Social and Technological Innovation in Africa: Sustaining a Post COVID-19 Research for Development 9811601542, 9789811601545

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Social and Technological Innovation in Africa Sustaining a Post COVID-19 Research for Development

Solomon Nwaka

Social and Technological Innovation in Africa “This is an excellent and timely book that lays out the challenges and opportunities for establishing and strengthening innovation and entrepreneurship in Africa. The idea of establishing a specialized University to address Innovation and Entrepreneurship education in Africa is brilliant and apt. As the Minister of Education responsible for Science, Technology and Innovation education in Malawi, I am very keen to explore how Malawi can take this idea forward in partnership with other African countries, development partners and investors. This is part of the solution that we seek as we strive to build resilient postCOVID education systems. I particularly like the name IDEA University (Innovation Development and Entrepreneurship Africa University). Ideas are the wellspring of innovation. Properly implemented, the IDEA University concept will be a platform to capture and nurture the creative energy of Africa’s youth who form the majority of the continent’s population.” —Hon. Agnes NyaLonje, Minister of Education, Malawi “It is a truly cutting-edge and timely analysis by an internationally recognized African who has given a lot to the African research and Innovation landscape. It will contribute in strengthening Africa’s research and innovation beyond the present COVID-19 challenges.” —H. E. Prof Sarah Anyang Agbor, Commissioner for Education, Science, Technology and Innovation, African Union Commission “An impressive, balanced, timely and brilliant insights highlighting valuable contributions that situates technical, business, financial, capacity and sustainability aspects of African innovation into perspective and context. The author continues to contribute in strengthening Africa’s research and emerging innovation ecosystem in a diversity of ways.” —H. E. Professor Muhammadou M.O. Kah, The Gambian Ambassador to Switzerland and Permanent Representative to the UNOG, WTO and Other International Organisations at Geneva Former Vice Chancellor, The University of The Gambia, Former provost; VPAA American University of Nigeria & Former Vice Rector for Technology and Innovation & Founding Dean, School of IT & Engineering, ADA University, Baku, Azerbaijan

Solomon Nwaka

Social and Technological Innovation in Africa Sustaining a Post COVID-19 Research for Development

Solomon Nwaka Geneva, Switzerland

ISBN 978-981-16-0154-5    ISBN 978-981-16-0155-2 (eBook) https://doi.org/10.1007/978-981-16-0155-2 © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover illustration: Timothy Hodgkinson / Alamy Stock Photo This Palgrave Macmillan imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

To my late parents—HRH Boniface U. Nwaka and Philomena N. Nwaka. Also, to the African youth, as a token of encouragement.

Preface

This book was inspired by the empirical data generated and lessons learned in course of the work of the African Network for Drugs and Diagnostics Innovation (ANDI) that started in 2008. It draws from the international, regional and national experience of the author in managing research and innovation with the associated human resource development. While the book focuses on the health research, development and innovation ecosystem in Africa, it draws from the broader Science, Technology and Innovation (STI) landscape, including digital- and bio-technologies. On the one hand, the book discusses the untapped opportunities that await the African continent in science- and technology-driven innovation, entrepreneurship and the potential value creation around its traditional knowledge and natural resources. The vibrant and growing demographic of the African youth that want to succeed, the African Diaspora, the prospect of African integration that supports trade and creates new markets are all important opportunities for the continent. On the other hand, the author exposes the conflict between the quest for local leadership, ownership and governance of innovation in Africa versus the lack of political leadership that is rooted in the continents inability to “pay” and the resultant over-dependence on external aid and fragmentation of efforts. This

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desire, as outlined in several African policy and strategic documents, may unfortunately not be realized, with the current fragmented landscape and donor-driven science in Africa. While external support for research and innovation in Africa has been important and needed, sustainability should be incorporated into such support through better coordination and alignment with local development agendas. Importantly, an African political leadership that orchestrates and delivers sustained investment, enabling infrastructure and environment as well as practical, implementable and measurable policy frameworks to support local innovation and entrepreneurship, is needed. The COVID-19 pandemic presents the starkest reminder yet for countries about the importance of research, innovation and education systems that generate knowledge and contribute in addressing societal problems. Hopefully, a good part of the general public now appreciates the nexus of science—research and technology with government policy, leadership and financing as well as the role of academia and the private sector in product innovation and access. The challenges faced by African institutions, scientists, innovators and entrepreneurs in accessing basic facilities and funding on a sustainable basis to address important questions, and in translating research results from the laboratory to market, reflect the current state of science on the continent. The root causes of these challenges, including the reasons that many African institutions, both within and across countries, do not effectively collaborate among themselves the same way they collaborate with institutions in developed countries is explained. In the same vein, many existing African initiatives that support research and innovation depend on external sources of funding for their operations, and when the donors withdraw, the initiatives fold up. These challenges, their solutions and opportunities for innovation in Africa are contextualized in a series of chapters that are supported with evidence, examples, illustrations and personal stories. Several aspects of the African innovation that are not often discussed, such as stages of research, development and the innovation value chain as well as the business, legal, financial, collaborative, technology transfer and intellectual property aspects are addressed.

