When Covid-19 pandemic hit in 2020, South Africa was caught short as it did not have the vaccine manufacturing capability.
From its initial Covid case reported on March 5, 2020, the country quickly became the continent’s epicentre of the pandemic — with the first local death reported on March 27, 2020.
As more people were getting infected, a three-week national lockdown took effect on March 27, followed by the compulsory use of face masks.
Russia, China, and India quickly invented vaccines, and donated them around the world and in Africa. SA billionaire Johann Rupert sparked controversy when he flew to Switzerland for a Covid-19 jab at a clinic his family has investment ties to.
In 2021, SA allocated R10 billion for vaccine procurement and distribution, with the first roll-out to healthcare workers.
As of April 2024, there were 4 million Covid cases, 3.9 million recoveries, and 102 595 deaths in SA. Globally, the deaths stood at 7 million.
Four years post the pandemic, is the country ready to manufacture its own vaccines?
Despite great strides in ensuring the country is in a much better position to prepare for future pandemics, South Africa is not yet ready to produce its vaccines.
This was revealed by at least three experts in the science and medical fields who warned that while many initiatives are heading in the right direction, not enough was being done to speed up the capability of vaccine mass production and ensure the end-to-end capacity of the country’s vaccine manufacturers.
Professor Glenda Gray, a chief scientific officer at the South African Medical Research Council (SAMRC), said the best way to future-proof SA for pandemics is to invest in vaccine and drug manufacturing and go to scale if something happens again.
“The only way to go to scale with vaccine manufacturing is if you are already doing it. Then you can just pivot your vaccine capability to the new pathogen. It is important to take vaccines to scale so you know how to produce vaccines en masse.
“There is no use in having a vaccine manufacturing plant that’s a kind of mock board. You need practice in Good Manufacturing Practices (GMP) to know that you are good at it,” Gray said.
She likened the vaccine manufacturing process to a marathon.
“It’s like a marathon. If you have to run a marathon, you must be fit. You can’t just wake up tomorrow and go and run a marathon — you have to train every day. So, it’s the same thing with drugs and vaccines, if we are not making vaccines every day, it will take us a long time to become GMP compliant.
“But if we are making vaccines every day, the regulators like the South African Health Products Regulatory Authority (SAHPRA) will know the facilities, they would have inspected them and so they know that they are trusted.
“If you don’t do this every day, you are going to have to hire your workforce, you are going to have to get SAHPRA to approve your plant. You can’t have trained people (scientists) sitting in a room and not doing anything,” she said.
Gray said South Africa’s vaccine manufacturing capability resides mostly with Biovac Institute, which is partly owned by the government, and has a 47.5% share. The government also partly owns Afrigen, with 49.7%.
Aspen Pharmacare on the other hand is privately owned.
She said Biovac is currently developing an end-to-end vaccine manufacturing process through a tech transfer agreement and they are set to make an oral cholera vaccine.
“This will be the first time that an African manufacturer will be producing a vaccine end to end in Africa, and that’s an exciting thing,” she said.
She said China and India were successful during Covid-19 because as part of the government strategy, they invested in vaccine manufacturing and created tax concessions with some of the provinces in China and India giving prospective pharmaceutical companies cheap land and co-funding projects.
“The government must make it lucrative for people to want to do manufacturing in the country. The government in these two countries saw the value added of having this capability and supported commercial plants to do this,” the professor said.
She added that South Africa, with its almost 70 million population and one million babies born annually, can’t have too many vaccine manufacturers because there won’t be enough people to give vaccines to. Two or three are enough to supply the region, the continent, and the world.
She said the Department of Science, Innovation and Technology recognises the role of science and technology in boosting GDP and the business case for this.
“What we need is more people that are taking the business case to the Treasury. We need to support the Department of Science and Technology in its innovation strategy and ensure that the government puts aside funding for these things.
“I guess when you are in a fiscally constrained environment, these things that people think are luxuries, but aren’t, are usually put on a shelf and it’s at your peril when you stop investing in science. It’s almost counter-intuitive not to invest in science because science will get you out of this economic climate,” Gray said.
Professor Patrick Arbuthnot, from the Wits/SAMRC Antiviral Gene Therapy Research Unit (AGTRU), said while South Africa is in a much better position and the system has improved a lot, there needs to be a seamless process.
“We are not over the line yet. The mRNA vaccine production still faces challenges with GMP compliance — working towards a plant that can supply the rest of the continent.”
Messenger ribonucleic acid (mRNA) is a kind of RNA that conveys genetic information from DNA to protein by way of the processes of transcription and translation.
He said that as academics they make vaccines at a small scale, just to show what the mRNA vaccine actually works.
“The mRNA vaccine production takes three months from concept to preclinical proof by the Wits lab. The methodology is always improving and for now, three months is pretty good,” Arbuthnot said.
In 2020, when Covid-19 hit, Arbuthnot and his team got involved with the World Health Organization (WHO) to establish the first mRNA hub.
His team initially provided training to Afrigen in South Africa and then to other low- and middle-class countries (LMICs).
Afrigen is the host of the mRNA hub and has since taken the technology further. “We quickly adapted what we knew about gene therapy using mRNA and used that for making vaccines.”
He said the biggest advantage with mRNA is that the vaccines can be made very quickly. If a new pathogen or a new virus comes along, it’s possible to use modern technology to work out how to make a vaccine very quickly.
Professor Benjamin Kagina, a principal investigator and project director of NISH (National Immunisation Technical Advisory Group (NITAG) Support Hub) at the University of Cape Town said the country is indeed in a better position, but not better enough to be sufficient in producing “our” own vaccines.
“We are not ready to manufacture our own vaccines as a country yet, however, we do have everything in place – the partnerships for manufacturing, we have political will, amongst other things.”
He said that vaccine manufacturing takes time and there are a lot of regulation processes that a manufacturer needs to complete. They need to open their manufacturing facility for audit both internal and external.
Kagina noted that with technological advancement, scientists can even test how the vaccine works in silico (a computational biochemical preparation of vaccines).
“We are frequently witnessing shorter and shorter timeframes from pathogen (virus) discovery, antigen (cure/ vaccine) discovery, all the way to approval of the vaccine for use in humans,” he said.
“High-income countries are more advanced because they no longer spend money on infectious diseases. They have the basics right — water, hygiene, and sanitation.”
He said last year’s cholera outbreak was related to hygiene and water.
The Minister of Science, Technology and Innovation Dr Blade Nzimande said Afrigen, in partnership with the SAMVAC (South African mRNA Vaccine Consortium, led by the SAMRC) group of scientists, successfully developed a mRNA Covid-19 vaccine candidate, AfriVac 2121, on par with a commercially available Covid-19 vaccine.
This was after the major pharmaceutical corporations were unwilling to share the Intellectual Property (IP) after the mRNA vaccine technology transfer hub was conceived in Cape Town in 2021.
The rejection pushed the SA Consortium to embark on the de novo development of a South African mRNA platform using local scientific expertise and readily available, open-access databases.
“Afrigen and SAMVAC led by the SAMRC are developing a further three vaccine candidates using the mRNA technology platform developed at Afrigen. The candidates are HIV, TB, Rift Valley Fever (One Health approach by developing a human and veterinary vaccine),” Nzimande said.
He added that the Biovac Institute is doing the secondary manufacturing of the SANOFI Hexaxim vaccine and Inactivated Polio Vaccine, both used in the Expanded Programme from Immunisation (EPI) of the Department of Health.
The department and its entity, the National Research Foundation, have since created the South African Institute for Pandemic Preparedness and Prevention (SAIP3) to strengthen the detection and monitoring of emerging threats, among others.