Local Pharmaceutical Production (LPP).

Russia and Bangladesh are examples of countries that have deliberately and successfully supported the development of LPP. As a result, these countries have experienced an increase in foreign direct investments in the sector. They have also benefited from training and skills development, accelerated technology transfer and job creation. 

Africa should be expected to reap these kinds of benefits were it to fully embrace strategic support for LPP. Besides, it would compel countries to strengthen regulatory systems.

Already African manufacturers of pharmaceuticals have been brought into a federation to enable them to share information and business intelligence and to have a unified voice. And plans are underway to establish a fund for the sector, which will cushion companies’ financial inadequacies.

In June this year, the AU launched the Africa Medical Supplies Platform which promotes the procurement of medical supplies from local manufacturers and taps into the harmonized regulatory systems created in the context of the PMPA.

Countries will invariably need to formulate education policies that foster research and development in pharmaceuticals as well as encourage thousands to acquire the skills required in the industry.

Undoubtedly, Africa needs integrated markets. It must implement trade facilitation policies. Countries need to strengthen and harmonize their regulatory systems to assure the quality of medical products and ensure that local manufacturers adhere to international standards.

When fully implemented, the PMPA business plan will create jobs for millions of Africa’s unemployed and usher in a knowledge economy that will drive the Fourth Industrial Revolution.

To answer the question at the beginning of this piece, yes, Africa can potentially manufacture its medicines. The PMPA business plan is the way to go.  

Dr. Janet Byaruhanga is Senior Programme Officer, Public Health, at the African Union Development Agency (AUDA-NEPAD).

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Pharmaceutical Sector Development in Africa: Progress to Date

• Current Opinion
• Published: 19 January 2018
• Volume 32 , pages 1–11, ( 2018 )

Cite this article

• Paul A. Lartey   ORCID: orcid.org/0000-0003-2091-3547 1 ,
• Alexandra E. Graham 1 ,
• Patrick H. Lukulay 2 &
• Margareth Ndomondo-Sigonda 3  

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The African Union’s Pharmaceutical Manufacturing Plan for Africa was established to develop the African pharmaceutical industry, a sector with considerable promise for reducing the burden of disease in Africa. With a projected value of over US$40 billion by the next decade, the sector also has the potential to promote economic growth. Additionally, as a technology-based industry it is positioned to advance Africa’s aspiration to transition into a knowledge-based economy. Considerable progress has been made since the development of a business plan for implementing the Pharmaceutical Manufacturing Plan for Africa. This includes initiatives to harmonize medicine regulation on the continent, address human capacity and skills shortages, and to promote cooperation and advocacy in the industry. The promise of the sector has also galvanized countries and regions with manufacturing capacity to harness support for its development. The rate-limiting step in this quest is making funding available to build the needed capacity in infrastructure and in Good Manufacturing Practices, as stipulated by the Pharmaceutical Manufacturing Plan for Africa. A proposed new initiative, the Fund for African Pharmaceutical Development, currently under consideration by the African Union, may provide the boost needed to overcome this final hurdle.

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Source: Illustrated by authors

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Lartey, P.A., Graham, A.E., Lukulay, P.H. et al. Pharmaceutical Sector Development in Africa: Progress to Date. Pharm Med 32 , 1–11 (2018). https://doi.org/10.1007/s40290-018-0220-3

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Published : 19 January 2018

Issue Date : February 2018

DOI : https://doi.org/10.1007/s40290-018-0220-3

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Africa’s Shot at Local Pharma Production

By Alison Buckholtz

During the COVID-19 pandemic, small pharmacies and large medical stores in Rwanda ran out of stock .

In South Africa , it became nearly impossible to fill prescriptions for psychiatric drugs and oral contraceptives.

In Kenya, oncologists complained about challenges treating their cancer patients.

And in Nigeria , stocks of treatments to manage chronic illnesses, including HIV medicines, dipped critically low.

Margaret Ilomuanya, Editor-in-Chief of the Nigerian Journal of Pharmacy and a Senior Lecturer in the Department of Pharmaceutics and Pharmaceutical Technology at the University of Lagos, doesn’t blame the foreign governments that halted their pharmaceutical exports during the pandemic — which triggered shortages of medications across Africa.