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The author brings into focus the interplay between social and technological innovation in Africa and shows that the features and trends of most of the ongoing research and innovations on the continent make them largely “social” rather than “technological.” This is the first time social innovation is presented as the dominant innovation in Africa, and the author frames this as the “African Innovation Development (AfID) Theory”. It is significant, as it offers new avenues for framing supportive policies and optimizing and sustaining innovation that creates value and market opportunities for many in Africa. It also opens new research avenues for studying innovation and in addressing Africa’s developmental challenges. The book makes the important and sometimes overlooked point that, besides the activities in the local informal sector, which are not addressed in this edition, some of the more successful technologies or innovations in Africa today have largely been driven or supported by non-African players, institutions, companies, donors or the African Diaspora. These advances are increasingly presented as African innovations and rightly so because some of them are taking place on the continent and impacting lives. It is however important to understand who and what are behind those successes, such as funding, intellectual property rights, know how and sustainability issues. Concrete proposals are presented on the avenues to optimize and scale up research and innovation in Africa: (i) the engagement of various stakeholders to strengthen social innovation that creates value and market for all, (ii) implement a blended pan-African financing mechanism that includes grants, venture and impact-investing modalities for early-stage research and downstream manufacture and commercialization, (iii) promote adoption and adaption approaches for innovation and heighten local production of essential goods and intermediates that boost local supply and value chains, and (iv) implement an innovation, entrepreneurship and vocational training system(s), which interfaces with the private sector and venture financing, and creates jobs. Specifically, the concept of “Innovation Development and Entrepreneurship Africa (IDEA) University or Academy” as a model for building sustained capacity is presented. The book may not be perfect, and the author takes responsibility for any errors or omissions. The goal of writing the book is to share lessons that will hopefully contribute to sustainable development of Africa. The

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importance of sharing such lessons has been highlighted in various highlevel continental strategies such as the African Union (AU) Agenda 2063 and other documents. It is hoped that this book will appeal to the general public, policy makers, academics, students, entrepreneurs, donors, investors, private sector and everyone interested in development. Geneva, Switzerland

Solomon Nwaka

Acknowledgements

It is difficult to mention everyone that have been associated with some of the work reflected in this book. The members of the ANDI (African Network for Drugs and Diagnostics Innovation) Task Force, Scientific Advisory Committees and Board as well as some scientists, government officials and partners are mentioned in parts of the book. Special thanks to colleagues at the World Health Organization (WHO) and the Special Programme for Research and Training in Tropical Diseases (TDR), ANDI, European Commission (EC), United Nations Economic Commission of African (UNECA) and United Nations Office for Project Services (UNOPS) for their support and collaboration. Special appreciation goes to Dr Tshinko Ilunga for all his encouragement and support as well as to Dr Mahmoud Sakr, Dr Barthelemy Nyasse, Mr Issa Matta, Dr Kevin McCarthy, Dr Albrecht Jahn, Dr Robert Ridley and Dr John Reeder. Dr Ridley provided useful comments on the early draft of this manuscript. I am indebted to Prof Johan Thevelein, late Prof Helmut Holzer, Prof Hitoshi Iwahashi, and Prof Bob Dickson for their academic support and mentorship. Johan Thevelein and Helmut Holzer supported some of my early work in implementing capacity building in biotechnology in Africa.

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Most importantly, my loving family was enthusiastic about this book and their support made it possible. Solomon Jr, Gozie, Chika, Nene and Anne—all helped to shape the title of the book at a dinner discussion. I love you all and wish Nene well with the health challenges that she has endured.

About the Book

This book discusses the landscape of sustained investment in research and innovation in Africa, which are critical for development. It addresses both the salient and hidden aspects of the African research and innovation landscape based on empirical evidence and the author’s experience  in managing health and related innovations on the continent and globally. It explains the components of the innovation value chain and identifies the challenges faced by African innovators and entrepreneurs within the chain. Particularly, the financing, collaboration and coordination patterns for these activities on the continent show a fragmented ecosystem that is largely dependent on external donors and aid. It concludes for the first time that African innovation is driven by the principles of social, rather than technological innovation. It calls on African leaders and partners to support, scale up and sustain this dominant innovation to create value, accessible markets and impact toward local and global challenges. This focus is timely, as it might: i) help to support equitable and sustained post COVID-19 normalization and development, ii) help to defragment the African innovation ecosystem that is presently rooted on donordriven agenda, and iii) help to lay a strong foundation for sustainable technological innovation on the continent. The book emphasizes how the COVID-19 pandemic has demonstrated the importance of government policies that incentivize and create xiii

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About the Book

enabling environment for public and private sector entities to innovate and avail essential tools. Importantly, it provides novel avenues for policy and developmental discourse in support of post COVID-19 reconstruction. The author proposes an African innovation and entrepreneurship university that supports formal and vocational training and interfaces with industry and venture financing as a mechanism for scaling up and sustaining human resources and micro- small- and medium-sized enterprises (MSMEs) that proactively address local changes. The book emphasizes the need for an integrated pan-African research and innovation fund that stimulates intra-­African collaboration in health, agriculture, energy, environment and other sectors. These approaches will help to create mechanisms for equitable triangular collaborations rather than a one-sided North-South partnership. They should also leverage the technical support of the African Diaspora.

Contents

1 Introduction: Demographics and Frameworks for African-­Led Research, Innovation and Development  1 2 Landscape for Research and Innovation in Africa 11 3 Research, Invention and Innovation: Social and Technological—What Do They Mean? 25 3.1 Social and Technological Innovation  29 4 ANDI and African Health Innovation 35 4.1 Role of African Scientists and Institutions in the Launch of ANDI and Its Operations  37 5 Human, Institutional and Financial Resources, and Partnerships 59 5.1 North-South, South-South Partnerships and Official Development Assistance  64 5.2 Financing, Official Development Assistance and Proposed African Innovation Fund  70

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6 African Traditional Knowledge, Other Technologies and Emerging Areas 83 6.1 Digital, Bio- and Chemical Technologies in Africa  88 6.2 Emerging Technologies and the Future of Innovation in Africa  95 7 Technology Readiness Levels, the Valley of Death and Scaling Up Innovations 99 7.1 Scaling Up Innovations 105 8 Manufacturing in Africa109 9 Adopting and Adapting Innovations: Frugal, Leapfrogging and Open Innovation Approaches121 9.1 Frugal Innovation 122 9.2 Leapfrogging Innovation 122 9.3 Open Innovation 125 10 Brain Drain, the African Diaspora and Innovation in Africa129 10.1 African Diaspora and Innovation on the Continent 131 11 COVID-19 Pandemic, Leadership and Ownership of Innovation in Africa137 11.1 Leadership and Ownership of Research and Innovation in Africa 150 12 Integrating Innovation and Entrepreneurship into the African Educational System: Concept of IDEA University153 12.1 Overview and Rationale for IDEA Academy or University153 12.2 Vision and Operational Framework 155 12.3 Additional Supporting Information 156

