As Africa’s disease burden shifts, access to essential medicines is emerging as an even bigger challenge. A new report launched by the Access to Medicine Foundation has spotlighted how generic medicine manufacturers are responding to rising demand for treatments, particularly for diabetes, cardiovascular diseases and cancer, while warning that only one in two people living with type 1 diabetes on the continent has reliable access to insulin. Chiemelie Ezeobi reports
The growing number of Africans living with diabetes, cardiovascular diseases and cancer is creating a new challenge for health systems already struggling to keep essential medicines within patients’ reach.
That concern took centre stage during a virtual press briefing where the Access to Medicine Foundation launched a new report examining how generic medicine manufacturers are responding to Africa’s changing healthcare needs.
The report warned that non-communicable diseases (NCDs) could become the leading cause of death in sub-Saharan Africa by 2030, raising the stakes for a continent where access to medicines is already uneven.
For a person living with type 1 diabetes, the problem is particularly stark. Insulin is not a medicine that can be taken when it becomes available or stopped when supplies run short. It is a daily necessity.
Yet the report found that only one in two people living with type 1 diabetes across Africa has reliable access to insulin.
Behind that statistic are patients who must depend on a medicine supply chain that is often affected by fragmented procurement, uncertain demand, financing difficulties and regulatory differences between countries.
The challenge is becoming broader as more Africans require treatment for conditions that demand continuous care.
A Changing Patient Population
Africa’s healthcare priorities are changing.
Infectious diseases and maternal health conditions remain significant, but NCDs are becoming an increasingly dominant part of the continent’s health burden.
Given that Diabetes, cardiovascular diseases and cancer are illnesses that often require patients to remain on treatment for long periods, this places a different demand on pharmaceutical systems that have traditionally had to respond heavily to infectious diseases and acute health needs.
The implication is straightforward: medicines must not only be produced, but remain available. A patient managing diabetes cannot afford an unpredictable insulin supply. Someone taking cardiovascular medication cannot simply stop treatment because a particular medicine is unavailable. For families already struggling with healthcare costs, repeated shortages can add another layer of uncertainty.
The report therefore examines an industry that will have to become more responsive to this changing pattern of demand.
What Manufacturers are Doing
During the study, Access to Medicine Foundation studied eight generic medicine manufacturers including Sothema, Universal Corporation Ltd, Cipla Ltd, Hikma Pharmaceutical, Aspen Pharmacare, Emzor Pharmaceutical Industries, Sothema, EVA Pharma and Viatris Inc to examine how generic medicine manufacturers are responding to Africa’s changing healthcare needs.
According to the report, generic manufacturers already occupy a central position in the global pharmaceutical market, producing about 80 per cent of medicines by volume and in Africa, they are seeking to strengthen that role by expanding the medicines they offer and making their supply chains more resilient.
While several manufacturers are expanding into priority NCD areas, including diabetes and cardiovascular diseases as well as continuing to provide medicines for infectious diseases and maternal health, others are also investing in local production of active pharmaceutical ingredients where possible.
Where local sourcing is not feasible, manufacturers are diversifying their suppliers to reduce the risk that a disruption in one location will affect the availability of medicines.
Long-term supply agreements are another strategy identified by the report. Such arrangements can provide manufacturers with greater certainty about future demand and allow them to plan production more effectively. The importance of this becomes clearer in markets where demand is difficult to predict.
A pharmaceutical company may know that thousands of patients need a particular medicine, but still struggle to determine how much to produce when procurement systems are fragmented or purchasing commitments are uncertain.
That uncertainty can discourage investment in new manufacturing capacity.
For patients, the consequence can eventually appear at the point of care, as an unavailable medicine, a delayed treatment or a product that becomes too expensive.
The Problem Beyond the Factory
The report makes clear that Africa’s medicine access problem cannot be solved simply by asking manufacturers to produce more.
Much of the difficulty lies in what happens between production and the patient.
African pharmaceutical markets remain fragmented, with countries operating different regulatory systems and procurement arrangements. Financing is also uneven, while demand can be unpredictable.
These conditions make it difficult, particularly for emerging regional manufacturers, to determine where to invest and how much capacity to build.
