At the end of last year, I was lucky enough to get an insight into the thinking of a lawyer who advises some of the world’s richest people on their investments in Africa. Most of what he said came as a wake-up for me.
Many private-sector investors are considering health in Africa. Maybe that’s no surprise; the African Development Bank says the Continent could almost double its GDP if health were better. Robert Appelbaum, though, thinks that many are interested in what Africa might export as well as the potential unlocked at home.
Appelbaum has advised multinational pharma companies through the most difficult episodes of the past three decades including the disputes over HIV medicines patents and the transfer of technology to African producers. He also provides legal and business counsel to billionaires who are household names. “Today, investors are looking at the African Continental Trade Agreement (AFCTA) and the commercialisation of African drugs and devices for use across the world,” he told me. “The AFCTA is making Africa into a legitimate manufacturing hub for the full gamut of manufacture from API [active pharmaceutical ingredients] through to fill and finish, whereas in the past we have been in the business of fill and finish,” he added.
The day before we spoke I had been to see the Biomedical Research Institute at Stellenbosch. It houses a network of 26 BSL-3 — highly secure — laboratories to handle infectious diseases samples. There are probably a third as many BSL-3 labs at Stellenbosch alone as there in all of China. The Biobank in the same facility has space for up to seven million samples and provides an exceptionally rapid way of looking back at the evolution of disease outbreaks. It was designed to allow another seven million to be stored when needed. To give an idea of how massive this is, the largest biobank in China can hold 10 million samples and the largest human biobank in Europe can keep 20 million. Maybe the most impressive statistic is that the Stellenbosch institute was completed for about €65 million, a fraction of what it would have cost in Europe.
Cost is not Africa’s only advantage: it has the kind of frugal innovation that hard-pressed European and American health systems need. “There is a huge amount of work taking place — more in devices and technology than in drug discovery. Africans are very innovative at creating for ourselves what does not already exist,” Appelbaum said. These are exactly the areas in which slow first-world innovation is holding back medicine: commissions on antimicrobial resistance assumed point-of-care diagnostics would by now have been able to differentiate between viral and bacterial illnesses and between different kinds of infectious bacteria. They cannot.
Pre-history gives Africa another advantage. As humans spread across the globe from Africa, we lost genetic diversity. It’s said that today there is more genetic diversity within Mozambique than between people in South Asia and people in Europe. In that vast genetic storehouse are hidden undiscovered clues to resisting and treating disease — clues that can be transformed into prevention, diagnosis and treatment by health innovators. As Africans have more access to health services, those genetic assets and liabilities will become more and more evident and accessible. This is a key aspect of the African Human Genome project and of South African agreements with commercial entities such as Illumina and MGI.
To spot the real life implications of these genetic patterns, to find population clusters and to identify possible genetic outliers, a country needs easy, secure access to massive numbers of records. The United Kingdom sees this as a competitive advantage for its four national health services while France’s La poste, the nation’s post office, is bringing together over 40 million patients’ referrals, visit reports and test results. These and other developed world efforts, though, are having to retrofit national analytical frameworks onto multiple old data systems and to pry data loose from academics and care systems with strong proprietorial instincts. African countries are building new national data systems from the bottom up with integration and analysis as part of the original design. Appelbaum thinks that Africa may again leapfrog over Western competitors, just as it did by introducing modern mobile telephony and mobile payment systems while legacy system owners slowed down adoption in Europe and the Americas.
Many think that Oracle has already honed in on the opportunity. It has partnered with the Tony Blair Institute to introduce vaccine tracking systems in Ghana, Rwanda and Sierra Leone and to promote them Continent-wide. Given the vast effort that Oracle continues to put into developing a nationwide repository of health records in the USA and the Gulf states, many see its efforts in Africa as a test run for much broader and more ambitious national health databases. African countries are not waiting. Kenya’s Afya Yangu platform is already operational in a third of the nation’s counties and provides portable individual records including medical history, prescriptions, lab results, and appointments for three million users. South Africa faces some of the same challenges as Europe in unifying or supplanting existing systems but its Health Patient Registration System has registered over 57 million patients across more than 3,000 facilities as a foundation for portable electronic health records. Africa’s health data is a vast opportunity which governments will need to use as the basis for investment.
Private sector health investors are indispensable to Africa, Appelbaum thinks. In the US and Europe, they find far more R&D than governments and foundations combined; that must be the pattern in Africa if the Continent is to not just meet its own health needs but to develop innovations for the world.
