‘We Have Reached a Breaking Point.’ As Third Wave Hits Africa, Senegal Races to Build a Facility to Make COVID-19 Vaccines

Until recently, the West African nation of Senegal was handling COVID-19 well. Public health measures included rapid testing, nighttime curfews, a ban on large gatherings, mandatory mask-wearing and the temporary closure of its borders. Cases remained low for the first 18 months of the pandemic, and in an assessment by Foreign Policy of 36 governments in their responses to the pandemic, it came second only to New Zealand.

But now the country — and surrounding region — is struggling to keep up with a third wave of COVID-19, fueled by the more transmissible Delta variant. Until the end of June, Senegal had registered a total of just under 44,000 confirmed COVID-19 cases. Since then, it has recorded more than 26,000 cases and more than 400 deaths.

Senegal’s hospitals are close to being overwhelmed. In the capital Dakar, two large care centers for critically ill COVID-19 patients, Hospital Center University De Fann and Dalal Diam hospital are full. “So the other hospitals just do with what they have,” says Nicolas Mouly, head of the Alliance for International Medical Action’s emergency response (ALIMA), which has been supporting coronavirus treatment in Senegal.

Dr. Alioune Badara Ly, director of Senegal’s Health Emergency Operations Center, who is leading the country’s public health response to COVID-19, says hospitals have added 700 more beds but capacity is still stretched. “It’s particularly during this third wave which we’ve had to face the Delta variant that Senegal has struggled and that’s because of the increased transmissibility of the variant and the increased demand on oxygen,” he said. “Senegal consumed in three months the amount of oxygen that it usually consumes in a whole year.”

It’s the same story elsewhere in the region. Across Africa, COVID-19 related deaths skyrocketed by 80% over the past month, according to the World Health Organization. Dr. Phionah Atuhebwe, WHO’s vaccine introduction officer for the African region, tells TIME that demand for medical oxygen is estimated to be 50 times higher than at the same time last year. “There is limited production capacity on the continent because of too few production plants, mainly of which are in disrepair or poorly maintained,” she says. “We have reached a breaking point.”

‘The vaccines have not arrived.’

In Senegal, experts say the increased transmissibility of new variants has powered the third wave, as well as relaxed adherence to social distancing measures during Muslim celebrations for Eid al-Adha in mid-July, known locally as Tabaski. But the crucial missing piece of the public health puzzle is vaccines. Fewer than 2% of Senegal’s 16 million people are fully vaccinated — a rate that matches that of the 1.2 billion people in the continent as a whole.

This is less to do with demand than supply, according to Tedros Adhanom Ghebreyesus, the director general of the WHO. “Many African countries have prepared well to roll out vaccines, but the vaccines have not arrived,” he said at a press briefing on July 30.

Read more: Tedros Adhanom Ghebreysus on Why There Should Be a Moratorium on COVID-19 Booster Shots

After COVID-19 hit, most African countries were unable to compete with wealthy Western countries in the race to buy shots, and instead relied on the global vaccine-sharing initiative called Covax, that mainly sourced vaccines from the Serum Institute of India. However, exports halted as India looked after its own vaccination needs in curbing a deadly wave earlier this year. A flurry of new donations from Europe, China, and the U.S. have since boosted supplies. Around 91 million doses have arrived to date, though that still only covers fewer than 10% of Africa’s population.

Now, several countries across Africa are attempting to take matters into their own hands, by boosting manufacturing themselves. Currently the only coronavirus vaccine facility in Africa is South Africa’s Aspen Pharmacare, which produces the Johnson & Johnson shot yet cannot control where vaccines are allocated — some 32 million doses bottled and packed in South Africa were was shipped abroad.

In Senegal, the Institut de Pasteur in Dakar is building a manufacturing plant in the hopes of starting production of COVID-19 vaccines later this year. Its goal is to produce 25 million doses per month by the end of 2022. But creating a facility — and an industry to match — from scratch is a huge challenge.

