Local manufacturing, local supply chains and health security in Africa: lessons from COVID-19

African health systems have been damaged during the pandemic by a toxic combination of high import dependence, low purchasing power allowing African countries to be outbid for resources and relatively low local manufacturing capabilities. Examples from several countries6 include: restarting and scaling up hand sanitiser production, using local ethanol and adapted plastic bottle delivery systems; making local swabs from scratch and scaling up viral transport medium output, alongside developing PCR test kits for local laboratories; making locally produced masks and protective equipment while struggling to replace meltblown fabric imports suddenly unavailable; scaling up dexamethasone production; and inventing and producing local ventilators and low-tech oxygen therapy delivery methods. African countries have suffered severely from a globally transmitted supply chain crisis, through competitive procurement by governments with deeper pockets that drove price hikes, and national export controls on essential commodities and raw materials that blocked access. Manufacturing supply chains and industrial development are very rarely included, as they should be, in the social determinants of health.5 When global health has turned its attention to supply chains, as in WHO prequalification initiatives or global fund purchasing rules, the result has often been to generate dependence on a few suppliers.4 The pandemic has foregrounded longer standing worries about global, and specifically Indian, over-dependence on API supplies from China.7 8 To challenge the exclusionary and disequalising dynamic represented by the wave of ‘crisis nationalism’ in monopolising essential supplies, of which ‘vaccine nationalism’ has the highest profile,9 10 research and planning for health security must turn greater attention to localising supply chains and tackling severe concentration risk.