Rwanda, South Africa and Senegal are among countries calling for the establishment of full vaccine-manufacturing plants to prepare for future pandemics after Africa found itself at the back of the queue for Covid-19 shots.

While many developed nations are well advanced with their vaccination rollouts, most African countries are almost out of initial supplies and the continent accounts for just 2% of global administered shots, data from the Africa Centers for Disease Control and Prevention show.

There are fewer than 10 vaccine manufacturers in Africa, based across Egypt, Morocco, Tunisia, Senegal and South Africa, according to the World Health Organization. And most of those carry out packaging and labeling rather than manufacturing. That makes the continent ill-equipped to source and supply doses in times of crisis, as this pandemic has demonstrated.

“The only way to ensure vaccine equity is to produce more vaccines where they are needed,” Rwanda President Paul Kagame said this week. “So long as Africa remains dependent on other regions for vaccines, we will always be at the back of the queue whenever there is scarcity.”

Among the biggest barriers to local manufacturing are intellectual-property protections. Almost 100 developing countries led by India and South Africa have petitioned for a waiver and the sharing of recipes for Covid-19 doses, but that’s been opposed by some nations and the drugmakers themselves.

The U.S. unexpectedly changed its stance to back the proposal this week, opening the door to negotiations between members of the World Trade Organization.

The campaign “is understandable given past and present experience of waiting in line to get life-saving medications and vaccines,” Ngozi Okonjo-Iweala, director-general of WTO, said at a conference last month. WTO members “must increase vaccine production now and also look for pragmatic outcomes” to the intellectual-property protection issue.

Specialized Skills

Vaccine manufacturing needs both significant financing and specialized skills to build factories that can be certified as free from contamination, said Stavros Nicolaou, chairman of South Africa’s local pharmaceutical manufacturers industry association.

“These skills and expertise are in limited supply on the continent,” he said. “It is possible to build further fill-and-finish capacity, but this requires local manufacturers having guaranteed off-takes and ongoing demand.”

The BioVac Institute, a state-backed South African vaccine company, has won a deal with U.S.-based ImmunityBio Inc. to make coronavirus shots if that company’s vaccine is approved. It expects a new plant to cost as much as 200 millon euros ($241 million). In Ghana, the pharma industry body has also proposed a local factory, but says it could take as long as two years to complete.

BioVac currently runs a fill-finish site, allowing it to package doses, but now wants to build a plant that produces the ingredients needed for the vaccines themselves. Aspen Pharmacare Holdings Ltd., another South African company, signed a deal with Johnson & Johnson to fill and finish its version of the Covid-19 vaccine locally. The plant being used cost 3.4 billion rand ($240 million) and came on stream last year, three years after Aspen started building it.

“The current Covid-19 pandemic presents a great opportunity to harness the various conversations and proposals into an action-oriented road map,” said William Ampofo, chairman of the African Vaccine Manufacturing Initiative. “Increased vaccine production in Africa will facilitate immunization of childhood diseases and control outbreaks of highly infectious pathogens.”