Online Reporter
Professor Francisca Mutapi-Herald Correspondent
In January and February 2026, we launched a paediatric treatment for schistosomiasis (commonly known as bilharzia), the second most important parasitic disease affecting children in Africa, in two countries — Zimbabwe and Tanzania.
This is a major milestone for child health in the two countries, but with the celebrations comes an important and urgent question: how will we meet demand, and how will we sustainably finance the procurement of this medicine beyond the launch activities?
The drug is currently manufactured outside the African continent by a single company, and is registered for use in only one of the endemic Member States of the WHO Africa Region.
This one medicine highlights many of the existing challenges of local pharmaceutical production in Africa—externalised R&D, delays in technology transfer, fragmented regulatory approaches, gaps in local manufacturing capacity, financing constraints, and quality assurance weaknesses.
Encouragingly, the roadmap to addressing these challenges may have been signposted during events at the 39th Ordinary Session of the African Union Heads of State Summit held in February 2026.
At this meeting, African leaders committed to producing at least 60 percent of essential medicines, vaccines, and health products locally by 2040.
This declaration places pharmaceutical manufacturing at the centre of Africa’s health security and economic sovereignty agenda — a direct response to vulnerabilities exposed during Covid‑19, including supply-chain disruptions and the persistent, costly reliance on imported medicines.
Africa imports a significant proportion of the pharmaceuticals and health products used on the continent.
The cost of this is passed on to African families. This is one of the reasons healthcare is disproportionately more expensive for African households.
In the WHO African Region (WHO AFRO), out-of-pocket (OOP) health payments accounted for an average of 35,8 percent of health expenditure between 2012 and 2020, compared with 15 percent in the European Union. Medicines and outpatient care are the leading contributors to health expenditure in the region. Across 11 African countries in the WHO AFRO Region, medicines and medical supplies account for roughly half of total household OOP spending.
Taking this together, an estimated 50 percent of household OOP health spending is on imported medicines — a major “foreign exchange at the pharmacy counter” problem. This means that import dependence translates directly into household hardship.
Economic leakage due to import dependence
Africa imports between 70–90 percent of the pharmaceuticals it consumes. Almost all active pharmaceutical ingredients (APIs) are sourced externally, predominantly from India and China. A few countries, such as South Africa, have capacity to produce APIs for simple drugs.
This creates structural exposure to exchange-rate volatility, supply-chain risk, freight costs, and global price shocks.
Africa’s pharmaceutical market is worth tens of billions of US dollars annually, yet much of this value is realised outside the continent.
Foreign exchange that could finance domestic employment, industrial upgrading, and technology transfer instead leaves African economies to procure APIs and excipients.
During Covid‑19, export restrictions and supply bottlenecks exposed this vulnerability starkly.
Local health security is inseparable from industrial capacity and capability.
The cost competitiveness challenge
Despite the arguments above, domestic production is not automatically cheaper. During the Covid‑19 pandemic, Africa had “local” production steps for some vaccines—for example, Aspen Pharmacare in South Africa filled and finished Johnson & Johnson’s vaccine, using drug substances supplied by J&J.
Yet the price was not automatically lower: South Africa paid US$10 per dose for the J&J vaccine, while the EU paid US$8,50 per dose — meaning an African buyer paid more even when part of the manufacturing and finishing value chain.
In this case, the fill‑finish approach still depended on imported substances and specialised inputs priced by the originator.
Furthermore, unit costs rise when plants lack predictable, high‑volume orders — a risk Aspen itself highlighted when it warned that its Covid‑19 vaccine facility faced closure after receiving no orders.
This pricing pattern is not unique.
Evidence from Ethiopia shows that, for 8 of 9 comparable medicines, locally produced products were procured at prices 45 percent higher than imports.
In Ghana, in addition to using imported APIs, structural drivers of higher costs for locally produced pharmaceuticals include low production scale, higher electricity tariffs, and higher domestic interest rates on capital.
These factors limit economies of scale, especially compared with large‑scale Asian manufacturers who benefit from specific export incentives and subsidised financing for the pharmaceutical sector.
However, these challenges should be viewed as barriers to overcome — not as reasons to maintain reliance on imports.
Case studies in Ethiopia and Nigeria indicate that, under conditions of scale and efficiency, some locally produced medicines could be up to 15 percent cheaper than imports from India.
Thus, the challenge is not feasibility but enabling scale through coordinated market shaping and investment.
Quality and regulatory strengthening
Beyond economic considerations, there is a public health imperative for domestic production of pharmaceutical products — quality and safety.
In 2022, widespread concern arose over paediatric cough medicines from India that resulted in the deaths of African children.
The WHO issued a medical product alert concerning four contaminated paediatric cough syrups linked to deaths in The Gambia.
Examining praziquantel, locally produced adult formulations of the drug have raised pharmaceutical quality concerns in some batches.
A study of products collected from markets and health facilities in Burkina Faso, Côte d’Ivoire, Ghana, and Tanzania showed that, while active ingredient levels were generally correct, many tablets — including those manufactured locally — failed dissolution and disintegration tests, with only about 46 percent meeting full pharmacopeial criteria. These failures can affect effectiveness.
Despite these incidents, many Africans prefer imported medicines to local products due to mistrust in local quality, and findings such as the above do little to dispel this.
A recent continent‑wide review highlights that many Africans cite concerns about regulatory effectiveness and past counterfeit incidents.
To address this, African governments must accelerate the strengthening and harmonisation of regulatory frameworks, alongside supporting the African Medicines Agency.
There is also a need to increase transparency around local product standards and to promote successful local manufacturers. This will foster trust in “Made in Africa” medicines.
We have been here before — what’s changed?
The February 2026 Presidential Declaration on Advancing Local Manufacturing of Health Products in Africa is not the continent’s first declaration on pharmaceutical self‑reliance.
In 2005, the AU Assembly mandated the development of a continental Pharmaceutical Manufacturing Plan for Africa, formally endorsed by Heads of State in 2007, to strengthen local production capacity.
Progress, however, was constrained by fragmented national markets, weak demand certainty, limited access to long‑term industrial finance, and regulatory fragmentation across countries.
Francisca Mutapi is Professor of Global Health and Infection and Deputy Director of the Tackling Infection to Benefit Africa (TIBA) Partnership, University of Edinburgh, and can be contacted at [email protected]
