Africa carries around 24% of the global disease and illness burden but its pharmaceutical industry is worth less than 1% of this $857bn global industry.While the amount that is spent on healthcare in Africa is rising rapidly, access to medicine is often a matter of life and death, and demand is not based on choice but on absolute need. This throws up several controversial issues, including that of generic drugs that can be hundreds of times cheaper than original branded products. Associate Editor, Neil Ford examines all these issues and look at the encouraging growth of local manufacturing on the continent.
The health and pharmaceutical industries are bound to provoke great emotion, not least because there is a significant difference between the two. Many of the great advances in global public health have been achieved without the benefit of pharmaceuticals, through improved access to clean water and sanitation. Yet the drug industry provides the key to tackling HIV-AIDS, malaria and many of the other big killers in Africa.
Moreover, the pharmaceutical industry is probably the best microscope under which to examine the tensions between the private sector, state finances and individual benefit, as it ultimately requires putting a price on human life.
In the context of sub-Saharan Africa, these tensions become all the more acute because of the prevalence of so many illnesses encompassing both those that have been brought under control in much of the rest of the world; and newer illnesses, such as HIV-AIDS and Ebola, which have generated a great deal of headlines in the rest of the world, but which claim the majority of their victims within the continent.
Africa can be seen as the frontline in the battle between health and illness but there is a huge mismatch between African medical needs and the continent’s ability to pay. The World Health Organisation (WHO) estimates that sub-Saharan Africa accounts for 24% of the global disease burden.
The big problem is that most of the global pharmaceutical sector’s big guns are deployed elsewhere. The industry was worth $857bn in 2012 but this figure was distributed extremely irregularly around the planet.
North America accounted for a massive 41% share of this figure, partly as a result of the continent’s prosperity but also because of the strong influence exerted by the private sector over public policy. By contrast, sub-Saharan Africa’s share was worth just 1% of the figure, underlining the extent of the region’s exclusion from the global pharmaceutical mainstream.
However, the region’s spending is increasing rapidly, as many governments seek to improve their population’s health on both social and economic grounds.
All humanitarian and demographic concerns aside, an ill population is not an active one. Healthcare expenditure, including on pharmaceuticals, increased by an average of 9.6% a year in sub-Saharan Africa between 2000 and 2012 and it is widely expected that this rate will continue to grow at a similar rate over the next few years.
Most of this money is directed at capacity building, health care infrastructure and the provision of treatment but there is still a long way to go to make up for the backlog in investment over several decades. It is, however, at least a start.
Rise of ‘lifestyle’ diseases
The composition of the African pharmaceuticals market will almost certainly change dramatically over the next 20 years. Infectious and parasitic diseases will continue to attract a great deal of attention, and there is a great deal of scope for growth in the sale of anti-malarials, vaccines and antiretrovirals (ARVs).
However, there are expected to be rapid rises in the incidence of diabetes, and cardiovascular and respiratory diseases. Non-communicable diseases (NCDs) are often connected to lifestyle choices and are likely to become increasingly common as people become more wealthy, eat too much, particularly processed food that is high in fat and sugar, and exercise too little.
The governments of Botswana, Kenya and Nigeria have all already stated that tackling NCDs will be a priority in future health strategies.
For private sector manufacturers, distributors and retailers, the big money is to be made through the sale of drugs to the upper and middle classes to combat chronic conditions, such as high blood pressure, and regularly prescribed medicines, such as antibiotics.