By Devon Maylie
Dr. Morena Makhoana is the CEO of Biovac, a bio-pharmaceutical company and established vaccine manufacturer based in South Africa. During Dr Makhoana’s time as CEO, Biovac has secured three successful technology transfers with global pharmaceutical companies such as Sanofi and Pfizer that have allowed the company to grow. The company is also part of a consortium of organizations that partnered with the World Health Organization (WHO) and its COVAX partners to establish the first COVID-19 mRNA vaccine technology transfer hub in South Africa. In this edited interview with IFC on the sidelines of the IFC-hosted Global Health Conference in Cape Town, South Africa, Dr. Makhoana discusses the critical inflection point African vaccine manufacturers are at, and the tough questions the industry is asking itself regarding growth, access to funding, and sustainability.
Dr. Morena Makhoana
Q: What does the future of vaccine manufacturing look like in Africa?
A: There are three segments to the question that need to be addressed to give some context. There was a pre-COVID time where the future of African vaccine manufacturing was not even a topic outside of African manufacturers and their governments. Then in the peak of COVID and with the inequities that came through, that’s when people woke up and said, ‘OK, what should we do on the continent?’ We're now in this third stage. The hype of COVID has come down and this is where the rubber is now hitting the road in terms of the sustainability of Africa and African vaccine manufacturing. We already have more manufacturers that have come up in the past three years, and we need to support them and make sure that we are on a sustainable footing as an industry. I think the future is looking bright but the path to getting there may not be as easy as others would think.
Q: What are the roadblocks or barriers that are going to be a factor?
A: Like any business in any industry, there's always a simple question that needs to be asked: ‘Who's going to buy your product and how are you going to differentiate it?’. I think that’s where the difficulty is -- who's actually going to buy African manufacturers’ products if there is capacity in other parts of the world? That question is really at the center of everything else. There are funders that are waiting to fund African vaccine manufacturers, but they're also looking at it as a business model. We need to find what is the differentiator that we will have compared to other manufacturers. Or we need to find the buyer that says out of all the 10 brands that we typically buy from I have space for an 11th. And that's where the rubber hits the road. I think once we solve that, then the funding would come to African manufacturers a lot quicker than the current pace.
Q: There has been a lot of discussion the past couple of years about African countries buying vaccines manufactured in Africa. If that picks up, is there enough demand or do you need demand outside of the continent too, to be sustainable?
A: Any sustainable manufacturer has to look at global demand for their product. Take India as an example. India is the largest manufacturer of vaccines, and we know that a large part of those volumes come to the continent. So, they didn't look at it with a lens of only selling in India, they also looked at where the demand is.
While I think African manufacturers should look wider than Africa, it gives us a starting point being in Africa. It's a very good footing because the volumes are in Africa. The birth rates, which is what we follow in terms of tracking demand for children's vaccines, are here. And in 2050, Africa is going to have the single biggest population. Selling vaccines in Africa has to be a minimum and that minimum is significant. But I think generally it would be nice that African manufacturers just have a much broader view than Africa alone.
Q: What would you say are some of the key lessons that vaccine manufacturers in Africa have learned in the past three years?
A: I think what we are learning is where we should start as a manufacturer. A lot of us are looking at fill and finish because it is seen as low hanging fruit. Manufacturers are learning now that even that part takes a long time to establish. There's a growing sentiment that we should not only look at fill and finish, but that we should go upstream and look at drug substances. Now the more you go upstream, the riskier it is and the more expertise you need. So, it's easier said than done. But I think there's a realization that if my next-door neighbor is also going to do fill and finish, I need to think about where I will position myself. The answers may not be available, but I think what is happening is that the questions are starting to become clear in many of the African manufacturers’ mindsets. The other thing that's awesome and becoming clear is that everybody is talking about the whole issue of sustainability, whilst before it was a political statement to say we need to have African vaccine manufacturing. Now everybody is using the word sustainable and thinking about how we are going to make it sustainable. It's stretching us.
Q: What is the differentiator for African vaccine manufacturing that will help it be sustainable?
A: I think each manufacturer will probably have their own differentiator. I can only speak about our company in terms of how we're looking at differentiating ourselves as an example. Fill and finish is there so I think it's important that we also get into drug substance — to be an end-to-end manufacturer. That's one differentiator. And then another is to get into areas that maybe others don't want to get into, but that also need to be sustained. As an example, we are going to get into the cholera vaccine space where few manufacturers are. Another element which is a little bit outside of many vaccine manufacturers purview is procurement. Maybe one vaccine maker in another part of the world is producing the same vaccine and they say instead of them manufacturing in their home country, let me rather work with an African manufacturer.
Q: How important are partnerships going to be to help bolster Africa's sustainability?
A: Partnerships will always play a factor. I always say we wouldn't be where we are if it wasn't for partnerships. We need to build trust and build capability, and we need to have partnerships with multilateral organizations, and have partnerships with financiers.
Q: What does the future look like for Biovac?
A: Our vision hasn't changed in terms of wanting to be an end-to-end manufacturer with a global reach. End-to-end is important for us because that talks to sustainability. I think those two (end to end plus global reach) would make Africa proud.
Published in April 2023