Speech: How Can China Support African Health Sovereignty through Innovative Finance?

Speech Delivered By Development Reimagined CEO Hannah Wanjie Ryder at The Seminar on Deepening High-Quality Health Development Cooperation to Build a Global Community of Health for All, December 12th 2023

Your Excellency Mr. Zhongdong Tang of the Department of African Affairs, Ministry of Foreign Affairs, China;

Your Excellency Mr. Martin Chedondo, Ambassador for the Republic of Zimbabwe to China; Your Excellency Mr. Lahcene Kaid Slimane, Ambassador of People’s Democratic Republic of Algeria to China

Distinguished guests, Ladies and Gentlemen,

As an African woman who works from three continents where my firm, Development Reimagined, is based, I am delighted to virtually join you to present my thoughts, reflections, and possibly recommendations on health cooperation, especially with African countries.

Let me express my particular gratitude for the efforts of the team at the China National Health Development Research Center and for their kind invitation. Their commitment to the theme, “Deepening High-Quality Health Development Cooperation to Build a Global Community of Health for All”, sets the stage for our discussions today.

Ladies and Gentlemen,

Let’s begin with a vision – a world where health cooperation in African countries is not just about trying to save lives today, but about building African capacities to save lives tomorrow

and every day into the future. A world in which health cooperation has what is known in English as an “exit strategy” – a plan to not exist.

This vision, in fact, has been a reality in countries like China and India.

In the late 1970s, China began to accept aid from bilateral donors and multilateral organisations. Official statistics suggest that over the 22 year period from 1979 to 2001, China received just under US$40 billion worth of international aid from multilateral and bilateral sources, with Germany and Japan being the two largest bilateral donors. While this was small in comparison to China’s GDP and population, and it also accounted for just 4% of global aid flows over that same period, nevertheless, it supported China’s development path. Some of this, as well as aid after 2001, was for health challenges – for instance, China received over US$800 million in assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria from 2003 to 2013, making it the Fund’s largest recipient over that period.

Yet, today, China is mostly health sufficient, able to deal with its own health challenges, extend health aid to other countries, and, in some cases, lead the way in global innovations for health.

Similarly, India, over the same period 1979-2001, received just over US$41 billion in aid, some of which was for health, and unlike China that reduced aid receipts significantly thereafter, continued to receive similar amounts of international aid from multilateral and bilateral sources over the next 20 years – around US$40 billion also. With this, and its own domestic actions, India has made significant strides in life expectancy, infant and under-five mortality rates, and disease incidence. Many diseases, such as polio, guinea worm disease, yaws, and tetanus, have been eradicated in India.

Same goes for China, which, for instance went from having 30 million malaria cases a year in 1949, to zero in 2021.

The question is how? The evidence suggests it is not international cooperation. If it were, the African continent, which has been the recipient of over US$350 million in aid from 1979-2001,

and over US$840 million in aid from 2002-2021, much larger figures than China or India, especially per capita, would be in an incredibly strong position today.

So, what is the difference? There are development experts out there who will blame bad governance or corruption as the main reason for Africa’s challenges. I take issue with this. Africans are humans just like all others. Corruption and good and bad governance exist everywhere.

No, what has been different when it comes to health are the degrees to which China and India, and others in a similar position, especially in Asia, have sought to, alongside receiving health aid, developed their own pharmaceutical industries, and managed aid carefully to ensure it boosts the country’s health sovereignty, and does not encourage or exacerbate dependence.

China was initially and remains a net-importer of pharmaceutical products, but its exports have grown extremely fast over the past two decades, with its exports valued at US$12.3 billion in 2020. Today, China does not only excel in innovation, research, and development, particularly in addressing domestic health issues, it has a global leadership position in the production and export of Active Pharmaceutical Ingredients (APIs).

India, on the other hand, has steadily increased its trade surplus in pharmaceuticals – especially of generics – since the early 1990s, with a carefully calibrated intellectual property and pricing regulatory regime that prioritised domestic players and domestic health needs, reaching an export value of US$19.8 billion in the same year, with its imports only at US$2.87 billion, much lower than China at US$30 billion a year.

The two countries now represent the world’s 18th and 10th largest markets by export volumes, respectively – and have self-sufficiency for medicines.

In contrast, as a 2022 Development Reimagined report outlined, every single African country remains a net importer of pharmaceutical products, no matter the size of their domestic pharmaceutical industry, no matter how great their regulatory and business environment and intellectual property protection. Putting this differently, Africa represents only 3% of global drug production but imports over 80% of its consumed pharmaceutical goods. Or put another way – while the first colonial multinational pharmaceutical manufacturers were set up on the continent in the 1930s, and today there are an estimated 600-1000 pharmaceutical companies operating, 22 African countries have no local production of pharmaceuticals at all.

Part of this has been due to the impact of health aid. And let me just give one example to illustrate, but these issues applies to almost every single type of development cooperation.