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 ppendix A: Examples of Email Exchanges with African A Scientists and Institutions That Resulted in Establishment of ANDI159  ppendix B: Report of the External Review of ANDI in A October 2012 and Response of the ANDI Board167  ppendix C: External Initiatives Coordinating R&D and A Innovation179  ppendix D: African Initiatives Coordinating R&D and A Innovation189 Index195

About the Author

Solomon  Nwaka’s multi-faceted career spans academia, international organizations and diplomacy, development finance, biotechnology industry, and public-private partnerships in several countries of Europe, Africa, Asia, and the Americas. He has implemented global and regional R&D, partnerships, financing, and capacity-building programs for health and Science, Technology and Innovation (STI), and has written broadly on these and related policies. Nwaka is presently working on the framework for the development of IDEA University—Innovation Development and Entrepreneurship Africa University—in collaboration with some partners. He led the establishment of ANDI (African Network for Drugs and Diagnostics Innovation) and other regional networks at the World Health Organization (WHO) and served as ANDI’s Executive Director within the United Nations in Addis Ababa, Ethiopia. He also served as the Director of the STI Department of the Islamic Development Bank and has advised the African Development Bank and Afreximbank on health programs. Nwaka headed various units at the WHO’s Special Programme for Research and Training in Tropical Diseases in Geneva Switzerland. He also served as Scientific Officer/Director of Drug discovery and innovation at the Medicines for Malaria Venture in Geneva, and as a Senior Scientist/Manager at QuantaNova Canada—a biotechnology company. xix

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Nwaka has served on boards and technical advisory committees of several organizations as well as on scientific editorial boards of journals. He has received fellowships and awards, including fellow of the African Academy of Sciences. He holds a PhD with a focus on Molecular Biology and Biotechnology from the University of Freiburg, Germany. His postdoctoral and academic research focused on molecular mechanisms for stress responses, trehalose, and lipid metabolism—at the University of Kentucky Medical Center, Lexington, USA; the National Agency for Bioscience and Human Technology Tsukuba, Japan; the University of Freiburg, Germany; the Catholic University of Leuven, Belgium; and the International Centre for Genetic Engineering and Biotechnology Trieste, Italy. He is also an alumnus of the Harvard University Kennedy School of Government, Cambridge, USA.

List of Figures

Fig. 2.1

Illustrative figure of African R&D and innovation hotspots showing the pattern of R&D projects received from calls for applications through ANDI Fig. 2.2 Pattern of collaboration in clinical trials—lack of or little collaboration among Africans Fig. 2.3 Patenting trends for key diseases and technologies of interest to Africa Fig. 2.4 Malaria research collaborative pattern Fig. 2.5 HIV research collaborative pattern Fig. 2.6 TB research collaborative pattern Fig. 2.7 Epidemiology research collaborative pattern Fig. 2.8 Chronic diseases collaboration pattern Fig. 2.9 Bioinformatics collaboration pattern Fig. 2.10 Traditional medicines collaboration pattern Fig. 2.11 Diagrammatic illustration of the publications analyzed for the period 2010–2015 Fig. 2.12 Simplified “research to product to market” diagram Fig. 4.1 Integrated Global Drug Discovery Platform for Neglected Diseases. From Nwaka and Hudson (2006)—Nature Review Drug Discovery Fig. 4.2 More than 500 people at the ANDI stakeholders’ meeting, Nairobi 2010

14 16 17 18 18 19 19 20 20 21 21 24 36 38

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Fig. 4.3

List of Figures

ANDI stakeholders’ meeting 2015. Left, right and bottom photos are Dr Tshinko Ilunga—Chairperson of the ANDI Board, Dr Solomon Nwaka—Executive Director of ANDI and Mr James Macharia—Cabinet Secretary for Health (Kenya) during the opening session 39 Fig. 4.4 Example of recipients of the ANDI Innovation Awards in 2015 44 Fig. 4.5 ANDI pan-African Centres of Excellence as of 2016. ANDI implements regular reviews and calls to update, add or remove centers based on criteria 49 Fig. 6.1 Prototype TAM knowledge platform (database) designed by ANDI and partners as part of the initial formulation of this project86 Fig. 7.1 Illustration of the Valley of Death (RTLs 4 –6). The illustration also shows the types of institutions involved in the different RTLs in terms of the work and financing. The overlap in the boundaries is important as those boundaries are increasingly becoming blurred. In all cases, government policies and incentives are important. Diagram is not drawn to scale. 100 Fig. 9.1 ANDI integrated operational and business framework 127 Fig. 11.1 Map of the world showing the spread of COVID-19 around the world and in Africa as of 22 March 2021 https:// covid19.who.int/140 Fig. B.1 Level of agreement with selection of CoE 169

List of Boxes

Box 4.1 Box 4.2

List of Task Force Members List of Board and STAC Members

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1 Introduction: Demographics and Frameworks for African-Led Research, Innovation and Development

With a population of about 1.35 billion in 2020, Africa represents about 17% of the world’s population. This population is projected to reach 2.5 billion by 2050. The median age of the African population is about 19.7 years, suggesting a high and vibrant youth population. The continent’s land area is about 30 million square kilometers, which represents 20% of the earth’s land area. The African continent is the second largest and second-most populous after Asia.1,2 Its middle class is growing, desiring better living standards, products and services, and becoming more involved in governance. The continents diverse and rich natural resources and biodiversity presents an unprecedented opportunity for innovation to overcome some of its developmental challenges. Africa remains the least developed part of the world today—with the lowest average gross national product (GNP). It is notable that 33 of the 54 African countries represent the world’s 47 least developed countries (LDCs) at the time of writing. Those 33 LDCs are part of

