Enough is enough! It’s time for Africa to produce its own medicines
Dr Isaac Opole with Dr Coleen Christmas, the governor of the Maryland Chapter, the American College of Physicians, at the White House in the United States. Dr Opole notes that certain medications are stable and could be manufactured locally.
Although some medications are manufactured in Kenya, South Africa, Morocco, and Egypt, Africa imports more than 85 per cent of its medicines.
Africa should confront the pharmaceutical behemoths of the West by adopting a more assertive approach against unfair policies that threaten the health of its populations. Dr Isaac Opole, President of the American College of Physicians (ACP), has decried the poor state of healthcare on the continent and is urging African governments to collaborate and produce their own medications.
This strategy would help reduce overreliance on donations, which can be unstable due to unpredictable global dynamics and geopolitical tensions. Although some medications are manufactured in Kenya, South Africa, Morocco, and Egypt, Africa imports more than 85 per cent of its medicines.
“We should ask ourselves: After 50 years of independence, why are we not producing basic medications in our countries? Why are we still relying on imports? Why haven’t we figured this out? Certain medications are stable and could be manufactured locally. Drug manufacturing is not a complicated process. Many of these medications, like aspirin, are quite simple to produce. A basic high school chemistry student could produce aspirin. Early antiretrovirals were made from elementary molecules. These are straightforward compounds,” says Dr Opole, the Kenyan leader of an influential global organisation comprising 161,000 medical practitioners.
The ACP is the largest organisation for medical specialties and the second-largest physician membership society in the US. Its members include internal medicine physicians, retired subspecialists, and medical students. Internal medicine physicians are specialists who use scientific knowledge, clinical expertise and compassion to provide preventive, diagnostic, and therapeutic care for adults, ranging from healthy individuals to those with complex illnesses.
Over the decades, when demand exceeds supply — especially during pandemics — wealthy countries use their abundant resources to secure priority access to medications over poorer nations. This often leaves millions at risk of infection and death. “Take the example of Covid-19 and the vaccines. Why are we not producing our own vaccines for humans? We already manufacture vaccines for livestock such as cows, cattle, sheep, and goats in Kenya. We need a policy-driven initiative to address the drug crisis by firmly stating: ‘Enough is enough. We will produce these medications ourselves.’ We have a historical precedent with HIV medications in the mid-90s when antiretroviral treatments became life-saving after we achieved breakthroughs in antiviral medications, allowing us to help patients living with HIV,” he explains.
Africa should learn from India, which is on the brink of becoming the global hub for drug manufacturing. To meet diverse new demands for medicines, the Indian government has developed a national pharmaceutical policy that focuses on drug pricing and accessibility. One of the primary objectives of the policy is to reduce drug prices by manufacturing Active Pharmaceutical Ingredients locally.
“There's no reason we cannot manufacture insulin, for example. It simply comes down to the question of whether we have the will to do so. In Kenya, we produce some antibiotics, but many medications used in the country come from India. This raises the question: Why are these medications made in India? India is the largest pharmaceutical manufacturer exporting to the US. What is it that allows India to manufacture medication while the whole of Africa does not? There is no miracle behind this; it's a matter of planning, political will, and a commitment to providing the necessary resources to manufacture medications for our own people,” says Dr Opole.
The use of what is commonly referred to as “alternative medicine” in Africa is one of the oldest therapeutic systems. Medicinal plants play a critical role in the traditional healthcare system across the continent. In many regions, traditional healers who prescribe plants are often the most accessible and affordable health resources for the local community, and in some cases, they may be the only option available.
Alternative medicines
“Modern or Western medicine often stems from what were previously used as alternative medications. For example, quinine, a primary treatment for severe malaria, was originally extracted from a plant and used by various communities. South American Indians used quinine to treat fevers, and Artemisinin was utilised in China. Both treatments have been refined and standardised over time, eliminating the need to chew tree bark for medicinal effects. There are valid natural products that demonstrate therapeutic benefits,” observes Dr Opole.
Kenya Medical Supplies Authority offices pictured in Embakasi, Nairobi, on December 10, 2024.
Photo credit: Bonface Bogita | Nation Media Group
“Let’s also remember that when I provide a drug, I am administering a substance that can be toxic, but in a controlled manner. The goal is to deliver the right dosage — enough to cure or treat your condition without causing harm. For instance, too much quinine can result in an overdose and potentially be fatal. The same situation arises with alternative therapies. We often lack knowledge regarding the appropriate dosage for many herbal remedies because we do not have sufficient data to ensure their safety or efficacy. What might seem effective for one person may not work for another, and this uncertainty makes me skeptical about using unregulated remedies.”