Instead, she and an ever-growing number of health-care practitioners, regional organizations, and industry analysts back a solution that has been gaining strength for over a decade. They want to build pharma manufacturing capacity on the African continent.

“Africa must begin to produce medicines for Africa, with raw material produced in Africa,” she said. “There’s a big risk in relying on elaborate global supply chains in which the supply of many essential and critical drugs is dependent on overseas suppliers. We have the wherewithal to build the local pharmaceutical industry, and we have the hands. We can take it from bench to bedside.”

The potential benefits of Africa-based pharma production have been recognized for years. The Pharmaceutical Manufacturing Plan for Africa, rolled out in 2005 by the African Union Development Agency, created a business plan to boost local pharmaceutical production and improve public health outcomes. Other strategies to promote African pharmaceutical manufacturing include initiatives from the African Medicines Agency and the African Vaccine Regulatory Forum. In late May 2021, 54 African countries co-sponsored a resolution on the local manufacturing of medicines, medical technologies, and vaccines that was presented at the WHO’s World Health Assembly.

What’s different now is that the pandemic has captured the attention of investors who have noted the imbalance between supply and demand in the pharmaceutical sector, said Frannie Leautier, CEO of SouthBridge Investments, a pan-African investment bank. Africa’s lack of essential medicines and active pharmaceutical ingredients (APIs) during the pandemic “had implications on the pharma and health sector in Africa over and above the direct effects of COVID-19,” she said. Since the crisis began, “a lot of thinking about the demand side has been happening at the country and regional level, and also among investors who want to bridge that gap for pharmaceutical products. Investors are looking at Africa with new eyes.”

Local production can “fill the gap”

The scarcity of pharmaceuticals in Africa has been a problem for decades. Roughly half the population of 1.1 billion people lack regular access to even the most essential medicines, according to the WHO. The COVID-19 pandemic has undermined recent progress on access to HIV, malaria, and tuberculosis medicines as well as to reproductive, maternal, and newborn treatments and medicines, said Jean-Baptiste Nikiema, a doctor who leads the medicine supply team at the WHO’s regional office in the Republic of Congo.

In-country production of generic drugs could help ensure access and affordability, according to Subir Basak, Senior Life Sciences Specialist at IFC. Generic medications are manufactured by pharma companies that receive permission from a major pharmaceutical company to create their own version of the drug, and they are typically less expensive than the original branded medication. Wider availability of generics would offer people affordable treatment choices and lessen African health systems’ vulnerability to supply chain disruptions, Basak said.

But Africa has very few local or regional pharma manufacturing companies. There are roughly 375 drug makers, most in North Africa, to serve a population of just over 1.1 billion people. Those in sub-Saharan Africa are clustered largely in nine of 46 countries, a 2019 report from McKinsey noted. (By comparison, according to the report, China and India, each with roughly 1.4 billion in population, have as many as 5,000 and 10,500 drug manufacturers, respectively.)

To establish an environment for API production and local pharma manufacturing in Africa, IFC is working in several countries to “put together the components needed” for a mature pharmaceutical industry. This involves partnering with local and international pharmaceutical companies to co-create projects, identify technical partners, and develop commercially viable projects and financing structures, said Zeynep Kantur, Principal Investment Officer for health projects at IFC. “COVID-19 showed us how vulnerable countries in Africa are, and how local API and pharma facilities can fill a long-term gap,” she said.

Senegal-based Institut Pasteur, the only WHO-certified vaccine site in Africa, is already embarking on a program to accelerate production of COVID-19 vaccines in Africa. Building capacity there will benefit the region, post-pandemic, because such an effort can be scaled and repurposed to produce other drugs and vaccines needed in the region, according to Kantur. Currently, only 1 percent of vaccines needed in Africa are produced in Africa.

Potential vs. production

Notable changes have made the continent a “much more viable market for manufacturing pharmaceutical products than it was a decade ago,” Leautier said. “Many countries now have social security systems and insurance systems that pay for health care, so it is a more structured market, with people able to afford longer term treatments.” That progress, along with Africa’s growing population and the necessity of specialized treatments for diseases that are highly concentrated in Africa, such as waterborne diseases, malaria, tuberculosis, HIV, and AIDS, “make strong arguments in favor of local pharmaceutical manufacturing.”

However, IFC research shows that the African pharma manufacturing facilities now in operation are not at the right stage of maturity to attract investors and scale up production. The elements of success, according to this research, include economies of scale, access to technology and know-how, strong supply and distribution networks, government incentives, and access to investment capital.