 Africa’s Population Boom: Will It Mean Disaster or Economic and Human Development Gains? http://www.worldbank.org/en/region/afr/publication/africas-demographic-transition. 2  https://en.wikipedia.org/wiki/Demographics_of_Africa. 1

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the 46 countries in sub-Saharan Africa,3 and they are characterized by low income (based on gross national income per capita of below $750), human resource weakness (based on indicators of health, nutrition, education and adult literacy) and economic vulnerability (based on the instability of agricultural production, export of goods and services and others).4 These indices have a direct or indirect correlation with the state of health system and level of Science, Technology and Innovation (STI), and/or research activities on the continent. The majority of, if not all the remaining 21, African countries  also have challenges as far as health, STI and research-related developments are concerned. The continent bears the greatest burden of preventable diseases today— with about 25% of the global burden as measured in disability adjusted life years (DALYs).5,6 The burden of non- communicable diseases is increasing at an alarming rate with weak access to basic control and treatment amenities. The continent’s poor cut across all age groups but children, women and the elderly bear the brunt of the limited essential services and infrastructure that support strong health systems, education, clean water and sanitation, food supply and others. Civil unrest and poor governance in part exacerbates the socio-economic situation in some countries. The good news is that progress has been made in the past two decades through both local efforts and  international support. The work of the African Union (AU), the AU Development Agency (AUDA-NEPAD), the United Nations (UN) and bilateral and multilateral partners in support of peace and security initiatives, trade, stronger health systems, improved agriculture and nutrition, infrastructure, energy and legal affairs are noteworthy.7 Some of these sectors have dedicated departments  https://www.un.org/development/desa/dpad/least-developed-country-category/ldcs-at-a-­ glance.html. 4   Facts about Least Developed Countries (LDCs) http://www.unohrlls.org/UserFiles/File/ Publications/Factsheet.pdf; see also note 3. 5  See series of articles in Lancet on global burden disease https://www.thelancet.com/journals/lancet/issue/current. 6  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf. 7  Website of the AU (https://au.int/). 3

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within the AU, working on relevant initiatives in coordination with countries. It is important to stress that African integration is an important component of its development strategy—which aims to carry along African economies or prevent them from working in isolation. It promises significant economies of scale for all sectors. Several countries are also taking bold steps in bettering the lives of their people. However, in all cases of pan-African and country-level initiatives, major challenges remain, especially in the area of implementation of agreed plans, strategies and resolutions. A number of previous and present international multi-sectoral development initiatives, such as the Millennium Development Goals (MDGs),8 and now the UN’s 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs),9 have provided renewed global blueprint to support development, reduce poverty and protect the environment in developing countries. Indeed, in the past decade, prior to the COVID pandemic, the world witnessed a decreasing child mortality10 and better access to information in Africa. Improving on and sustaining these gains in the long-term will require good leadership and innovation from within to address the causes of the problems in the first place. This is particularly important, with any post COVID-19 pandemic reconstruction and retooling agenda. It is widely believed that the under-supported Science, Technology and Innovation (STI) sector, backed with a robust Science, Technology, Engineering and Mathematics (STEM) education, holds the key to overcoming some of the developmental challenges of the continent and unlocking its full potential, in the various sectors. For example, the continent is already witnessing the power of ICTs through the multifaceted application of the internet, mobile phones and associated technologies. Over the years, the AU and AUDA-NEPAD have formulated several important policy documents and strategies to support these desires.  http://www.un.org/millenniumgoals/.  Sustainable Development Goals (SDGs) https://sustainabledevelopment.un.org/?menu=1300. 10  Davey G. and Deribe K. (2017). Precision public health: mapping child mortality in Africa. Lancet, 390; https://www.who.int/news-room/fact-sheets/detail/children-reducing-­mortality, https://www.usaid.gov/sites/default/files/documents/1860/Africa%20Key%20Facts%20and%20 Figures.pdf. 8 9

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Recent among those are the Science, Technology and Innovation Strategy for Africa 2024 (STISA), whose mission is to accelerate Africa’s transition to an innovation-led, knowledge-based economy11; the Health Research and Innovation Strategy for Africa (HRISA): 2018–2030,12 whose mission is to facilitate coordinated, sustainable and responsive health research and innovation that will provide effective interventions for health in Africa; the Pharmaceutical Manufacturing Plan for Africa (PMPA),13 as well as several other related strategies. Some of these developmental desires have formed the basis for a broader pan-African socio-economic developmental framework called Agenda 2063—The Africa We Want.14 This is a high-level and long-term strategy, and the main driver of continental policy, just as MDGs and SDGs have driven international development. As with many pan-African strategies and frameworks, past and present, the bottleneck is with implementation. Perhaps an aspect that is not well understood is why African leaders will approve the development and implementation of a strategy, but do not provide or allocate enough funding to support its implementation at country or regional levels. This has contributed to a fragmented way of financing and implementing certain important continental and country developmental level strategies through aid and international development support. The parts of such frameworks that are eventually implemented are largely financed on adhoc short-term basis by development partners and non-African funding sources. For example, about 72% of the budget of the African Union is financed by non-African sources and developmental partners.15 This type of overdependence on development partners and aid fuels the said fragmentation and the lack of coherence that we see in several sectors of the continent’s research and innovation activities.  Science, Technology and Innovation Strategy for Africa 2024. http://hrst.au.int/en/sites/default/ files/STISA-Published%20Book.pdf. 12  https://www.nepad.org/publication/health-research-and-innovation-strategy-africahrisa-2018-2030. 13  Pharmaceutical Manufacturing Plan for Africa, Business 2012. https://au.int/sites/default/files/ pages/32895-file-pmpa_business_plan.pdf. 14  AU Agenda 2063—The Africa We Want. Second edition, 2014. Popular Version. https://archive. au.int/assets/images/agenda2063.pdf. 15  See 14; AU Reforms (https://au.int/en/AUReforms). 11