Regulatory differences can further increase the cost and complexity of supplying medicines across borders.
A manufacturer that wants to serve several African countries may have to navigate different registration requirements and processes, limiting the advantages of operating in a regional market.
But there are signs that this could change.
The report points to growing momentum towards regulatory harmonisation, regional trade integration and better-coordinated procurement.
If these efforts translate into more predictable markets, manufacturers could have stronger incentives to invest in production and expand access.
Building Africa’s Own Capacity
The report also identifies a shift in the nature of pharmaceutical partnerships.
Rather than focusing only on distributing medicines or opening markets, newer partnerships are increasingly centred on technology transfer, regulatory support and localised production.
The potential benefit is significant.
A partnership that helps an African manufacturer acquire new technical capabilities can create capacity that remains within the market after the initial collaboration.
It can also help local companies expand their product portfolios and eventually reach more markets. But the report warns that this will require sustained investment.
Technology transfer cannot deliver lasting results if local manufacturers are left without the financing, regulatory support or market opportunities needed to use the capabilities they acquire.
The objective, therefore, is not simply to establish partnerships but to build a foundation for manufacturer-led growth.
Making the Medicine Reach the Patient
Claudia Martínez, Director of Research at the Access to Medicine Foundation, said manufacturers have an important role to play in responding to Africa’s changing healthcare needs.
“Africa’s healthcare needs are evolving, and manufacturers across the ecosystem will play an important role in determining whether medicine supply evolves alongside them.
“Our research shows encouraging progress – from growing local manufacturing to the emergence of new partnership models – but also highlights that companies cannot succeed in isolation. Coordinated action between stakeholders will be essential to ensuring affordable, life-saving medicines can reach patients consistently, sustainably and at scale.”
That coordination is at the heart of the report’s recommendations. It identifies eight opportunities for manufacturers, governments and global health partners, including improving visibility of future demand, making medicine supply more affordable and predictable, coordinating procurement, harmonising regulatory practices and reducing fragmentation.
It also calls for capital to be directed towards areas where it is most needed and for regulatory bottlenecks and unnecessary red tape to be reduced.
These may sound like industry-level reforms, but their consequences will ultimately be felt by patients.
Better procurement can mean fewer stock-outs. More predictable demand can encourage manufacturers to invest. Harmonised regulation can make it easier for medicines to move between countries. Greater financing can support production where capacity is currently limited.
And stronger local manufacturing can make supply chains less vulnerable to disruptions elsewhere.
Africa is therefore approaching a critical point. The continent is not only dealing with the health problems it has always faced; it is also preparing for a rapidly growing population of patients who will need lifelong treatment.
The Access to Medicine Foundation report suggests that generic manufacturers are already adapting to this reality. But it also makes clear that the industry cannot close the access gap alone.
Governments, regulators, procurement agencies, financiers and global health organisations will have to make the pharmaceutical environment more predictable if manufacturers are to invest at the scale required.
For the patient, however, the issue remains much simpler. It is being able to walk into a pharmacy and find the medicine prescribed by a doctor, not today alone, but every time it is needed.
With NCDs projected to become the leading cause of death in sub-Saharan Africa by 2030, ensuring that this basic expectation becomes a reality could determine how prepared the continent is for its next major healthcare challenge.
For Mariatou Tala Jallow, Director of the African Pooled Procurement Mechanism, local manufacturing could eventually contribute to lower medicine prices, but only if manufacturers have predictable demand and sufficient production volumes.
During the launch, she posited that governments should invest in African manufacturers rather than focusing exclusively on securing the lowest price in the short term. She also raised concerns about the quality of some medicines entering African markets, particularly products sourced from outside the continent.
While a number of manufacturers have obtained World Health Organisation (WHO) prequalification or other international quality certifications, she questioned how effectively African markets can guarantee the quality of medicines supplied through wholesalers and other distribution channels.
As succinctly opined by Dr. Jay Iyer, Chief Executive Officer of the Access to Medicine Foundation, the progress documented in the report should not obscure the scale of the remaining challenge, as she added that “the work is not done yet, as the scale of access to medicines in Africa is still far from being realised”.