EDITORIAL COMMENT: Zimbabwe must push for local drug manufacturing UNAIDS executive director, Ms Winnie Byanyima

Zimbabwe has modernised, innovated and expanded much of industrial base and can now return to manufacturing a wide range of common medicines and make a decisive impact on local production within Africa, helping the continent be more self-sufficient.

The topic came up this week when the visiting executive secretary of UNAIDS, Winnie Byanyima, met President Mnangagwa on the sidelines of the 22nd International Conference on AIDS and STIs in Africa being held in Harare this week, and she was strongly supportive because of Zimbabwe’s track record on health matters for the country to go further.

There were the sanctions problems, but she was willing to lend her support for their removal with besides the reasons of natural justice there also being the opportunity to see Zimbabwe become one of the pharmacology manufacturing centres in Africa since a lot of the required infrastructure was in place or could easily be added.

Zimbabwe once had a flourishing pharmacology manufacturing sector with two major companies and several small concerns producing the bulk of the higher volume essential drugs and looking at expanding ranges. This started unravelling in the 1990s as importing became easier and local industry was reluctant to upgrade.

A lot of the downward slide was reversed in the last five years, and the creation of the innovation hubs at universities and technical colleges means that new approaches are now possible and new products, such as purified traditional medication with proven results, is now possible.

One very important factor is the existence and activity of the Medicines Control Authority of Zimbabwe, an independent regulator that checks the quality of both imported and locally made medications, and insists on a swathe of standards being maintained. Problems that can arise, and have arisen, when a pharmacology company is allowed to be self-regulating simply do not arise.

This regulation has shown the size of the markets in Zimbabwe, and the lengths to which foreign suppliers are willing to go.

When imported medicines are sold the packaging is often tailored for the Zimbabwean market, with the Zimbabwean registration numbers, right next to the foreign address where the drug was made.

This is the law, especially when the medicine is not handled by a retail pharmacist who would put their own labelling and instructions on the product.

The importance of the independent regulation, and thus of independent certification of the products from any locally manufactured medicines, cannot be underestimated, either for the safety of the patients taking the drugs or of the industry and manufacturers creating markets.

People want to be sure that what they are using is safe and effective, and if we are to expand our markets to include exports that will be critical in opening other markets.

One potential roadblock on the journey to creating a local manufacturing industry is the network of agencies and other commercial ties between the Zimbabwean pharmaceutical wholesalers and the foreign manufacturers.

These are strong, and profitable for both parties, and can often mean that the best or cheapest generic drug can be bought only from a single source.

Quite often the problem for a new importer with a different supplier has is the regulatory requirements before they can start selling. They need to spend the initial sums before the can import and sell a single box.

This entry cost along with exclusive agency rights helps keeps prices higher than they should be for many drugs sold in Zimbabwe.

Since a local manufacturer would automatically register any product they started making, and because if they were competitive on price and availability they would be viably building their market, frequently selling directly to hospitals, health systems and retail pharmacies, and so cutting out the middlemen who add a large slice to the price.

The undesirable side-effects of competition in other sectors, leading to the rise of tuckshops and unregistered traders, cannot arise in the pharmaceutical retail trade, since every pharmacy, no matter how small a one-person business, has to be registered as a pharmacy and maintain strict records and follow strict rules.

But that huge growth in the retail pharmacy sector does mean there is a large pool of graduate pharmacists, with business sense and innovative minds, so the human resources side of building a manufacturing sector is largely catered for. The huge range of modern medicines is not a limiting factor. Although new drugs come out all the time, and their formulation goes into the public domain where any manufacturer can make them, happens regularly, we still have well over 90 percent of illnesses that need drugs can be sorted out with around 100 drugs.

This is what makes building up essential drugs lists possible, the sort of stocks that even small clinics can have on hand and be able to sort out most community illnesses and cope with the most common chronic illnesses.

This is obviously the starting point for building up the Zimbabwean manufacturing base. There will still be need of imports and still need imports, although perhaps some generic manufacturers would be willing to look at joint ventures, the critical elements coming from outside but the rest of the formulation and the packaging being Zimbabwean.

This was starting to be explored before the top manufacturers started losing out to imports in the 1990s. The Government could also help the building process, as it has made clear it would like to, using the huge buying power of NatPharm, which supplies the bulk of the public sector and is continually looking for the best value for money without compromising quality.

Here the independent regulator assumes even greater importance, since public sector patients cannot be thought of or be used as test subjects. When they are given their medicine it has to the best there is, so a build up of local product has to meet international standards with no loopholes and no exceptions.

But with those conditions met there will be a growing demand for good quality products at lower prices.

The cost of medicines is high, everyone agrees, and obviously this does not come from the retail sector where there is a pharmacy in almost every city block and suburban shopping centre, no matter how small.

If the supply chain that feeds into that retail network, and feeds into NatPharm, can see an ever greater proportion of local manufacture there are good chances that drug prices can at least be stabilised, and preferably be reduced as the number of steps in a supply chain is cut.

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