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The AU Agenda 2063 acknowledges most of these challenges—paragraph 3 of the Popular Version of the document states: “In this new and noble initiative, past plans and commitments have been reviewed, and we pledge to take into account lessons from them as we implement Agenda 2063. These include: mobilization of the people and their ownership of continental programs at the core; the principle of self-reliance and Africa financing its own development; the importance of capable, inclusive and accountable states and institutions at all levels and in all spheres; … and holding ourselves and our governments and institutions accountable for results. Agenda 2063 will not happen spontaneously; it will require conscious and deliberate efforts to nurture a transformative leadership that will drive the agenda and defend Africa’s interests.” It further states: “We are deeply conscious that Africa in 2015 stands at a crossroads and we are determined to transform the continent and ensure irreversible and universal change of the African condition.” The reference to “taking into account lessons learned” is noteworthy. However, detailed operational, financial, managerial and governance aspects of the said lessons are not often analyzed and disseminated to guide future efforts on the continent. A report on the challenges faced by digital technology hubs in Africa also noted this fact: “while new hubs are starting, the old ones are dying. Very few documents the reasons for their death and those who are starting new ones don’t care much about learning from the mistakes of others. It is important to figure out this puzzle.”16 It is often difficult to see well-documented empirical analysis and data based on the said lessons by the experts that are directly involved in the implementation of such programs. Available reports are largely produced in house with the help of consultants or through academic publications based only on theoretical arguments or logic. This book is different in that it addresses the African health R&D and innovation ecosystem based on empirical evidence and analysis of the evidence. Agenda 2063 is full of hope! It presents the many positive and hopeful aspirations of the African people. A clear set of calls to action were  Jumanne R. Mtambalike (2018) The facts and fictions about innovation and technology hubs in Africa (https://medium.com/@jumannerajabumtambalike/the-facts-and-fictions-about-africainnovation-and-technology-hubs-b46d46c61f75). 16

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identified, covering areas such as the eradication of poverty; improvement of health condition and facilities for the African peoples; catalyzing education and skills acquisition; promoting science, technology, research and innovation; human capital, capabilities and skills development, and so on. This is as good as any strategy or call to action can be. The real hope is that the necessary investment for the approved calls to action will be made to enable concerted implementation. The year 2063 seems like a very long time away, and yes, it is a long time. This type of long-term view is refreshing and critical for Africa’s development, as most times African leaders focus on short-term goals to achieve rapid political, if not personal, gains. We are already several years into the implementation of the Agenda 2063, and sooner or later we will get there. Children born in Africa in 2020 will be 43 years old in 2063. They will read the Agenda 2063 document and ask questions. We have an opportunity now to think about the future of those children. It can takes up to ten or more years to put a new drug on the market with multi-million dollars of investment as well as technical and managerial inputs. Would it not be good to see several locally discovered, developed, clinically tested, scaled up, manufactured and widely accessed or marketed drugs, vaccines and medical devices on the market by 2063? It is estimated that 60% of unemployed Africans are youths and every year about 12 million African youth enter the job market but only about 3 million secure jobs.17 Many African institutions of higher learning lack robust laboratories for STEM education and upgrading those institutions could take anywhere between 2 and 20  years depending on the country and the institution. The COVID-19 pandemic has necessitated the need for a blended education system that incorporates robust digital, virtual and online education support for school children and universities in Africa. Achieving this goal will require access to robust internet connectivity and computers.

 Jobs for youths in Africa—strategy for 25 million jobs and equipping 50 million youth 2016–2025. AfDB publication. https://www.afdb.org/fileadmin/uploads/afdb/Documents/ Boards-Documents/Bank_Group_Strategy_for_Jobs_for_Youth_in_Africa_2016-2025_Rev_2. pdf; Kweitsu R. (2018) http://mo.ibrahim.foundation/news/2018/ brain-drain-bane-africas-potential/. 17

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It is understood that many African countries are poor and struggling with competing priorities. This reinforces the opportunities for stronger collaboration and integration among countries to overcome obstacles. In his first speech at the foundation meeting of the Organization for African Unity (OAU), now African Union, held in Addis Ababa in May 1963, President Kwame Nkrumah of Ghana said: “The resources are there. It is for us to marshal them in the active service of our people. Unless we do this by concerted efforts … we shall not progress at the tempo demanded by today’s events and the mood of our people. It is said, of course, that we have no capital, no industrial skills, no communications and no internal markets …Yet all stock exchanges in the world are pre-occupied with Africa’s gold, diamonds, uranium … We have the resources … but we ourselves have failed to make full use of our power in independence to mobilize our resources for the most effective take-off into thoroughgoing economic and social development … It is within the possibility of science and technology to make even the Sahara bloom into a vast field with verdant vegetation for agricultural and industrial developments. … we have emerged in all the age of science and technology in which poverty, ignorance and disease are no longer the masters … Not one of us working singly and individually can successfully attain the fullest development.”18 It is those same challenges outlined by Dr Kwame Nkrumah almost six decades ago that Africa is grappling with today. A great book by the late Dr Clayton Christensen and his colleagues at Harvard University discusses innovation and the prosperity paradox, and presents example with Singapore: “decades ago Singapore was very impoverished, and one of the main initiatives of the government was to educate its citizens. But when Dr. Goh Keng Swee, one of Singapore’s ministers, would see hundreds of children streaming out of school at the end of the day, instead of being happy, he was heartbroken. He and the Singaporean government understood that simply attending school wasn’t enough. What would the students do after they graduated? How would the economy create and sustain jobs for all these newly educated children? … Focusing on  Dr Nkrumah’s speech at the 1963 OAU Summit. http://www.ghanaculture.gov.gh/modules/ mod_pdf.php?archiveid=2007. 18

