Vaccine equity in Africa: a rapid review of policy, legal and governance frameworks to improve research and development

Abstract

Background: Vaccines are instrumental in promoting preventive health and improving health outcomes globally. However, stark inequities in vaccine production, distribution, and access disproportionately burden low and middle-income countries (LMICs), which suffer significantly from these disparities. The COVID-19 pandemic further reinforced these existing inequities, prompting renewed debates on scaling up Africa's research and development (R&D) capacity as a proactive approach to enhance very limited domestic vaccine production and counter persistent inequities. However, there has been no consolidated review of the policy, legal, and governance frameworks that shape this capacity and their implications for vaccine equity. This rapid review asked which policy, legal, governance, and investment frameworks influence vaccine R&D and manufacturing capacity in African countries, and how they affect the continent's ability to secure equitable access to vaccines. Methods: We conducted a PRISMA guided rapid review of peer-reviewed and grey literature. Searches were conducted in Academic Search Premier, Business Source Premier, CINAHL via EBSCOhost, EconLit, Embase, and Ovid Medline via OVID Platform, as well as Google Scholar databases. Eligible documents reported on African vaccine R&D, manufacturing, or related policy, legal, governance, or investment frameworks. Grey literature was identified from the WHO, the World Bank, the Africa CDC, government organizations, private institutions, and policy think tanks. Data was extracted using a structured template and synthesized narratively into thematic areas that aligned with the study objectives. Findings: From 18,038 records, 68 publications met the inclusion criteria. We identified twelve active vaccine manufacturers in Africa and eleven additional initiatives in development, with the majority focusing on fill-and-finish operations and relatively few investing in upstream R&D and drug substance manufacturing. Persistent under-investment in vaccine R&D, fragmented and weak regulatory systems, and dependence on external financing constrain sustainable local manufacturing. Global and regional instruments, including the TRIPS Agreement, the Doha Declaration, ACT-A/COVAX, and the Pandemic Influenza Preparedness (PIP) Framework, create opportunities for technology transfer and impose intellectual property and supply-chain barriers that limit expansion of African vaccine R&D. Conclusion: Africa has the capacity to produce vaccines and related health products. However, this potential is undermined by structural under-investment in R&D, constrained access to technologies and inputs, and weak coordination of policy and regulatory frameworks. Strengthening domestic R&D financing, enhancing regional regulatory and policy harmonization, and proactively engaging in IP and trade negotiations, alongside strategic public-private and product development partnerships, are critical to achieving vaccine equity for African populations.