In the wake of the Covid-19 pandemic, African governments, regional organisations like Africa CDC, and civil society organisations have focused on how the expansion of medical manufacturing capabilities might promote continental health sovereignty. These ambitions are organised around a conception of sovereignty as collective self-reliance – which echoes Third Worldist conceptions of sovereignty embraced by the Non-Alignment Movement in the 1960s and 1970s.
Though contemporary efforts to establish medical manufacturing infrastructures on the continent are sometimes framed as path-breaking, they in fact precede the Covid-19 pandemic, and even the HIV/AIDS pandemic. In a recently published article, Hamish Evans, Anne Pollock and I, explore the continuities and areas of divergence between how medical manufacturing was imagined and pursued in Africa in the 1960s and 1970s versus now (in the post-Covid period).
Entitled “Wisdom, solidarity and investment from within’: medical manufacturing as an expression of sovereignty and solidarity in post-independence Africa”, the article draws on existing literature, interviews and site visits with key informants, and documents from the online archives of the Organisation for African Unity (OAU) to get a sense of what is distinctive about contemporary efforts to make medicines by Africans, for Africans.
First, we argue that earlier efforts to establish a medical manufacturing base on the continent were embedded in broader efforts by African governments to industrialise their economies and reduce their dependence on primary commodity exports. These efforts occurred in tandem with the non-aligned movement’s efforts to establish a more just and equitable global economic order, as articulated in the Declaration on a New International Economic Order (NIEO) and its Programme of Action. Both were adopted by the UN General Assembly in 1974, largely thanks to the efforts of the Group of 77. The membership of the G77 of course contained many newly sovereign states in Africa and Asia that had successfully overthrown colonial rule and were seeking economic sovereignty alongside political sovereignty. On their understanding, this goal could not be achieved through merely national level reforms, but required a total transformation of the global economic order – hence the call for a NIEO.
In contrast, contemporary efforts to establish a medical manufacturing base on the continent are more narrowly focused on medical manufacturing as such, and are not systematically connected to an industrialisation agenda for the continent, or to a project fundamentally aimed at transforming existing power structures within the global political economy. Rather, the emphasis seems to be on navigating the prevailing neoliberal orthodoxy, which includes making a convincing “business case” for local manufacturing on the continent, trying to demonstrate the conditions under which the African medical manufacturing sector might achieve sustainability, and identifying patient investors who are willing to wait for returns on their investment. At the same time, actors engaged in this endeavour are trying to ensure the continent develops a business model that centres the public interest, by securing predictable access to essential medicines and medical countermeasures for health emergencies, thereby protecting African populations from the whims and caprices of global health partnerships, big pharma, and donor governments.
Second, contemporary efforts often use the language of health security to explain Africa’s commitment to creating a medical manufacturing ecosystem on the continent. However, earlier discourses positioned medical manufacturing as an essential to delivering on anti-colonial liberation movements’ promises of bringing “bread, peace and justice” to their people. Earlier discourses also focused on demonstrating the unique scientific contributions of African researchers and scientists to the field of biomedicine. The ambitions of the contemporary project are by no means small – especially in the face of entrenched inequalities in the distribution of intellectual property, infrastructural capabilities, financing for research and development, and significant disagreements between the Global North and Global South about how to operationalise solidarity in the sphere of health. However, it is less explicitly connected to discourses of liberation and social transformation but instead resonates more closely with articulations of health as a geopolitical and economic security issue.
In the end we argue that:
"although the language of the 1960s and 1970s used economic terms to describe the importance of building medical manufacturing capabilities on the continent, a radical vision informed it. Then, health sovereignty was a constitutive element of achieving true political economic sovereignty; building an industrial base that could contribute to dismantling the mechanisms of neocolonialism (Nkrumah 1965) and creating a form of ‘revolutionary medicine’ (Guevara 1960) forms part of the conceptual and political infrastructures of these discussions. In comparison, contemporary discussions seem much more economistic and frame the significance of medical manufacturing less in terms of justice and liberation, and more in terms of economic growth and health security. This shift is in some way reflective of the dominance of neoliberalism and its narrowing of political futures, as even progressive, decolonial aspirations are seen as being realisable only through the logic of the market.
Although contemporary thinking around medical manufacturing has a less explicitly anti-capitalist articulation than in the immediate post-independence period, it does remain anticolonial and solidaristic in its orientation. Moreover, this framing seems to be achieving a limited but significant durability in building a medical manufacturing base on the continent. Proponents of local medical manufacturing today are having a tangible impact as they rise to the current historical moment.
The contemporary vision for medical manufacturing also reflects ideas of sovereignty that echo the necessity of pan-African collaboration present in earlier discussions of medical manufacturing. However, rather than the ambition of ‘remaking the world anew’ (Fanon 1968), there seems to be a different project – perhaps more ‘implementable’ and equally necessary – of refocusing efforts on medical manufacturing as an experiment in how the ‘regional’ might offer a buffer zone against the violence and wilful neglect the continent experienced at the hands of the ‘global’ during the Covid-19 pandemic."
About the author
Lauren Paremoer is a staff member of the Political Studies Department at the University of Cape Town and a member of People’s Health Movement (PHM) South Africa. She also serves as PHM's Global Steering Council representative for the Democratising Global Health Governance programme. Her research focuses on health activism, global governance for health, and political mobilisation aimed at realising social citizenship in societies of the Global South. She has explored these themes in relation to the struggle for the right to HIV/AIDS treatment in South Africa, the social reproduction work undertaken by community health workers and women more generally, and the use of for-profit markets and philanthrocapitalism to ameliorate the worst effects of deteriorating public health systems.
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