Pandemic Center

Now is the time to continue the momentum towards achieving African vaccine sovereignty. We must work to both increase the continent’s vaccine manufacturing capacity and then develop strategies to promote their uptake.

Five years to the day after the World Health Organization first referred to Covid-19 as a pandemic, the US National Institutes of Health slashed grant funding for projects that aim to understand vaccine hesitancy and promote vaccine uptake. The Covid-19 pandemic and more recent outbreaks of mpox, Marburg and Ebola underline the importance of regionalised vaccine manufacturing to ensure access to vaccines for people in Africa. Yet, without research to inform strategies to improve trust in vaccines and promote their uptake, the gains in manufacturing will not translate to lives saved.

Defunding research that aims to improve vaccine uptake is another historic mistake in what has become a sad litany of health science reversals by the Trump administration. In January 2025, before the funding cuts were announced, leading vaccine researchers from around the world published an article calling for countries to measure the social and behavioural reasons that people choose to get vaccinated or not and to use this information to design approaches to improve vaccine uptake. Heeding this call is now more important than ever to ensure that the vaccines produced in Africa are taken up by those who can benefit from them – otherwise what is the point?

We must work to both increase African vaccine manufacturing capacity and develop strategies to promote their uptake once they are made. Currently, only 1.1% of Africa’s vaccine supply is produced locally. This overdependence on foreign vaccine supplies leaves African people vulnerable. This challenge is heightened by the inequity in access to foreign supplies, a disparity that became especially evident during the Covid-19 pandemic. While the Covid vaccination campaign was the largest and fastest in history, Africa faced significant challenges in access and distribution. By November 2022, almost two years after high-income countries began vaccinating their citizens, only 25% of the people in Africa had been fully vaccinated against Covid-19.

At the beginning of the pandemic, initiatives such as the Covax facility, a global Covid-19 vaccine procurement mechanism, signalled positive steps towards global solidarity for equitable vaccine access. Although this effort was highly commendable, the reality was very different. Gavin Yamey, the director of Duke University’s Center for Policy Impact in Global Health who was involved in the early discussions about Covax, declared that “rich countries behaved worse than anyone’s worst nightmares”. Wealthy countries were first in line to receive vaccines because they were able to place orders for multiple candidates in their early stages of development. Hoarding of these vaccines led to what World Health Organization (WHO) director-general Tedros Ghebreyesus called “vaccine apartheid”, as booster doses of the Covid-19 vaccine were widespread in high-income countries before people in low-income countries had even received a first dose.

Once vaccines are available on the African continent, how can policymakers be sure that the regulatory process for their approval, technical expertise to run clinical trials, and health workforce to administer vaccines are in place to be able to ensure that vaccines reach those who need them? For example, the response to the current mpox public health emergency of international concern has been plagued by delays in authorisation for the vaccine and limited data on the effectiveness of these vaccines in children.

The ongoing challenges with vaccine access in Africa continue to cause preventable loss of life even though it is well established that early access to vaccines in an outbreak can stop a virus in its tracks. Strengthening vaccine manufacturing capacity on the continent will ensure long-term health security across the continent. Promising efforts are already under way that must be supported and expanded, particularly in light of uncertainties surrounding US funding for global health. As of late 2024, there were five African vaccine suppliers in four countries – South Africa (Aspen Pharmacare and Biovac), Senegal (Institut Pasteur de Dakar), Morocco (Marbio) and Egypt (Vacsera) – with scaled facilities that are close to commercialisation. A further 20 suppliers across the continent are in development or awaiting technology transfer.

In 2021, the African Union announced its goal of supporting the African vaccine manufacturing industry to produce more than 60% of the vaccine doses required on the continent by 2040. The Partnerships for African Vaccine Manufacturing was created under the Africa CDC in 2021 to achieve this goal and was expanded in 2024 to include all health products under a new name, the Platform for Harmonized African Health Products Manufacturing. As of June 2024, there are 25 active vaccine projects across the continent. Initiatives such as the WHO’s mRNA technology transfer hub and those supported by the Coalition for Epidemic Preparedness Innovations (Cepi) also have been working to increase African vaccine manufacturing, and fostering vaccine sovereignty.

In 2024, major African-led initiatives were launched to accelerate African vaccine manufacturing. The African Vaccine Manufacturing Accelerator received a $1.2-billion investment, through reallocated Covid-19 funds from other country’s governments and philanthropies, to expand vaccine manufacturing on the continent, Afreximbank pledged $2-billion in support of African Health Products Manufacturing, and regulatory bodies from seven African countries signed a memorandum of understanding to promote a strong, harmonised regulatory system on the continent.

Countries including Rwanda are also setting a strong example. Leveraging a tremendous amount of preparation and partnerships with the private sector and global public health organisations such as Cepi, just 10 days after the outbreak was declared, Rwanda implemented clinical trials of the Sabin mpox vaccine.