Nigeria, the most populous country in Africa and one of the countries with the greatest potential for rapidly scaling up pharmaceutical and API production, is not yet where it needs to be, said Jude Nowokike, Vice President and Director of the Promoting the Quality of Medicines Plus (PQM+) Program at USP, a scientific nonprofit organization focused on building trust in the supply of safe medicines.

Pharmaceutical manufacturing production in Nigeria currently utilizes around 40 percent of actual installed capacity, Nwokike said. The obstacles, he believes, include challenges in sourcing active pharmaceutical ingredients and raw materials, along with a lack of available investment to scale up operations, modernize equipment, and resolve local infrastructure limitations.

The role of regulation

Regulatory reform is also essential to progress, said Tania Holt, a global public health and pharma expert at McKinsey. Attention to regulatory standards is especially important because Africa accounts for around 42 percent of the world’s cases of sham drugs.

In addition to contributing to more stable health systems and supporting a domestic manufacturing sector that addresses issues of access and affordability, a stable regulatory environment can attract long-term financial support. Regulatory standards are key to attracting investors “because investors want certainty, and regulation, verification, and certification provide that certainty,” Leautier said. Such standards and accountability mechanisms also “buffer against significant consequences when things go wrong and help deal with emerging risks. Otherwise, it is very difficult to function.”

Multilateral organizations have a “huge role” to play in supporting the development of domestic pharma operations in Africa, Nwokike said. For example, not every country in Africa needs to have the capacity to produce every medication, and multilaterals can help determine which nations and regions can share capacity.

“There should be a reliance on regional neighbors based on their separate strengths, with manufacturing closer to the people who the medicines are serving,” he said. “This is what builds confidence in health systems.”

First published in June 2021 Updated in June 2022

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Pharmaceutical Manufacturing Plan for Africa is critical for pandemic preparedness, prevention and response

Michael mynhardt.

1 Group Executive at Avacare Health Global, Managing Director at Barrs Pharmaceutical Industries (Pty) Ltd, Ndabeni, Cape Town 7405

NICAISE NDEMBI

2 Chief Science Advisor, Office of The Director General of The Africa Center for Disease Control and Prevention (Africa CDC), Souh Africa

The authors declare no potential conflict of interest.

The 12th International Aids Society Conference on HIV Science ( 1 ) was recently held in Brisbane, Australia, featuring a number of studies that have come to represent several important advances in HIV prevention, treatment and cure research. The conference offered the World Health Organisation (WHO) an opportunity to announce ( 2 ) that there is negligible, or almost zero risk of transmitting HIV when a person has an HIV viral load measurement of less than or equal to 1,000 viral load copies per ml, commonly referred to as having a suppressed viral load ( 3 ).

The evidence presented by the latest advancements in WHO's scientific research on HIV viral suppression confirms that people living with HIV (PLWH) who achieve and maintain an undetectable level of the virus through the consistent use of antiretroviral (ARV) therapy do not transmit HIV to their sexual partner(s) and are at low risk of transmitting HIV vertically to their children.

Meeting UNAIDS 95-95-95 targets in Africa

These findings have underscored the significance of meeting the Joint United Nations Program on HIV/AIDS (UNAIDS) ‘95-95-95’ targets, which call for 95% of people living with HIV to be aware of their status, 95% of those aware of their status to be on antiretroviral therapy (ART), and 95% of those on ART to achieve viral load suppression.

Achieving these targets across the African continent will remain a critical undertaking if we want to improve the lives of those living with HIV at the global epicenter of the virus. According to UNAIDS 2023 epidemiological estimates ( 4 ), over 65% of the global population living with HIV are based in eastern, southern, western and central Africa, with a collective 25.6 million infections as of 2022. Sadly, all four regions are yet to meet these targets. In the middle east and northern Africa alone, only 50% of people living with HIV are currently on ARTs, increasing the risk of transmission and rate of infection on the continent.

Thankfully, a number of countries have already met their 95-95-95 targets, including Botswana, Eswatini, Rwanda, the United Republic of Tanzania and Zimbabwe. Their commitment and dedication to this campaign offers a useful blueprint for other African countries that aspire to achieve the same targets in the long-term.