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creating prosperity—in contrast to focusing on alleviating poverty— compelled Dr. Keng Swee and the government to ask entirely different questions, pursue different activities and emphasize different metrics … And so, instead of primarily building schools, Singapore prioritized investments and innovation and attracted companies that created jobs. This decision increased the need for education. As a result, Singapore has become one of the richest nations in the world with a GDP per capita of approximately $57,714 … What would have happened if—as many nations do today—Singapore focused primarily on the data of how many children were educated? It might not be as successful today.”19 Many African countries face this dilemma at various levels, for example, thousands of graduates are produced yearly without jobs, and hospitals lacking basic infrastructure, essential medicines and adequate healthcare workers abound. In alignment with the messages in this book, Christensen suggested that developing or emerging economies need to focus on market-­creating innovations that will be accessible and lift many out of poverty. Some scholars have argued that African science and research is confused with Western-driven paradigms, definitions and external donor financing that negate local knowledge, culture and socio-economic standing of the continent.20 At the turn of the century, there seemed to be a hype about Africa’s position on the Science, Technology and Innovation (STI) ladder, supported by  other economic indicators that probably fueled the “Africa is rising” narrative, which may be justified. While African research and innovation agenda should not be “cut and paste,” African scientists and institutions should be empowered to ask and address their own scientific questions and at the same time ensure that their work meets globally established norms and standards. If not, the international competitiveness of some African science may continue to  Christensen C. M., et al. (2019) The Prosperity Paradox: How Innovation Can Lift Nations Out of Poverty (Harper Collins). See also a linked short article by the same authors published at the World Economic Forum 2019 (https://www.weforum.org/agenda/2019/01/poverty-data-never-tellsthe-whole-story/). 20  Mavhunga C. C. (Editor) What Do Science, Technology, and Innovation Mean from Africa? (2017) The MIT Press, Cambridge, MA. 19

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be under-rated. This could partly explain the bottleneck in advancing certain African knowledge such as African traditional medicines, which are often promoted for use for different diseases in Africa based on folklore, without enough supporting data that are backed by proper regulatory oversight.21 Similarly, some scientists claim biases toward the publication of African research in some international peer-reviewed journals.22,23 One could also ask: why African countries are not advancing and scaling up the use of their indigenous knowledge based on their own criteria and guidelines? The fact is that in most cases those local criteria and guidelines do not exist, and local funding to advance research into those local knowledges is hardly made available. The reasons that these challenges exist and the opportunities to address  them, are further addressed in the various sections below. Specifically, the lessons from the work of ANDI (African Network for Drugs and Diagnostics Innovation) and the landscape for health research—including the value chains for innovation from idea to research to development to manufacturing and commercialization, and how they are perceived from Africa—are presented. These evidences helped to shape the conclusion that the dominant African innovation is social in nature, even when some of them have strong technological components. Scaling up this social innovation approach will contribute to sustainable development of Africa, including the various SDGs—whether it is SDG 3.8, which addresses universal health coverage, or SDG 3b, which addresses research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, or SDG 17.16, which addresses global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge and resources to support the achievement of the goals in all countries.  African traditional medicines and traditional African medicines (TAM) have been used interchangeably here, even though there may be subtle difference between them. 22  https://www.npr.org/sections/goatsandsoda/2018/03/26/597067628/scientists-in-africa-wonderif-theres-bias-against-their-research?t=1590829705867. 23  Carroll H. A., et al. (2017) The perceived feasibility of methods to reduce publication bias. PLoS ONE 12(10): e0186472. https://doi.org/10.1371/journal.pone.0186472; Nelson R.  G. (2019) Racism in science: a lingering taint. https://media.nature.com/original/magazine-assets/ d41586-019-01968-z/d41586-019-01968-z.pdf. 21

2 Landscape for Research and Innovation in Africa

The UNESCO Institute of Statistics publishes a series of reports and fact sheets on the global and regional trends in R&D and innovation—covering investment, productivity, number of researchers per capita and global innovation indices. The most commonly used indicators to monitor resources devoted to R&D are gross domestic expenditure on R&D (GERD) expressed in purchasing power parity (PPP$) and R&D intensity (percentage of gross domestic product [GDP] devoted to R&D activities).1 Using these indices by region from 2009 to 2015: sub-­Saharan Africa (SSA) and Central Asia are at the bottom of the R&D investment ladder. The 2015 regional averages for the share of GDP devoted to R&D activities are: 1.7% for the world, 2.5% for North America and Western Europe, 2.1% for East Asia and the Pacific, 1.0% for Central and Eastern Europe, 0.7% for Latin America and the Caribbean, 0.6% for South and West Asia, 0.5% for Arab states, 0.4% for sub-Saharan Africa and 0.2% for Central Asia. Some visual representation of the world in terms of

 Global Investments in R&D (2018): http://uis.unesco.org/sites/default/files/documents/fs50-­ global-­investments-rd-2018-en.pdf; see also various UNESCO data on it as it relates to R&D: http://uis.unesco.org/en/news/rd-data-release#slideoutmenu. 1

