How outbreaks have shaped Africa, Before and After: Senegal
Why isn’t Senegal producing its own vaccines?
By Sellma Mahi, Chief Marketing Officer for AHI
Senegal has the highest rate of recovery in Africa and third globally and did so with a fraction of the budget Western countries have, such as the USA and the United Kingdom. One example of Senegal’s “innovation on a budget” are the $1 USD COVID testing kits that give results in 10 minutes. Furthermore, instead of importing ventilators that would cost $16,000 each, Senegal chose to print ventilators locally using 3D machines, with a record cost of $60 USD each. Clearly, through it’s innovation, Senegal has achieved incredible results in controlling COVID-19 (1 ,2,3). Given this fantastic example, a question begs to be asked. If Senegal is known to provide efficient healthcare services on smaller budgets, why is the system in its entirety still struggling? Why are centenary diseases such as Yellow Fever(YF), that have a vaccine, still endemic?
A key thread through the successes of Senegal in handling infectious diseases is that they make every effort to locally produce its resources. Using yellow fever vaccinations as an example, I will briefly explore the need to locally produce healthcare resources.
The YF virus is mainly transmitted through the bite of the mosquito Aedes aegypti or Aedes albopictus. It has been an endemic disease since the 19th Century and it has moved across continents, claiming millions of lives across the world. Although a cure does not exist, prevention through vaccination and other methods have been at the centre of campaigns to control YF spread (4).
A vaccine against the YF has been available since 1937, when Max Theiler designed it in New York, USA. It was backed by the Rockefeller Foundation and was produced at a low cost in the Institut Pasteur, Dakar (Senegal). In 1941, vaccines were compulsory in Francophone colonies and in the six years that followed approximately 14 million people were immunised (87.5% of the current Senegalese population).
These incredible results were possible due to the colonial health services which provided inexpensive production and straightforward delivery. These factors combined resulted in herd immunity of 86% by 1953 with 56 million people being vaccinated by the end of the year. In contrast, in Anglophone colonies, where vaccination was not practised widely (Nigeria, Sierra Leone), YF pandemics occurred at regular intervals (5).
The independence Senegal gained in 1959 negatively affected healthcare provision. As the colonial systems were being dismantled, the vaccination policy was also terminated causing the country to revert to a YF endemic status. By the mid-60s, Senegal experienced its first epidemic since 1937 (5).
The thing we fail to notice is that vaccines that are not produced locally but, imported from the States, India or other countries have far reaching negative consequences. Supplies are never enough. The transport and delivery process is not simple. There are conditions to be met such as the temperature the vaccines are kept at, and there needs staff that can manage to oversee the delivery and receipt of the serums(6). What I want you, as my audience, to meditate on is, if Senegal has produced its own vaccines before, why can’t it do it again? The not sugar-coated answer I can give you is ‘money’.
Beyond the scope of this article you might also want to argue that the effect of decentralization on the Senegalese healthcare spawns from the Bamako Initiative (encouraged by WHO and UNICEF) in the 1990s. In addition, the poor management of the initiative at regional and peripheral level has contributed to a vicious cycle of unaccountability and financial funds mismanagement, but that’s for another discussion (7).
Although Africa is home to 17% of the world’s population, it produces less than 1% of all the vaccines used worldwide. All pharmaceutical products, including vaccines, are imported. The solution would be to produce our own vaccines. Though, it is not easy to overlook the initial low return investment, African countries like Senegal should instead focus on the long-term benefit.
Still, as we know, healthcare is as much a social issue as it is a financial and political one. Unless the leading politicians don’t look beyond money, we will never get anywhere. Nevertheless, people are starting to take action. Associations such as the Africa Vaccine Manufacturing Initiative (AVMI) are moving to make vaccine production a reality (8).
William Ampofo, head of AVMI, broke down the calculations in an interview with Deutsche Welle said:
“In 2014 alone, Africa governments purchased almost $900 million (€790.7 million) worth of vaccines for basic child immunization. If these were produced locally, 30% of the expenditure would remain in the country. It makes economic sense to look at producing locally. You’ll be building capacity locally. You’ll be increasing your workforce, you’ll be providing jobs for your younger population, you’ll be bringing back home to Africa experts, expatriates who are living outside who have the know-how. I think for me it’s a win-win.” (8)
And it is for me too.
REFERENCES:
1. Haque N. Senegal trials begin for $1 COVID-19 test kit [Internet]. Aljazeera.com. 2020 [cited 1 July 2020]. Available from: https://www.aljazeera.com/news/2020/04/Senegal-trials-1-covid-19-test-kit-200428132313740.html
2. Zavis A. Ebola-free: How did Nigeria and Senegal do it? [Internet]. latimes.com. 2014 [cited 1 July 2020]. Available from: https://www.latimes.com/world/africa/la-fg-nigeria-Senegal-ebola-20141022-story.html
3. Senegal [Internet]. World Health Organization. 2015 [cited 1 July 2020]. Available from: https://www.who.int/csr/don/archive/country/sen/en/
4. Thonnon, Spiegel, Diallo, Sylla, Fall, Mondo et al. Yellow fever outbreak in Kaffrine, Senegal 1996: epidemiological and entomological findings. Tropical Medicine & International Health. 1998;3(11):872–877.
5. Artenstein A. Vaccines. 1st ed. [Place of publication not identified]: Springer; 2014.
6. Rey-Jurado E, Tapia F, Muñoz-Durango N, Lay M, Carreño L, Riedel C et al. Assessing the Importance of Domestic Vaccine Manufacturing Centers: An Overview of Immunization Programs, Vaccine Manufacture, and Distribution. Frontiers in Immunology. 2018;9.
7. Foley E. No Money, No Care: Women And Health Sector Reform In Senegal. Health Policy, and Health Care Delivery in Africa [Internet]. 2020 [cited 2 July 2020];30(1):1–50. Available from: https://www.jstor.org/stable/pdf/40553416.pdf?seq=1
8. Pelz D. Africa wants to manufacture its own vaccines [Internet]. DW.COM. 2018 [cited 2 July 2020]. Available from: https://www.dw.com/en/africa-wants-to-manufacture-its-own-vaccines/a-46151389
