A system governed by Africans in Africa is needed to provide a sustainable funding mechanism that would encourage African scientists to collaborate on common health concerns, share expertise, and build capacity.
The health status of Africans remains far worse than that of people in many other developing regions, to say nothing of Europe and North America. Although a lack of access to health care and serious health system deficiencies are important reasons for this phenomenon, other elements aggravate it. One is insufficient research and development aimed at addressing Africa’s unmet health needs. The result is a lack of efficient therapies for many illnesses that affect that continent almost exclusively and are therefore beyond the scope of most research efforts in the developed world. Consequently, improving the health of Africans implies not only addressing the deficiencies of access and health systems but also stimulating the development of suitable drugs and diagnostics.
A look at the relationship between GDP per capita and life expectancies illustrates the magnitude of the problem. While the GDP of Africa as a whole has grown by over 200 percent in the past 20 years, only two extra years of life expectancy were added during that time. Asian countries with comparable GDPs per capita tend to have life expectancies 5 to 10 years higher than those of their African counterparts. Even high-GDP African countries, boasting per capita figures comparable to those of many countries in Eastern Europe and South America, have life expectancies 10 to 20 years lower than those of comparable nations in the other continents. Undoubtedly, Africa’s weak health systems and HIV/AIDS epidemic are contributing to the problem. Yet several countries elsewhere, such as Jamaica and Thailand, with similarly weak systems or similarly burdensome HIV/AIDS rates, still have life expectancies that are 5 to 25 years longer.
A big part of the problem is a lack of tools to diagnose and treat the diseases of Africa. Some available drugs addressing those that affect it disproportionately are not fully effective and present high toxicity levels. Acquired resistance has made other therapies less effective.1
Low levels of patient compliance because of the duration and complexity of certain treatments is another impediment. What’s more, diagnostic tools for some common diseases in Africa are hard or impossible to apply in the field or could be made more broadly usable in difficult environments. While emerging public–private partnerships between international organizations and pharmaceutical companies are making inroads, these efforts are still few and far between. In fact, only about 1 percent of new drugs developed from 1975 to 2004 treat diseases of the poor, although such diseases account for more than one-tenth of the global burden.2
Current R&D efforts aimed at treating African diseases mostly depend on organizations outside Africa. They try to find solutions for its pressing health needs but not to create a sustainable R&D structure on the African continent. To develop a plan for a pan-African health R&D project, McKinsey analyzed five years of health research output and scientific networks involving African scientists. As highlighted in other recent publications,3
we conclude that a system governed by Africans in Africa is needed to provide a sustainable funding mechanism that would encourage African scientists to collaborate on common health concerns, share expertise, and build capacity.
The challenges ahead
The argument for increased R&D to develop drugs and diagnostics for diseases that disproportionately affect Africa is compelling. Although promising trends are fostering the development of such an R&D capacity, the African countries responsible for the largest number of biomedical-research publications—such as Egypt
, and South Africa
—generate 15 to 150 times fewer research articles than leading developed countries do. More alarmingly, they generate 1.2 to 8.0 times fewer research publications than other developing countries, such as Argentina, Brazil, India, and Thailand. These figures indicate that while research to treat predominantly African diseases and conditions is being conducted, major challenges still prevent these efforts from reaching sufficient scale and productivity.
A significant knowledge gap
Many diseases with a high prevalence in Africa are either almost exclusive to it (for example, onchocerciasis, human African trypanosomiasis, schistosomiasis, and malaria) or disproportionately affect the continent (HIV/AIDS, ascariasis, meningitis, trachoma, lower-respiratory infections, diarrheal diseases, leishmaniasis, tuberculosis, and lymphatic filariasis). World Health Organization (WHO) estimates indicate that this group of diseases accounts for more than 50 percent of Africa’s total disease burden. Accurately quantifing their economic impact is difficult, but rough estimates show that they reduce the continent’s GDP by as much as 20 percent, or $200 billion, a year.
Despite the terrible impact these diseases have on Africa’s economic development and welfare, they have been seriously underresearched: with the exception of HIV/AIDS and malaria, the pipeline of products aimed at treating them is just about empty (exhibit). Their almost exclusively African incidence means that interest from the international research community is low, which emphasizes the need for drugs and diagnostic R&D efforts owned by Africans.
A favorable trend is emerging, though. An analysis of five years of biomedical-research articles originating in Africa shows that the number of articles on different diseases correlates well with their incidence in Africa.
A low degree of collaboration
The productivity of R&D efforts, both public and private, is maximized by harnessing the synergies generated by networks of scientists with complementary skills and capabilities. These collaborative networks also benefit when expertise is transferred from one network member to another, which builds capabilities and increases a network’s capacity. In academic environments, the availability of funds drives the creation and work of collaborative networks, so African scientists strongly tend to collaborate not with one another but with scientists in Europe and the United States, where research funding and technology are more readily accessible. In fact, only 10 percent or less of the funding of R&D at many public-health research centers in Africa is local; the rest comes mostly from the United States and Europe, either directly or through collaborations.
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1 “Research and development for neglected diseases—Lessons learned and remaining challenges,” International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), 2005 (www.ifpma.org/documents/nr4959/neglecteddiseases_finaldoc2005.pdf).
2 Pierre Chirac and Els Torreele, “Global framework on essential health R&D,” Lancet, 2006, Volume 367, Number 9522, pp. 1560–61.
3 Tom Mboya-Okeyo, Robert G. Ridley, and Solomon Nwaka, “The African network for drugs and diagnostics innovation,” Lancet, 2009, Volume 373, pp. 1507–08; Strategic and business plan for the African Network for Drugs and Diagnostics Innovation (ANDI), World Health Organization, October 2009; and Solomon Nwaka et al., “Developing ANDI: A novel approach to health product R&D in Africa,” PLoS Medicine, 2010, 7(6): e1000293.