LENIAS HWENDA: Big pharma’s exit from Africa a blow for access to medicines

The trend of international pharmaceutical giants such as GSK, Sanofi and Bayer — and most recently Moderna — withdrawing from African markets is a worrying development in global healthcare dynamics.

The pharmaceutical companies mention challenges ranging from excessive taxation and power supply problems to a generally rising cost of doing business. GSK, which has been operating in the African market for more than 51 years, started the trend in August 2023 when it exited Nigeria, where it had been the second biggest manufacturer.

GSK ceased operations by terminating its marketing and distribution agreement, saying that in the future it would operate through third-party distributors to bring essential medications and vaccines such as HPV vaccines and oncologics like augmentin, to African patients. Among the challenges GSK says prompted its exit from Nigeria were the limited ability to access foreign currency, difficulty doing business, excessive bureaucracy, multiple taxation and malpractice within the industry.

Sanofi, also one of the largest and oldest corporations operating in the African market, followed suit three months later, citing similar challenges. Its commercial operations, including promotion and distribution, were to be handled by a yet-to-be-named third party starting in February 2024.

Bayer has taken a similar path in Kenya, attributing its decision to exit direct distribution in the country to a “financial and strategic recalibration” taking place within the corporation as it navigates mounting global economic pressures and changing market demands.

Now Moderna has announced that it is halting the establishment of a vaccine facility in Kenya, attributing its change of plans to financial and strategic considerations to improve the company’s business performance.

The exit of these pharma giants is a blow for Africa, particularly because the continent’s health challenges require an increased presence of such companies, rather than withdrawal. Attrition of Africa’s industrial base is a setback for continental efforts to create a level of self-reliance and security of access to medical products through local production of health products.

A healthy manufacturing ecosystem in Africa requires a mix of players. The retreat of big pharma from the market upsets the balance Africa should be striving for. It creates numerous challenges, including medication shortages and increases in the cost of medicines, as can already be seen with cancer medications. All of this has a negative effect on patients, leaving them vulnerable to substandard counterfeit medications.

According to World Health Organisation (WHO) director-general Tedros Adhanom Ghebreyesus, equity and sustainable access are at the heart of effective international co-operation, but achieving them is the biggest challenge as access to health remains elusive for millions of Africans.

The exit of pharma giants worsens an already grave situation. It can be expected to affect the cost and availability of essential medications, directly affecting disease management for millions, with the most vulnerable populations being worst affected. There are already indications that these withdrawals are negatively affecting patients in a number of therapeutic areas, including cardiovascular diseases, family planning and anti-infectives.

Sanofi’s manufacturing plant in Lagos produced a range of products including antimalarials, antibiotics and vaccines. Nigeria has been battling national shortages of medicines after the exit of GSK and Sanofi, as to a lesser extent have Kenya and SA.

But speaking at the recent ministerial summit on Africa-Europe co-operation in Brussels, Belgian health minister and deputy prime minister Frank Vandenbroucke noted that medicines shortages were a problem in Europe as well.

“We are all increasingly facing medicines shortages and it’s because global value chains are increasingly vulnerable and we want to produce some of the medicines in Europe. This is an international issue,” Vandenbroucke said.

However, any shortage of medications affecting Europe and Africa is bound to have the worst effect in Africa.

Then there is the economic effect. African governments are losing large taxpayers whose presence in African markets stretches back many decades. In the case of GSK its presence in Nigeria goes back half a century. Jobs are also lost, with knock-on effects on the local pharmaceutical economy and patient safety because the gap left by these companies is likely to be filled by illicit medicines trades and counterfeit medicines.

The one bright side to big pharma exiting the African market is that it creates opportunities for domestic pharma companies to step into the breach. However, on balance it is clear that losing these corporations is setting back Africa’s broader objective to achieve security of access to safe and effective medical products at all times.

• Dr Hwenda is founder and CEO of Medicines for Africa.