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research investment and output shows that Africa is barely visible in relation to other regions.2,3 When other parameters of R&D investment, such as the number of researchers per million inhabitants and other indicators are used, a similar picture emerges. R&D activities can be undertaken by government institutions, the private sector and non-profit organizations with public, private, philanthropic and venture funding. The private sector is by far the greatest backer of R&D in high-income countries, financing about 60% of these activities in North America and over 50% in many European countries.4 In contrast, R&D is mainly funded by the public and philanthropic sectors in Africa, with significant amounts coming from development agencies, and external private and philanthropic agencies. Of the billions of dollars spent by companies in R&D in 2018, for example, little or no investment is recorded for African companies.5 This shows that African companies, in large part, are not R&D-based, and it is best exemplified by the African pharmaceutical and health technology manufacturing companies, which are discussed in detail in Chap. 8. The Global Innovation Index (GII), a publication of the World Intellectual Property Organization (WIPO) and other organizations, provides additional metrics about the innovation performance of 126–130 countries, which represent 90.8% of the world’s population and 96.3% of global GDP. Its indicators explore a broad vision for innovation, including political environment, education, infrastructure and business sophistication.6 Its 2018 report7 shows the ranking of some African countries out of 162 countries worldwide. South Africa was ranked 58 and number 1 in sub-Saharan Africa (SSA), Tunisia ranked 66 and 9 in North Africa and Western Asia (NAWA), Morocco ranked 76 and 13 in NAWA, Mauritius 75 and 2 in SSA, Kenya ranked 78 and 3 in  https://qz.com/449405/this-map-of-the-worlds-scientific-research-is-disturbingly-unequal/.  https://worldmapper.org/. 4  https://www.tellmaps.com/uis/rd/#!/tellmap/-659373586. 5  https://www.statista.com/statistics/265645/ranking-of-the-20-companies-with-the-highestspending-on-research-and-development/. 6  Global Innovation Index (https://www.globalinnovationindex.org/Home). 7  Global Innovation Index 2018: Energizing the World with innovation (https://www.wipo.int/ edocs/pubdocs/en/wipo_pub_gii_2018.pdf ). 2 3

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SSA, Botswana ranked 91 and 4 in SSA, Tanzania ranked 92 and 5 in SSA, followed by Namibia at 93, Egypt at 95, Rwanda at 99 and Senegal at 100. While this is encouraging news for several African countries, regional ranking shows that sub-Saharan Africa is at the bottom of the ladder, behind Central and Southern Asia. Turning to specific analysis within Africa: a series of landscape analysis and data published by the African Network for Drugs and Diagnostics Innovation (ANDI) in 20098 and 20109 showed that some of the most productive African countries in terms of biomedical research publications for diseases that are predominant in Africa, such as South Africa, Egypt and Nigeria, generate 15–150 times less research articles than many developed countries. Importantly, they produce 1.2–8 times less than most developing and emerging countries, such as Argentina, Brazil, India or Thailand. These findings indicate that while research aimed at tackling diseases and conditions that disproportionally affect Africa is indeed being conducted (albeit, largely through external funding by governments and philanthropic organizations), there are still major challenges which prevent research efforts from reaching the scale and productivity that is needed. That analysis identified three main African challenges: (1) a significant knowledge gap for diseases disproportionally affecting Africa within the continent, (2) a low degree of collaboration among African researchers, and (3) insufficient investment and ownership of R&D in Africa. Some other analysis by ANDI10 and other initiatives in the general area of Science, Technology and Innovation11 mirror the picture described  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf. 9  Nwaka S., et al. (2010) Developing ANDI: A Novel Approach to Health Product R&D in Africa. PLOS Medicine 2010; 7(6): e1000293. https://doi.org/10.1371/journal.pmed.1000293. http:// journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000293. 10  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11; Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf. 11  Africa Capacity Report 2017: Building Capacity in Science, Technology and Innovation for Africa’s Transformation. African Capacity Building Foundation. https://elibrary.acbfpact.org/acbf/ collect/acbf/index/assoc/HASH01ad/e44e7241/b749d69a/1a6c.dir/ACR2017%20English.pdf. 8

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above and consistently show that the bulk of the said activities undertaken in African countries are concentrated in a few Africa countries. Analysis of data from calls for pan-African Centres of Excellence in health innovation, research projects and funding in Africa shows that South Africa consistently comes on top, followed by Egypt and then countries such as Tunisia, Nigeria, Kenya, Ghana, Uganda and Cameroon. Figure 2.1 shows a pattern of R&D projects received by ANDI as a result of its calls for application. Some more recent studies by ANDI based on publication outputs by African scientists and their global peers between 2010 and 201512,13 show the following trends for 20 African prevalent diseases and related technology developments:

Fig. 2.1  Illustrative figure of African R&D and innovation hotspots showing the pattern of R&D projects received from calls for applications through ANDI

 Facilitating Health Innovation in Africa—ANDI’s Five Year Strategy (http://andi-africa.org/ ANDI_File/Strategic_Plan/Facilitating_Health_Innovation_in_Africa_ANDI_Strategic_ Plan(2016-2020).pdf ). 13  Nwaka S. (2017/2018). Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review, pp. 76–80. 12

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(a) Of some 7.5 billion articles produced from 2010 to 2015, only about 0.4% include African authors, even though the scientific issues addressed are those that predominantly affect Africa (see Fig. 2.11). This demonstrates that while progress in expanding African R&D capacity is being made, Africa is still lagging in research and innovation. (b) On average, only about 0.22% of patents filed globally originated from African innovators, suggesting that Africa represents a small subset in terms of patent-driven innovation. Many specific indications like malaria show even lower percentages. While this is indicative of the gap in the translation of technologies from laboratory to market, it also highlights the need to explore suitable options for intellectual property management in Africa, as African R&D institutions find the cost of patent filing prohibitive. Importantly, this also shows the need to incentivize the development of research- and innovation-­driven companies on the continent. (c) Several African institutions are leaders in their areas of focus, suggesting that scale and technical know-how can be improved if more partnerships are created with established institutions within and across African countries. (d) Intra-African networks are not well articulated but national clusters are growing, and most of the time a foreign institution serves as a bridge or link between various African institutions in various countries. While this shows the important role that foreign institutions can play in Africa, it also highlights the importance of financing in those linkages. Figures 2.2 and 2.3, showing the pattern of clinical trials and patenting trends in Africa, respectively, further illustrate some of these findings and corroborate earlier findings.14 They also highlight the consistent weak capacity of institutions in the Central African region that has been noted in various other studies (see also Figs. 2.1 and 4.5). This trend is also seen in analysis of R&D capacity, calls for project proposals and Centres of  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf; 32. 14