Development of local pharmaceutical manufacturing framework key

WHO's scientific research and findings must incentivise public and private stakeholders to work together to spearhead the development of Africa's pharmaceutical and biological manufacturing framework if we want to improve our ability to prevent, detect and limit the transmission of the virus. In fact, we should aim to offer a world-leading response to this crisis, given WHO's recent announcement regarding the impact of viral suppression on direct and vertical transmission rates.

In order to achieve this, we must decrease our reliance on foreign pharmaceutical imports and develop a sustainable, pharmaceutical manufacturing framework that will remain dedicated to securing Africa's supply of life-saving ARVs over the long-term.

A dedicated approach to this strategy will empower all African countries to meet their 95-95-95 targets, while simultaneously improving our continent's collective capacity to prepare, prevent and respond to the next global pandemic.

Decreasing reliance on foreign imports critical for PLWH & pandemic preparedness

Africa's recent response to the global COVID-19 pandemic exposed a number of inherent weaknesses in its healthcare systems. This included our deeply unsustainable reliance on foreign medicinal imports.

At present, between 80-90% of global HIV, Tuberculosis and Malaria cases occur on the African continent, and yet, we import ~80% of the drugs required to address these health risks. A large portion of this medication is funded by international donors at an estimated US$14 billion a year. In 2012, the Pharmaceutical Manufacturing Plan for Africa (PMPA) did propose an initial budgetary allocation of US$54 million for the manufacture of medicinal drugs over the next 5 years. Sadly, the funding did not materialize. Today, global interest to invest in Africa's call to establish a strong, quality-assured, locally-based pharmaceutical manufacturing sector is gaining momentum. The time has come to accelerate its implementation.

Nothing could be more critical to help improve our pandemic preparedness for future generations. Medicine supply and security will also form an integral part of a Pan-African approach to meet UNAIDS targets for PLWH.

Manufacturing APIs in Africa

In order to achieve medicine supply at this level, African scientists must be supported to develop their own intellectual property for active pharmaceutical ingredients (API). Only then will we be able to build an end-to-end manufacturing framework that works on the continent. Currently, the industry is based on fill and finish operations alone. This is not strategic or economically sustainable over the long term, and reduces our medicine security across the continent.

To date, local manufacturers have remained at a competitive disadvantage when it comes to APIs, due to a number of different market forces that have included poor and inefficient production value chains, the high cost of production of medicines and vaccines, as well as poor financing and financing models. Thankfully, a number of international organizations and Development Finance Institutions (DFIs) have heeded the call to improve these circumstances, paving the way for the development of Africa's pharmaceutical and vaccine manufacturing framework.

If we are to actualize the PMPA's recommendations to establish a robust pharmaceutical manufacturing sector in Africa, we must redouble our efforts in capacity-building, knowledge transfers, cross-sector coordination, and ensure the rigorous implementation of the AfCFTA. This will be paramount to further mobilize financial resources from international financial institutions and development banks, while encouraging cross-country collaboration to strengthen human capital funding. Only then can we close the implementation gap and accelerate the development of Africa's own pharmaceutical industry.

Pan-African approach to medicine supply critical

The Partnership for African Vaccine Manufacturing (PAVM) offers a leading example of how we might take a pan-African approach towards developing significant convening power and technical capabilities to galvanize global and regional partners towards building Africa's regulatory capacity, technical partnerships and vaccine procurement pooling mechanisms.

The PAVM recently formalized a sustainable ecosystem of action-oriented partners in support of achieving the African Union's (AU) vision of 60% locally produced vaccines by 2040 (at present, over 99% of vaccines in Africa are imported from manufacturers overseas).

To support the PAVM's vision for 2040 and the bankability of this project, the African Development Bank is implementing a flagship program in support of local vaccine manufacturing in line with its 2030 Vision for the Development of Africa's Pharmaceutical Industry and the 2040 AU/African CDC vision for increased local vaccine manufacturing.

Procurement agencies are also committed to sustaining accelerated progress. For instance, the U.S. President's Emergency Plan for AIDS Relief, PEPFAR, recently launched its 5-year strategy which aims to boost regional manufacturing in the Global South.

