Rwanda’s health sector has been praised for its adaptability in the face of the Covid-19 pandemic, including the efficient rollout of vaccines and virus-suppression measures.
By mid-February, nearly 7m Rwandans had been fully vaccinated against the virus. At 53.7% of the population, this is one of the highest rates in Africa and the developing world.
Centralised leadership and a coordinated strategy based on the latest data were rewarded with broad public compliance with tough virus-suppression measures. ICU capacity in provincial capitals was greatly expanded to avoid Kigali being overwhelmed, which helped prevent the spread of the disease and increased survival rates through quicker administration of treatment.
Oxygen production and distribution was ramped up to cover domestic needs. The country has officially reported 1450 deaths from just under 130,000 cases.
Much of the response was built on the country’s existing Community Health System, which ensures access to basic healthcare provision and advice at village level across the country through a network of health facilities.
“Having trained people who can give practical advice at a community level helped prevent the healthcare system from being overwhelmed with minor or asymptomatic cases, which allowed resources to be concentrated on serious cases,” says Dr Daniel Ngamije, Rwandan minister of health.
This system was bolstered by investments – including $150m from the World Bank – in testing, tracing and vaccination capacity.
Vaccine production plans
Rwanda is now hoping to build on that progress by becoming a centre for vaccine production in Africa. BioNTech’s choice of Rwanda and Senegal as manufacturing and distribution centres represents the most serious effort to date to address the stark global inequalities in vaccine access.
The German company’s partially prefabricated “containerised” labs are slated to be installed in July 2022 and are expected to reduce construction time by around 12 months. The first vaccines produced on Rwandan soil are due to roll off the production line 24 months later.
“It takes international solidarity to allow the transfer of knowledge, skills, and facilities, but this is just what BioNTech is doing for us,” the minister says.
Ownership and operation will be gradually transferred from BioNTech staff to Rwandan management. BioNTech expects its Rwanda-Senegal “production line” to have the initial capacity to produce 50m vaccine doses per year.
But although BioNTech is best known for its ground-breaking messenger RNA (MRNA) Covid-19 vaccine, the significance of its two new African manufacturing centres will most probably outlive the current pandemic. At the time of writing, attention was already turning to perennial scourges of the African continent, such as malaria and tuberculosis.
“Mastering new-generation MRNA technology is key to fighting many diseases as they are very effective and can be developed quickly,” says Dr Ngamije.
Clare Akamanzi, CEO of the Rwanda Development Board, has her eye on how this development dovetails with the country’s wider ambitions to become a centre of scientific excellence and innovation.
“The idea is not just to produce Covid vaccines, but vaccines against other diseases that exist across Africa,” she says. “The agreement with BioNTech represents an opportunity to up-skill our people and produce the level of scientists that this kind of facility depends on.”
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Boosting healthcare investment
Healthcare provision, not just as a right of Rwandan citizens, but also as an opportunity for private investment, is high on the list of the government’s priorities as it emerges from the Covid-19 pandemic and limbers up to take on the targets of Vision 2050, the country’s ambitious plan to reach high income status by mid-century.
“The pandemic has shown the value of investing in a healthy population and specialised doctors”, Dr Ngamije says.
This same system is largely to thank for life expectancy increasing from 49 in 2000 to 66.6 in 2017, and for maternal and child mortality dropping by 80% and 70%, respectively, between 2000 and 2014.
Access and administration are being further improved by the digitisation of health services, while the government is also trying to ensure that Rwandans are able to afford healthcare services through a system of community-based health insurance.
Other research and investment priorities include cancer research and heart operations, for which dedicated facilities were built mid-pandemic. Specialisations in imaging solutions, diagnosis, pharmaceutical production, medical technology, and radiology are priority areas for investment.
Dr Ngamije is particularly dedicated to improving access to cancer treatment through investments in nuclear medicine and radiation, which are in short supply in the region.
“We aim to have this capability by 2023, which will only be the second of its kind in Sub-Saharan Africa, along with South Africa’s,” he says.
Private clinics have proliferated and expanded during the pandemic and the aim is to integrate them into an advanced medical ecosystem.
Drone-based delivery services
One of the most eye-catching partnerships to emerge is between the Rwandan government and California-based drone company Zipline.
In 2016, Zipline approached Rwanda to use it as a proof-of-concept location for a drone-based delivery system that was particularly suited to Rwanda’s geography and the needs of its health sector. Working out of two distribution centres, Zipline makes 5000 deliveries of medical supplies to 375 health facilities per month.
“Because blood can be delivered from storage to anywhere in the country in under 30 minutes, the Zipline system has decreased the amount of expired blood by 50%,” says the minister.
Zipline has since exported its concept to Ghana and the US, with plans to move into Nigeria, India, and the Philippines.