Achieving self-reliance in vaccine production in Africa is possible. In combination with continued efforts to understand and promote vaccine uptake, we need whole-of-government approaches that support the growth of vaccine manufacturing on the continent. The ministries of health and finance must work together to develop strategic approaches for preferential procurement practices of regionally produced vaccines. There needs to be harmonisation of the regulatory bodies on the continent with the WHO’s prequalification process – an approval process required for vaccines to be bought by UN agencies such as Unicef – so that safe and effective vaccines can reach populations in need and at scale.

Now is the time to continue the momentum towards achieving African vaccine sovereignty. These efforts will save lives if people have the confidence and trust to take them. DM

Margaret Dunne is a doctoral candidate in the Department of Epidemiology; Thokozani Liwewe a medical doctor and global health professional working with the Ministry of Health, Malawi, and a Game Changers Fellow; Alice Im is a research assistant; Andrea Uhlig is a research associate; Carly Gasca is a project director; and Wilmot James is a professor and senior adviser – all at the Pandemic Center in Brown University’s School of Public Health, Providence, Rhode Island.

Five years ago, the NBA canceled the rest of its season in response to rapidly rising COVID-19 cases. It was then that people began to take COVID-19 seriously, according to Craig Spencer, associate professor of the practice of health services, policy and practice.

Moderated by Director of the Pandemic Center Jennifer Nuzzo, the School of Public Health and Warren Alpert Medical School co-hosted “The Next Global Pandemic: How ready are we?” on March 5. The event commemorated the five-year anniversary of the COVID-19 pandemic, Nuzzo said in an interview with The Herald.

Panelists included Adam Levine, director of the Center for Global Health Equity and the Center for Human Rights & Humanitarian Studies; Theresa Raimondo ’11, an assistant professor of engineering; Scott Rivkees, associate dean for education and professor in the SPH; and Larry Warner ’97 MPH’13, chief impact and equity officer at United Way of Rhode Island.

The event began with an introduction by Spencer, where he shared his experiences working as an emergency medicine doctor at the start of the pandemic.

“It was like walking into the apocalypse,” he said. “Those initial days were dominated by fear and uncertainty.”

In 2020, Rivkees was Florida’s surgeon general. He described how the rain ditches in Florida’s Emergency Operations Center, where he worked, were built to withstand category five hurricanes, but instead of collecting rainwater, the ditches served a different purpose during the pandemic.

“People would literally leave their post-stations, go out and lie in these ditches and would cry, and then they would dust themselves off, and then would come back and do their job,” Rivkees said.

Although five years have passed since the panelists’ experiences, Nuzzo pointed out the importance of applying lessons learned to the future.

For Warner, the COVID-19 pandemic underscored that addressing these crises goes beyond providing vaccines and medical care.

“We also learned about the importance of addressing social needs and how that impacts people's vulnerability to COVID-19 and our ability to connect to resources,” he said.

Strong public health communication is also crucial according to Warner, who said that “society has not been very forgiving” to public health experts for not having “all the answers up front.”

Pandemic-related misinformation was a key issue with public health communication, panelists said.

Levine explained how COVID-19 data dashboards “made the rich countries look like they had been hit” harder than poorer countries, when in reality, countries with higher GDP just had more COVID-19 tests.

“All babies sleep through the night, if only you turn off the monitor,” Levine said. “If you have zero COVID-19 testing sites, then you have zero COVID cases and zero COVID deaths.”

For the panelists, the COVID-19 pandemic highlighted the relationship between public health and politics.

“If you look over the first 18 months of the pandemic, the biggest risk factor for dying was age,” Rivkees said. “Past 18 months, your biggest risk factor was whether you voted for President Trump.”

Since then, Rivkees said the country has grown “even more polarized.”

Public health PhD student Margaret Dunne GS, who attended the event, agreed with Nuzzo’s point that it is “really important” to reflect on the past to improve the future.

“A million Americans died during the pandemic, and I think it’s on us as public health practitioners and people who care about autonomy that we learn lessons,” Dunne said.

Panelists ended by discussing their predictions for responses to future pandemics.

“COVID is not a one-off,” Nuzzo told The Herald. “It’s behind us, thankfully, but we are going to have to deal with more of these types of events in our future.”

Raimondo took an optimistic stance, pointing out that healthcare professionals have a “much more robust understanding” of advancing vaccines and providing a better “clinical response to patients with different backgrounds” as a result of the pandemic.

But many of the speakers at the event were concerned about government responses to future pandemics, including Nuzzo, who described the current moment as “the luxury of amnesia.”

“We’re at a moment where few people recognize that an outbreak abroad can be an outbreak here, and then there is critical importance in keeping our infrastructure for responding to such outbreaks,” Spencer said. “We are tearing that down actively at this moment, and I promise we will regret it.”