Part 2: Building the Autonomy of African Health Systems

Back-to-School Dossier 2025
Part 2 - Building the Autonomy of African Health Systems

The international health-financing crisis analyzed in the first part of this dossier reveals a structural fragility that goes beyond budgetary issues alone. Behind dependence on donors lies a deeper question: African sovereignty in health. How can systems be built that withstand fluctuations in external aid while meeting populations’ growing needs? Sovereignty is not limited to mobilizing domestic resources; it also means rethinking national priorities, asserting technological, industrial and regulatory control, and strengthening regional cooperation. In other words, it means redefining the role of the state and African institutions in the continent’s health governance.

The Covid-19 pandemic brutally revealed vulnerabilities linked to external dependence for vaccines, medicines and equipment. As Dr. Karem Bendhaou recalls, "never let a crisis go to waste"; this ordeal must serve as the starting point for strategic reflection. Building African health sovereignty therefore depends on several essential levers, including:

Health Dependence: Africa’s Vulnerability to Global Crises

Africa remains largely dependent on external health production, whether for vaccines, medical equipment or medicines. This fragility became glaring during the Covid-19 pandemic, when the continent had the lowest vaccination rate in the world,8% of its population according to Amnesty International.

Even today, less than 1% of the vaccines needed are produced locally, exposing African countries to supply disruptions and unequal access.

This dependence raises serious concern. In an op-ed published on April 27 in Le Monde, four researchers warned about the consequences of this vulnerability: Africa pays a heavy health toll, with 95% of deaths linked to malaria recorded on its soil, a disease that particularly affects children under five.

The same logic applies to pharmaceuticals. According to the World Health Organization (WHO), nearly half of Africa’s population lacks access to essential treatments. Dependence on imports, which cover between 70% and 90% of medicine needs, combined with weak local capacity to produce active pharmaceutical ingredients, deepens this deficit. Nigeria illustrates this reality: despite annual growth of more than 9% in its pharmaceutical industry, the country still imported 70% of its medicines in 2023. In its June 2025 report, the World Bank expressed concern about this situation and stressed the need to strengthen the country’s pharmaceutical sovereignty, and more broadly that of the continent.

Producing Locally to Save Lives

Faced with this drastic imbalance, the African Union (AU) has committed to ensuring that 60% of vaccines used in Africa are produced locally by 2040. This project is led by the Africa Centres for Disease Control and Prevention (Africa CDC) and supported by international partners such as the European Union, the African Development Bank and Gavi, the Vaccine Alliance.

This local production would help strengthen health security, guarantee faster and more equitable access to vaccines, and reduce dependence on external markets. For example, 25 vaccine-manufacturing projects are already under way at different stages of development across the continent, including five commercial-scale manufacturing plants with signed or ongoing technology transfers. These projects concern both vaccines against classic diseases such as diphtheria or tuberculosis and more recent vaccines against Covid-19 or human papillomavirus (HPV).

Morocco is a key actor in this dynamic. For vaccine production, the construction of the Benslimane plant, launched in 2022 with an investment of nearly 500 million euros, represents a major advance. This plant is equipped to produce more than 2 billion vaccine doses.

The country also has a relatively robust local pharmaceutical industry compared with its African peers, which, according to Morocco’s Ministry of Health, covers around 80% of national medicine needs and makes Morocco one of the few African countries with capacities extending to active-ingredient production. Morocco also participates in African initiatives to develop regional production capacity, such as the 75th session of the WHO Regional Committee for Africa, relying on international partnerships and adapted regulation.

Other African countries also play an important role in developing local vaccines and medicines in Africa. In Zambia, President Hakainde Hichilema, during the 75th session of the WHO Regional Committee for Africa, said Zambia would play a leading role in local manufacturing of medical products. The country has hosted international partnerships to develop local vaccine production, notably with China, which is supporting the installation of pharmaceutical production plants on site. Zambia thus aims to produce vaccines locally against diseases such as cholera, strengthening regional health sovereignty.

Finally, Senegal is also in the running to become an emerging African producer. It is currently the only country producing a vaccine on the continent: the yellow-fever vaccine. This vaccine is currently purchased by UNICEF for field administration, guaranteeing a steady revenue stream.

However, to ensure this development is effective and efficient, it is important to invest in training centers capable of producing a workforce that fully understands the stakes.

2. The New Generation That Will Save African Health

Building production plants is good. But building them without a workforce is a bit like building empty stadiums: "who’s going to work in those empty stadiums?".

The development of local vaccine and medicine production in Africa cannot be conceived without massive investment in training. As Karem Bendhaou emphasized during the USA Summit 2025, "we need to create bio training centers AND to train people." The creation of specialized bioproduction centers is therefore a strategic lever, enabling the continent to build the skills essential to health sovereignty.

These centers would play a key role in strengthening human capital: vaccine and medicine manufacturing requires advanced technical skills, from quality management to biotechnology and pharmaceutical production. Training qualified technicians, engineers and researchers locally guarantees the availability of a workforce capable of designing, implementing and supervising production units that meet international standards.

These training infrastructures would also be a privileged ground for technology transfer. Acquiring and mastering advanced technologies would promote not only the adoption of new production methods, but also the development of innovative processes adapted to local realities. In addition to strengthening African scientific expertise, they would help limit brain drain by offering attractive professional prospects on the continent.

Some projects already implemented in Africa:

In Morocco, some initiatives are already moving in this direction. The Institut Pasteur du Maroc organized the first African Workshop on Vaccine Manufacturing Essentials, designed to strengthen the technical skills needed for vaccine manufacturing, from production to regulatory aspects. However, these remain one-off workshops rather than genuine specialized centers capable of providing continuous, structured training in bioproduction.

In South Africa, a further step has been taken with the establishment of a technology-transfer center dedicated to mRNA vaccines. Supported by an international consortium including the WHO, this center plays a key role in training local talent and transferring skills essential to large-scale vaccine manufacturing.

3. What If AfCFTA Became the Engine of African Health?

Producing vaccines and medicines locally is an essential step, but it is not enough if these products or the inputs needed to manufacture them remain trapped in customs, regulatory or logistical mazes. Health sovereignty is not played out only in laboratories and factories: it also depends on the ability to move inputs, equipment and finished products freely across the continent.

This is precisely where AfCFTA becomes a strategic lever. By progressively eliminating 90% of customs duties, it facilitates access to essential inputs while opening a single market of 55 countries, favorable to investment and economies of scale. It also encourages regional cooperation and standards harmonization, creating an environment conducive to developing a competitive pharmaceutical industry.

But the stated ambition will have to confront realities: weak infrastructure, persistent non-tariff barriers and disparities between African economies risk slowing the promise. Without a concerted effort to overcome these obstacles, AfCFTA will remain a good idea on paper, unable to turn local production into genuine health sovereignty.

Conclusion

African health sovereignty can no longer be viewed as a simple political ideal: it is now a strategic necessity. The lessons of the Covid-19 pandemic, persistent dependence on imports and the fragility of international financing all underscore the urgency of a systemic response. Local production, talent training, easier circulation of inputs through AfCFTA, and stronger regulatory and technological capacities are all levers that must be activated simultaneously to build lasting autonomy.

More than a health challenge, this is a development choice. Investing in health means investing in economic growth, social stability and the continent’s resilience in the face of future crises. The question is no longer whether Africa can achieve this sovereignty, but how and how quickly it can turn its ambitions into concrete achievements. This reflection leads directly to another essential dimension: health economics as a growth driver. Beyond health security, health is a strategic sector capable of stimulating innovation, attracting investment and generating major economic returns for the continent. This will be the subject of the next part of this dossier.