This Opinion Piece was published in the Daily Maverick on 12 February
Professor Paul Watts is a Distinguished Professor and holder of the SARChI Chair in Microfluidic Bio-Chemical Processing at Nelson Mandela University.
SUSTAINABLE SOLUTIONS OP-ED
Local drug manufacturing technology already exists and can be expanded to fill in the gaps created by Donald Trump's executive order freezing aid to South Africa. (Photo: Bruno Guerrero / Unsplash)
South Africa suffers from one of the world’s worst HIV/Aids epidemics: more than 8.5 million people are living with HIV. The USAid funding crisis has caused widespread panic in South Africa, with people living with HIV in utter turmoil as their survival hinges on US President Donald Trump’s executive order to freeze USAid funding for 90 days.
It’s on hold for now, but for how long?
Whether it holds or not, surely this is a massive wake-up call to make medicines in Africa for Africa, which is absolutely possible utilising innovative technology. For years I have been advocating at the highest level that local drug manufacturing in South Africa has to be implemented to make sure that quality drugs for Africa are locally accessible at a much lower cost with a guaranteed supply.
It’s far from our first wake-up call. The drug accessibility issue was a massive problem when the Covid-19 pandemic hit and our pharmaceutical supply chain imports were completely disrupted.
This created significant social, health, economic and political stress in Africa. In response, South Africa invested in locally manufactured Covid-19 vaccine technology. At the same time the country should have invested in generic drug manufacturing technology, but this did not happen.
We are now in crisis again for political reasons. Surely local drug manufacture now needs to be implemented without any further delay? It is essential that we make medicines in Africa for Africa, and it is absolutely possible by utilising innovative technology.
Advanced stage of local drug manufacturing capacity
Our research team in the SARChI Chair in Microfluidic Bio-Chemical Processing at Nelson Mandela University is already at an advanced stage of local drug manufacturing capacity in South Africa. Our research team now has the ability to produce known generic medications for the big five: Aids, TB, malaria, cancer and diabetes, as well as for common illnesses including influenza.
Regarding the current crisis of Aids medicines, our research group has conducted studies on the local manufacture of a huge number of commonly used drugs including lamivudine, emtricitabine, efavirenz, nevirapine, dolutegravir, tenofovir, AZT and stavudine.
The National Research Foundation and the Technology Innovation Agency have funded this critical research for more than 12 years, supported by Nelson Mandela University’s Vision 2030 drive for innovation, entrepreneurship, social justice and sustainability.
We are building new laboratory facilities to enhance our research and innovation capacity, and are working with our Innovation Office to explore commercial opportunities for drug manufacture.
Our approach for all medications is to use continuous flow technology that starts with a microreactor the size of a mobile phone to synthesise the active pharmaceutical ingredients in medication.
To explain: in any tablet, whether an aspirin or Aids medication, about 70% of the cost of the drug is the active pharmaceutical ingredients, which are the principal component. The other 30% is for the excipients, the substances that help deliver the medication to your system. We have the necessary technology to enable the manufacture of the active pharmaceutical ingredients in South Africa, and also to make them 20% to 30% cheaper.
As an indication of overall market size, South Africa’s import of pharmaceutical products amounted to $3.06-billion in 2021 (UN Comtrade database), the vast majority being drug substances or active pharmaceutical ingredients from China and India.
Add to this the cost of formulating these active pharmaceutical ingredients into tablets or “finished drugs”, which fortunately a number of companies do in South Africa, including Aspen, Adcock Ingram, Cipla and Specpharm. Other African countries do not have formulators and have to import the finished drugs, which is even more expensive and which makes medications unaffordable to the majority of patients in Africa.
The continuous flow technology that is used to create the active pharmaceutical ingredients starts with a microreactor about the size of a mobile phone. Critically the scale of production can be easily increased through what we call parallelisation approaches to produce up to 2,000 tons of quality active pharmaceutical ingredients using this methodology.
Creating jobs
With continuous flow, the batches are all in specification, whereas with traditional technology one in 10 batches is out. Another important advantage of continuous flow is that it creates jobs within the country and contributes to South Africa’s research capacity.
Several members of our research team, which includes 20 PhD and master’s students, have graduated with PhDs. In 2023, four South African women graduated with their PhDs for this work. Sibongiseni Gloria Gaqa produced two diabetes drugs using continuous flow technology; Sinazo Nqeketo produced the Aids drug Dolutegravir; Kanyisile Mhlana produced the Aids drug Nevirapine; and Thembela Celia Sonti produced the Aids drug Tenofovir.
In 2024, three PhDs graduated: Mcquillan Moyo produced Ciprofloxacin (antibiotic), Kwakhanya Mkwakwi produced the AZT (Aids) and Melissa Sagandira produced prilocaine (anaesthetic) and betrixaban (an anticoagulant drug).
I am confident our technology is at a point that it could be used for drug manufacture. Investment in the technology would prevent shortages in the future. We would start with one centre in South Africa where the drugs would be manufactured, and it would make sense for it to be near a port for the export and procurement of raw materials.
We can do something big here. South Africa is always talking about increasing its manufacturing and technological capacity, and this is a critical opportunity.