How Uganda can fix the problem of drug shortages

The six countries of the East African Community (EAC) can only produce 30 per cent of medicines requirements and import the rest. These countries are Uganda, Kenya, Tanzania, Burundi, South Sudan and Rwanda.
Second Deputy Prime Minister and Minister for East African Affairs Kirunda Kivejinja made this revelation during the East African vaccine symposium that took place in Arusha, Tanzania from April 17 to 18.
“The region wholly depends on importing vaccines as there is currently no local production capacity,” Mr Kivejinja said.

As a way of enhancing local production capacity, Mr Kivejinja noted that there is need for investors from both developing and developed countries to come into the region to produce medicines because of high demand and the profits that would accrue from it.
“Uganda (for example) has gone a long way in trying to effect the idea of manufacturing medicines. We already have an internationally certified medicine manufacturing industry that only needs expansion. The facilities are there. There is no need to undertake the complicated process of attaining land,” he noted.

The situation in Uganda
Patients continue to die of preventable diseases as a result of having an inadequate stock of medicine in public health facilities.
A 2015 report by the Budget Monitoring and Accountability Unit of Ministry of Finance, shows that more than 90 per cent of public health facilities reported non-supply of ordered medical items, including drugs and stationery in 2014.
Similarly, a 2015 stock status report by the Ministry of Health, Pharmacy division indicated that Uganda was facing a shortage of essential drugs in government health facilities.
The status report showed that essential medicines like tuberculosis drugs, malaria medicines, and polio oral trivalent and measles vaccines were not readily available.

As a way of evolving an efficient and effective pharmaceutical industry in Uganda and other EAC member states, Kivejinja launched the second EAC regional pharmaceutical manufacturing plan of action, 2017 to 2027.
The plan, among other reasons, focuses on supporting production of active pharmaceutical ingredients and excipients as well as promoting the sector specific service industry.
The German government through organisations such as Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) provided technical and financial support for the development and implementation of the action plan as basis for increased local production of pharmaceuticals.

“This launch creates a new opportunity for the region to focus its energy on fully utilising the already installed factories production capacities, and value addition through new products with a specific focus on vaccines,” says Dr Kirsten Focken, GIZ programme manager.
According to Focken, the new goal should ideally be to grow the market share of locally manufactured medicines from the current average of below 30 per cent, and to more than 50 per cent by 2017. This will eventually support job creation and is the most sustainable way to grow investors’ appetite for setting up new factories within the East African Community (EAC).

To successfully implement this plan, Liberat Mfumukeko, the EAC secretary general, says it will require a combined effort of member countries’ ministries of health, national medicines regulatory authorities of EAC partner states, pharmaceutical industries, private sector, international development partners, non-state actors as well as national academic and research institutions.

Challenges in manufacturing drugs
The inability of the local pharmaceutical industry to adequately meet local demands for low-cost generic production and innovation has allowed foreign companies to dominate the medicinal markets.
During an interview with Sunday Monitor at the symposium, Mr Mohamed Nazeem, the chief executive officer of Kampala Pharmaceutical Industries, noted that EAC heavily relies on imports of medicines primarily from India, China as well as Europe.

“Our mandate in the next decade is to go from 25 per cent manufacturing to around half of the drugs we use. This is possible by partnering with our respective governments, the EAC and attaining technical support from other industries,” Mr Nazeem said.
The market share for imports in Africa is estimated to be more than 70 per cent, with a market share of generics estimated at 62 per cent in Kenya as well as other EAC partner states. In the EAC, more than 50 per cent of imported drugs come from Asia, particularly India and China.
Mr Nazeem points out three critical challenges affecting vaccine production in EAC.

“Vaccine production is a complicated process. It is resource demanding. Our universities do not teach the processes involved. To resolve this, we need technology transfer from others countries willing to work with us,” Nazeem says.
Secondly, the region faces a problem of inadequate funding for vaccine production.
“Borrowing money from banks kills the development of industries because of the interest rates. It would be a great initiative finding a fund where individuals can borrow money cheaply,” he says.
Lastly, Nazeem believes that although we are EAC, there is still a mentality of individualism among the states.
“But if we come together, it suddenly becomes an interesting market for investors,” he adds.

Among other challenges, finding appropriately qualified and skilled staff to cater for the needs of the pharmaceutical industry is another problem
“The skills are not yet available but as a region, we can mobilise investors to come and partner with us or even produce these medicines locally so that medicine can easily be accessible to our people,” Mr Christophe Bazivamo, the deputy secretary general (productive and social sectors) at the East African Community, says.

Resolutions
At the end of the symposium, a number of resolutions were made, aimed at mitigating the social and economic impact caused by infectious diseases. Some of these include EAC committing towards enhancing resources to improve system infrastructure, establishing a regional vaccine manufacturing facility either through public-private partnership or publically, promoting the establishment of a regional bio-technology and vaccine manufacturing hub as well as enhancing competitiveness in local production of vaccines.

Statistics of the EAC pharmaceutical sector

According to the 2017 pharmaceutical manufacturing plan of action document, Kenya is the largest pharmaceutical market estimated at $740 million, followed by Uganda ($450 million), Tanzania ($400 million), Rwanda ($100 million) and Burundi ($75 million).
The fastest growing market is Kenya, with an estimated year-on-year growth rate of 15 per cent. In South Sudan, political instability will remain a barrier to a significant investment in the pharmaceutical and healthcare markets.

Due to a lack of local production, the majority of pharmaceuticals in South Sudan continue to be sourced from abroad. Uganda recorded the strongest rise in export values, from $1.4 million in 2006 to $12.3 million in 2015.
Currently, national strategies including the Uganda National Pharmaceutical Sector Strategic Plan (2015 to 2020), Kenya Good Manufacturing Practice Roadmap, Strategy and Promotion of Domestic Production in Tanzania (2013 to 2023) are in place for promoting the sector.
These strategies are all anchored in the regional and continental plan of the 2012 to 2016 EAC regional pharmaceutical manufacturing plan of action and the pharmaceutical manufacturing plan for Africa respectively.

Way forward

Partner states face their own unique challenges in promoting local pharmaceutical production. These are the priority intentions crafted for Uganda to focus on.
Develop and implement a Uganda good manufacturing practice roadmap.
Support access to finance for upgrade of the sector.
Improve access to inputs and raw materials, for instance primary packaging materials in the country.

Increase competitiveness with imports by reviewing of tax regimes as well as tax exemptions on equipment and machinery.
Support harmonisation of drug registration and legislation in the region, for example through centralised registration and mutual recognition as well as increasing market opportunities in the EAC region and beyond.
Support local industries to expand their portfolio to include high-tech products such as delayed release formulations and vaccines.

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