Millions of Africans turn to traditional healers due to a lack of medical insurance, particularly when fighting chronic illnesses. Cancer, for instance, has had a devastating impact on communities across the continent, with Africa losing about 2,000 lives daily to this disease, primarily due to a lack of attention from policymakers. Given the high costs of pharmaceuticals, what alternatives does the continent have?
“Screening is crucial for the prevention, early treatment, and management of cancer. For many women in the US who are screened and diagnosed early with breast cancer, it is no longer a death sentence. Similarly, men diagnosed with prostate cancer through early screening and treatment often do not face a death sentence either; many end up dying from other conditions. Therefore, early screening is the most important factor. Unfortunately, even among my friends and family, many people ignore the importance of screening, often thinking, ‘If I don’t check, I won’t find anything’. We can develop a culture of screening, much like Kenya has fostered a robust culture of fitness. People are participating in marathons, and Karura Forest is filled with joggers and walkers. We should cultivate the same passion for screening as we do for cardiovascular fitness and health,” he notes.
“Colon cancer can be easily identified through a colonoscopy, and I have already had mine done. If you are over 45, I believe you should plan to have a colonoscopy as soon as possible. Women should also ensure they have mammograms and pap smears done. If you are a long-term smoker, it is essential to undergo lung cancer screening. Early detection allows for effective treatments, whereas identifying cancer at an advanced stage, when it has grown large or spread to multiple areas, makes treatment virtually impossible. This is why we see so much mortality and morbidity associated with cancer.”
The healthcare system has significant shortcomings, making it difficult for ordinary people to access screening services. Even when these services are available, many people fail to use them.
Although cancer seems to be more prevalent today compared to the past, largely due to increased life expectancy, lifestyle changes, and exposure to environmental pollutants related to industrialisation, Dr Opole believes the issue lies in the advancements in screening and the reporting of cases.
“I don’t necessarily believe that there has been an increase in cancer cases. What is likely happening is that we now have the technological capability to identify cancers that we weren't able to detect before. Modern medicine has advanced significantly, allowing us to identify many more cancer cases than we could in the past. With the help of imaging, scanning, screening, and blood tests, we can diagnose cancer much earlier and reach more people than ever before. There may be a slight rise in cases due to lifestyle changes. Many people are living different lifestyles from those of previous generations, and we face increased exposure to environmental pollutants, chemicals, and dietary products that may be harmful. I can’t deny that these factors probably contribute to the issue. However, we also have sophisticated diagnostic tools that help us identify cancers more effectively than in the past,” explains Dr Opole.
Many developing countries face challenges related to diagnosis, especially chronic illnesses. While early screening is crucial in combating cancer, inadequate technology and a lack of equipment hinder efforts to manage the disease effectively.
“We are not perfect. Physicians make their best educated guesses based on the information provided by patients. For instance, if a patient comes in with a fever, headaches, and back pain after traveling to Mombasa, a doctor might conclude that it is likely malaria. This is a best guess given the symptoms and context. However, we are often not precise, especially when relying solely on our knowledge. At my hospital, we have a highly sophisticated laboratory. If a patient presents with a lump on their throat, we can scan it and determine that we need to take a biopsy. Once we take the biopsy, it is sent to the lab, where the sample is sliced and examined under microscopes, often using various stains and antibodies for analysis. Sometimes, the pathology report returns with findings indicating that certain features are present. For example, it might say, ‘65 per cent of the time, this is associated with X lymphoma’. Even after all the steps are followed correctly, including the biopsy and lab analysis, the result s still indicate a probability rather than a definitive diagnosis.
“As the physician, you have to make what I call the ‘best bad choice’. You have the patient in front of you with a lump in their throat and a 65 per cent probability that it is Hodgkin lymphoma, along with a 35 per cent chance that it is something else. What do you do? You choose to treat the patient for Hodgkin lymphoma based on the higher probability. After six months of treatment, if there is no progress, you might reconsider and explore other possibilities. The diagnostic process is far from foolproof; it is complex and not as straightforward as portrayed on TV.
Doctors in the West have an advantage over their colleagues in Africa, especially in diagnosis, for the simple reason that the access to advanced technology aids them. Dr Opole offers a practical view.
“The situation has become more complicated with the advanced technology available today. I feel a strong connection to my community in Kenya because many of them practice medicine in environments where they lack the resources I have access to here. They often have to make educated guesses and choose the best possible options for treating their patients. Therefore, when we encounter cases of misdiagnosis, it's important to understand that they are not due to a lack of knowledge or skill. Until we provide our physicians with the necessary tools to reduce such cases, they will continue to occur. Physicians are not perfect and do not have an encyclopedic knowledge of everything. Often, they have to offer their best guess based on the information available about what is happening in your body.”