Dispelling the (African) Myth

When you think of Africa, what comes to mind?

Perhaps, you view the continent as the next frontier in the global economy. Or perhaps, the high morbidity and mortality rates dictate your point of view; the massive disease burden has made some believe that the continent is more suitable for providing candidates for clinical trials rather than leading them. It is true that historically, Africa has lacked the infrastructure, trained staff and enabling technologies to contribute to the global drug discovery and development sectors, with the continent importing up to 70 percent of its drug products (1). There are many working tirelessly to change the perceptions of the continent, but people who view Africa through the Western gaze must be willing to take the opportunity to see the ways that Africa is, and will continue to be, a source of healthcare and pharmaceutical innovation in order for the negative stereotypes to be broken down.

Afro-pessimism, or the notion that Africa has nothing to contribute, has plagued the pharmaceutical industry for too long, not only affecting those who live beyond the shores of the great land mass but also those born and raised there who pursued and are pursuing higher education and employment abroad, taking their skills and knowledge with them. Losing skilled professionals with the capacity to push Africa’s pharmaceutical sector forward is detrimental to say the least. Countries are defined by their people and when so many African nations lose their highly-trained professionals to European, Asian and American institutions and organizations, they lose their ability to shine on the global stage and create the infrastructure so desperately needed to transform the face of African pharma.

This, however, is not the case for all African nations. Rwanda is an example of a country with the capacity to train and retain its talent. In the years since the 1994 genocide, the country has had an astounding healthcare renaissance with 90 percent of the country’s population covered by national healthcare insurance. Life expectancy has increased and child and maternal mortality rates have plummeted (2,3). The country has also adopted Zipline, an autonomous logistics network for the delivery of blood and drug products to help address gaps in the healthcare and pharmaceutical systems.

While it is too early for other African countries to adopt the Rwandan model, there is much to be inspired by from the East African nation and its willingness to embrace change.

Homecoming

As a Zambian scientist who pursued doctoral studies at the University of Cambridge and the University of Liverpool in the UK, and worked for the US-based Scripps institute, I was motivated to found a drug discovery and development institute to address some of the problems faced by the African pharma sector.

The Drug Discovery & Development Center (H3D) was set up at the University of Cape Town in 2011. Our research focuses on malaria, tuberculosis and antibiotic-resistant microbial disease. In less than ten years the organization has attracted significant foreign direct investment in the form of several multi-year multi-million US dollar grants to conduct research projects. Like many other African nations, South Africa faces similar challenges in terms of drug discovery and clinical testing infrastructure. Low business R&D expenditure, poor government spending, insufficient critical mass to import consumables, chemicals, equipment and scant job opportunities mean that the country struggles to attract and keep young talent. Adding to the problem is the lack of continuity with respect to long term funding and a sustained pipeline of projects. Drug development must be viewed not as a set of fragmented functional silos, but a scientific continuum for improvements to be seen. Through H3D, we aim to encourage more young people to consider careers in the African STEM community through our internships and career programs and to search for the opportunities for collaboration. 

But one of our greatest achievements to date is that we are leading an international project team in partnership with the Medicines for Malaria Venture (MMV). Through this partnership, we have discovered the first ever small molecule clinical candidate for malaria, MMV390048, to be researched on African soil by an African drug development center. MMV390048 entered Phase II Human clinical trials in 2017 having successfully completed Phase I Human clinical studies conducted through the UCT Clinical Research Centre (CRC) during the 2014/2015 period. Furthermore, H3D led the same international project team that additionally discovered UCT943 as a next generation malaria preclinical drug development candidate in 2016.

These milestones have been positive, and we have no intention of resting on our laurels! We aim to develop research platforms that allow for the customization of medicines to the needs of African patients who have varied responses to drug products due to the genetic differences in the expression and activity of drug metabolizing enzymes across varying African ethnic groups and populations. An example of this is H3D’s African Drug Metabolism and Disposition project, whose goal is to validate a preclinical discovery tool that can be used to prioritize drug candidates during their chemical lead optimization phase based on their predicted pharmacological profile in African patients.

Changing perceptions

Regardless of how grand these breakthroughs are (or will be!), they are not enough to change the perception of Africa’s role in pharma. Greater efforts to harmonize standards and regulations should significantly improve the continent’s relationship with the industry and bring about multi-sectoral partnerships allowing for growth across industries. Unlike the EU region, whose pharma industry is supported by the European Medicines Agency, a regulatory authority with the same level of command has been missing from the African pharma landscape, with countries developing and abiding by conflicting legislation, hindering their capacity to work cohesively. The disjointed regulatory atmosphere cultivated by African countries results in the sluggish approval of drugs and drives up the cost of much needed medicines, which is then passed onto patients.

A treaty for the establishment of a new regulatory authority, the African Medicines Agency (AMA), was accepted by the African Union (AU) early this year during the 32nd Ordinary Session of Assembly held in Addis Ababa, Ethiopia. Once ratified by the 15 of the AU’s 55 member states, AMA will be able to begin its operations. The newly formed agency intends to provide regulatory leadership and coordinate the activities of the AU to further strengthen the progress made in the pan-African healthcare and pharmaceutical sectors giving the region a greater competitive edge.  

African manufacturers, for example, should be able to reap the benefits of the newly developed system as their products will be able to stand up against imported drugs, which are subject to VAT and other logistical charges. 

The pharmaceutical industries of countries including Ethiopia, Nigeria and South Africa are already on the rise and I am optimistic that others will follow suit. While the road to success for African pharma is an uphill struggle, our goals are achievable and within sight.