The facility received 6.75 million euros ($8 million) from European countries and institutions, and the U.S. government’s International Development Finance Corporation (DFC) has also committed $3.3 million towards it. So far DFC has struck deals with India’s Biological E, South Africa’s Aspen and Senegal as part of its overall goal to help vaccine producers in poorer countries.

U.S. officials told TIME they hoped to work with more African countries to ramp up production quickly. “But we are quite a way off from finding viable deals to invest in or even from proposals for grants yet from anybody else except for the few in South Africa and Senegal,” says Jim Polan, vice president of the office of development credit at the DFC.

India’s production capabilities took decades to establish, DFC officials point out. Building a similar footprint for the African continent “takes time,” says Nafisa Jiwani, managing director for health initiatives at the DFC. “It’s been extraordinarily quick for this sort of thing,” says Polan. ”[But] we can’t create the expertise and the necessary infrastructure from scratch at the beginning — that really has to come from a sponsor,” he adds.

Creating a new industry from scratch

Belgian biotech group Univercells will deliver that technology know-how to Institut Pasteur, a deal formalized after President Macky Sall’s visit to Belgium on April 13. Under the agreement, the Institut Pasteur would use Univercells’ manufacturing technology to supply COVID-19 viral vector vaccines such as those developed by Johnson & Johnson or AstraZeneca to countries across West Africa. It’s thought that the total cost of the project could be $200 million.

“We can help secure the appropriate license, manage the tech transfer over to Senegal, and make sure that the facility is constructed according to the appropriate processes and protocols needed to make that vaccine,” Univercells chief investment officer Kate Antrobus, tells TIME.

The larger issue here, and a challenge for Africa as a whole, is that 99% of all medicines used on the continent are imported. The European Union has committed €1 billion towards vaccine and medicine production in Africa, in alignment with an African Union goal for up to 60% of routine vaccines to be produced within the continent by 2040. But right now the infrastructure is extremely limited; there are only 10 African manufacturers that produce vaccines against any disease. “What that also says is that there is not an enormous pool of [qualified] vaccine manufacturing staff or workforce to draw from,” Antrobus says.

Univercells says it could outsource staff to the new facility until local staff are sufficiently trained to run operations, but emphasizes that there’s a desperate need for capability building from scratch. “In Belgium, if Univercells wants to hire there are a lot of other vaccine producers and an entire economic system and university degrees based around creating that workforce. Whereas I think Senegal in particular must actually try to seed and create that new industry.”

Other challenges remain. Senegal still requires a contract from a vaccine manufacturer or patent holder such as Johnson & Johnson. Some countries including South Africa and India have pushed for the World Trade Organization to temporarily suspend intellectual property rights on coronavirus vaccines — a waiver that has been backed by the WHO.

But Antrobus says much more is required of patent holder than just the recipe for a vaccine. “Without the active participation of the knowledge owner — not just saying here’s my equipment, but saying I will take you step by step through how you use it — you can’t make a vaccine.”

‘We need that capacity on the ground.’

In the meantime, Senegal aims to continue to seek out vaccines through Covax as well as purchase extra doses on its own. It was one of the first African countries to kickstart its vaccination drive using Sinopharm doses bought from China, and sharing its shots with neighbors Guinea Bissau and Gambia.

“The production of vaccines in Senegal will of course happen alongside other bilateral initiatives,” says Dr. Ly. “It’s obviously important to keep vaccinating the population before 2022.”

So far Senegal has vaccinated over a million people, according to Dr. Ly. The country has learned that “organizing ourselves to be able to guarantee a quick and effective response” is very important in terms of preparing for large scale health disasters such as Ebola and COVID-19.

For WHO’s Dr. Atuhebwe, production in countries like Senegal is about future proofing the region’s response to potential new viruses. She estimates richer nations “have delivered 61 times more doses than the African continent.”

“We cannot accept or stand to be dependent again like we have been in 2021, it has really been extremely painful,” says Dr. Atuhebwe. “We need that capacity on the ground.”