Access to funding available for pharmaceutical manufacturing expansion in Africa

The Access to COVID-19 Tools Accelerator (ACT-A) was an unprecedented global coordination mechanism that was co-chaired by South Africa and Norway and raised US$24 billion, for the distribution of vaccines, diagnostics, therapeutics and personal protective equipment. Notwithstanding its phenomenal success, there were a number of serious pitfalls that could cost people their lives: it took too long to raise the financing, while vaccine deployment was delayed by issues of export bans and other geopolitical tensions. The diagnostics and therapeutics pillars did not meet their targets and the health systems connector pillar did not operationalise adequately and failed to meet its mandate, compromising critical last-mile capabilities.

As a result the ACT-A fell short of delivering equity. This is evidenced by the fact that the average vaccination rate is 67% globally, while lower income countries only average at about 27%. The ACT-A independent evaluation had also recommended the establishment of a global medical countermeasure platform to ensure equity for future pandemic response.

Successful case studies: TEI offers large-scale investment for vaccine production in Senegal

The Team Europe Initiative (TEI) on manufacturing and access to vaccines, medicines and health technologies in Africa may offer one of the most successful case studies to date. TEI recently agreed to support a large-scale investment in vaccine production by the Institut Pasteur in Dakar ( 5 ), Senegal. Their commitment to this undertaking has been rolled out alongside other support measures to reduce Africa's 99% dependence on vaccine imports and to strengthen future pandemic resilience on the continent.

The TEI MAV+ also aims to increase equitable access to safe, effective, quality and affordable essential vaccines, medicines and health technologies for all Africans. It follows a 360-degree approach to ensure supply and demand within an enabling environment that is underpinned by six work streams, namely industrial development (supply chains and private sector), market shaping (demand and trade facilitation), regulatory strengthening, technology transfers and intellectual property management, access to finance as well as research and development (in terms of higher education and skills).

Manufacturing to improve prevention, detection & treatment of HIV virus

PrEP, or pre-exposure prophylaxis, describes the use of medications to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent, usually a virus. By investing in the development of advanced HIV technology in Africa with a locally-based manufacturing framework for APIs, we could begin to manufacture PrEP locally, for people who don't have HIV and are at risk of being infected.

South Africa's present capacity to manufacture PrEP tablets remains negligible at best, and should be improved. That being said, our vision to ensure long-term medicine security should focus on the production of biologics instead. PrEP tablets need to be taken once daily, ideally at the same time of day. This daily adherence is essential to maintaining its effectiveness, and any deviation from it could result in infection. The tablets have also been documented to cause a number of side effects, including diarrhea, nausea, headache, fatigue and stomach pain. Given the risk of infection and daily adherence, injectable PrEP with cabotegravir (CAB) offers a highly effective alternative to protect adults and adolescents who are at risk of contracting HIV through sex. While Cipla has announced ( 6 ) plans to manufacture these at two of their plants in South Africa, a production date is yet to be confirmed.

Investing (locally) in a biologics facility with the capacity to manufacture APIs and supply PrEP injectables will remain a significant undertaking to help make the injectable more affordable in emerging markets across the continent today.

mRNA technology to lead the way

mRNA vaccine technology is at the very forefront of making this possible. If we can develop the technology and APIs to manufacture PrEP locally, as well as mRNA based products on our continent, South Africa can position itself at the forefront of the development of a pharmaceutical manufacturing framework for improved medicine supply across Africa in the long term.

The world-renowned Afrigen Biologics mRNA hub in Cape Town already aims to contribute significantly to this project, by working on the development of new vaccines for diseases that are rampant in lower and middle-income countries. Their very first vials should be making their way to the market by 2024.

UNAIDS targets are possible with a Pan-African approach & locally manufactured APIs

A united and coordinated approach to develop Africa's pharmaceutical manufacturing framework will remain a critical undertaking to reach global 95-95-95 targets in Africa. This must be supported by the localised production of API's, ARVs and PrEP injectables for Africa, in Africa, to simultaneously insulate the region from its reliance on HIV medicinal imports.

We will have to leverage the expertise of our closest allies and make use of all grant funding opportunities to make this a reality. One thing is certain, a united Africa is a force to be reckoned with-anything is possible if we believe in ourselves.

Acknowledgements

The authors share their gratitude with the researchers and specialists working at the United Nations Program on HIV/AIDS (UNAIDS), the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the International Aids Society, among other stakeholders, for their commitment and work to decrease the rate of transmission of HIV/AIDS in Africa.