For instance, pooled global procurement of medicines can crowd out local manufacturing, especially at early stages before scale-up, where production costs are necessarily high, before efficiencies set in. Without active management, global procurement can reinforce established vaccine supply chains, which are heavily skewed to non-African producers. We have seen this with COVID-19. Of the almost 2 billion doses supplied by the WHO’s COVAX during the COVID- 19 pandemic, none were obtained from African manufacturers.

Thus, the global funds can end up harming health sovereignty in Africa rather than building it, and can be seen as being inconsistent with African development plans.

There are similar issues that apply to every type of health aid – from health strengthening work, to health workers and medical aid schemes, even to hospital and other medical equipment building.

This is why today, there is a renewed political ambition in Africa for ownership and sovereignty

– for instance to enhance local production of medicines, vaccines, and health commodities, emphasizing the importance of scaling up quality manufacturing closer to consumers, and learning from the experience of countries such as China and India in managing health aid actively, carefully to build health sovereignty rather than erode it.

This sets the stage for collaboration between Chinese and African stakeholders, presenting substantial opportunities.

Ladies and Gentlemen,

The African continent needs innovation in health cooperation; we need innovation in health financing; we need innovation in healthcare delivery to build a resilient and sustainable healthcare system for the future. And there is an opportunity for China to be at the centre of this, in three ways.

First, China has the opportunity to directly support Africa’s pharmaceutical sector to grow by finding ways to push more foreign direct investment into the continent. Africa is actively working on enhancing its vaccine production capabilities, with countries like Algeria, Egypt, Morocco, Rwanda, and Senegal leading efforts. Private sector investment can be a crucial driver for economic growth and development, and local production capacity for African medicines, can be focused on replacing Africa’s import volumes of health commodities reaching US$21.8 billion in 2021 globally.

And China is well placed.

For instance, of the total bilateral supply of COVID19 vaccines to Africa, our data suggests that China accounted for 75% of donated doses and 61% of delivered doses to African nations. Africa also has abundant raw materials, such as palm oil, latex, and cotton, for the production of essential medical devices and health commodities. With Africa’s growing population, tailoring these to address prevalent diseases, such as malaria, HIV/AIDS, cholera, even monkeypox and other diseases less prevalent in wealthy countries, will be an excellent place to start, especially if Chinese manufacturing firms make local partnerships to bring costs down, and emphasize the importance of indigenous research and development in the pharmaceutical and medical device sectors, with a specific focus on integrating Traditional Chinese Medicine (TCM) and Traditional African Medicine (TAM) practices. This will advantage local medicines.

And, with more efficiency and infrastructure, especially in pharmaceutical parks which already exist and continued to be established in key hubs on the continent, it will also be plausible to position manufacturing on the continent for export to global markets, including back to China,

especially if Africa is able to negotiate for more preferential trading schemes with various countries.

Supporting Africa’s health needs by directing private sector finance to invest in local manufacturing – not just sending and distributing health products – is something we have hardly seen other donors do. It is well overdue.

Second, China can support – with grant-based aid funds – comprehensive capacity-building programs tailored to the specific needs of African nations. This can build on China’s existing collaboration with Africa’s own central health institution the Africa Center for Disease Control (Africa CDC), and can include initiatives to enhance the skills and expertise of local professionals in manufacturing, quality control, and regulatory compliance. Collaboration with the new African Medicines Agency (AMA) will help to ensure that capacity-building efforts are aligned with the latest medical practices and standards standards that are diverse, reflect African needs at the stage of its development not just global multinationals needs for IP protection, and also reflect Africa’s own medical remedies. By helping to build a skilled local workforce in collaboration with Africa’s own medical associations, China can work to support African countries to develop a robust foundation for health sovereignty.

Again, while we have seen many partners including China send medical teams to Africa, or build hospitals, we have hardly seen partners bolster the African institutions that plan to do this, in a big way. At best, the support is ad hoc and small. Yet again, it is well overdue.

Third, and last but not least, China can support innovation in health cooperation to have an “exit strategy” by actively listening to and advocating African positions globally when it comes to health needs. For example, African Heads of State in 2022 agreed a position that all global procurement agencies such as GAVI, UNICEF and others should aim to source at least 30 per cent of all their vaccines from Africa. Similarly, African countries urgently need the WHO to be faster in approving more types or brands of the Oral Cholera Vaccine to improve global supply.

Seeking to understand and support African positions on the global health sector will be incredibly useful for China going forwards – and again, hardly practiced in international cooperation so far.

Ladies and Gentlemen, in conclusion, the road to a thriving health sector in Africa may have its challenges, but the lessons from China and other emerging economies illuminate the path forward. An exit strategy, with local manufacturing, local knowledge and African leadership at its core.

Let us embark on this vision for an exit strategy with optimism, resilience. Only through true health sovereignty everywhere will we build a brighter future for our communities and the generations to come.

Xie Xie!

December 2023

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