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Fig. 2.2  Pattern of collaboration in clinical trials—lack of or little collaboration among Africans

Excellence.15 Of course institutions in Cameroon and Democratic Republic of the Congo do much better. An observation that we have made several times is that Cameroon has consistently shown strength in the quality and quantity of applications received from the country. The reason for this could be partly because Cameroon is reasonably stable politically with some reasonable education and higher education infrastructure that has been developed over many years. Some other inner landlocked countries of Central Africa have not had that luxury, and this again highlights the importance of the African integration approach to support all countries. This dominance of North-South collaboration in African R&D and innovation has persisted for a long time for the various disease areas that we looked at, such as malaria, HIV/AID, tuberculosis, kinetoplastid diseases (e.g., leishmaniasis and trypanosomiasis), helminths (e.g., schistosomiasis and onchocerciasis), diarrheal diseases as well as chronic diseases.  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11; Africa Capacity Report 2017: Building Capacity in Science, Technology and Innovation for Africa’s Transformation. African Capacity Building Foundation. 15

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Fig. 2.3  Patenting trends for key diseases and technologies of interest to Africa

The same is true for several functional research areas, such as epidemiology, pharmacology, bioinformatics and even African traditional medicines. Additional unpublished data for some of these diseases and functional areas showing a lack of intra-African collaboration are presented in Figs. 2.4–2.10, covering research on malaria, HIV, TB, chronic diseases, epidemiology, bioinformatics and African traditional medicines. The general methodology used for this analysis is similar to what was described before,16 and the specific diagrammatic illustration showing the number of publications analyzed for the period 2010–2015 is presented in Fig. 2.11. To be clear, North-South collaboration is very important for all the parties involved, as discussed in other parts of this book, but it should be designed to be equitable and sustainable.

 Nwaka S., et  al. (2010) Developing ANDI: A Novel Approach to Health Product R&D in Africa. PLOS Medicine 2010; 7(6): e1000293. https://doi.org/10.1371/journal.pmed.1000293. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000293. 16

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Fig. 2.4  Malaria research collaborative pattern

Fig. 2.5  HIV research collaborative pattern

2  Landscape for Research and Innovation in Africa 

Fig. 2.6  TB research collaborative pattern

Fig. 2.7  Epidemiology research collaborative pattern

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Fig. 2.8  Chronic diseases collaboration pattern

Fig. 2.9  Bioinformatics collaboration pattern

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Fig. 2.10  Traditional medicines collaboration pattern

Sampling Methodology %

Universe

~7549 m

7.6%

All Papers published from 2010 to 2015

~572 m

Papers related with our 20 areas of interest

5%

~28.6 m

68%

Papers that included at least one African institution as coauthor

% of the previous stage that meet the criteria ~19.5 m

Final sample

Papers that included at least one African institution as lead author

SOURCE: SNA-KOL Capability, Thomson Innovation

Fig. 2.11  Diagrammatic illustration of the publications analyzed for the period 2010–2015

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The trends shown in Figs. 2.2–2.10 raise the possibility that African research and development are mostly not controlled by Africans, including the scientific questions being addressed. This may to some extent reflect the concept of “parachute research”17—which is an exploitative research phenomenon whereby researchers from largely high-income countries take research data and knowledge from predominantly low- and middle-income countries (LMICs) for publication and other purposes without due recognition of local partners, who in most cases have done or contributed to the work. This phenomenon goes beyond mere research and publications, but reflects a result of unequal partnerships due to overdependence on external funding for African research. It is a function of the fragmented R&D financing landscape in Africa that largely comes from rich countries and donors— who or whose investigators or funding terms in turn dictate the fate of the R&D outcomes. A recent correspondence to the editor of Nature Medicine highlights how the “Black Lives Matter” movement and other recent developments are exposing the continuing existence of colonial and racial legacies of many Western institutions that perpetuates this type of unequal research collaboration.18 The authors discuss how global health research imbalances and white centrism, for example, have narrowed the meaning of scientific inquiry and caused poor recognition of researchers from developing countries. Again, the significant gap in sustainable investment in African research and/or scientists has been echoed by others as a major reason significant African-based research is led by external institutions and donors.19 These unequitable North-South partnership challenges have resulted in several initiatives to counter unethical behavior in such partnerships. These include the development and promotion of the Global Code of  Lancet Editorial (2018) Closing the door on parachute and parasites. Lancet Global Health, 6, e593 (https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30239-0/fulltext); Smith J. (2018) Parasitic and parachute research in global health. Lancet Global Health, 6, 3838. (https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30315-2/fulltext). 18  Erondu N. A., Petra D. and Khan M. S. (2020) Can schools of global public health dismantle colonial legacies? Nature Medicine. https://doi.org/10.1038/s41591-020-1062-6. 19  Boum Ii Y., et al. (2018) Advancing equitable global health research partnerships in Africa. BMJ Glob. Health 3, e000868; Abimbola, S.  BMJ (2019) The foreign gaze: authorship in academic global health. Glob. Health 4, e002068. 17

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Conduct for Research in Resource-Poor Settings (GCC), which provides guidance on the significant power imbalances involved in international collaborative research.20 The GCC has also proposed a Research Fairness Initiative with contracting tools to address these challenges in low- and middle-income countries (LMICs). To ensure emphasis and for brevity, some of the lessons learned about these challenges and how they can be addressed have been summarized as numbered lessons after a relevant topic: Lesson 1: While some great scientists and institutions performing cutting-­edge research exist in Africa, they largely depend on external and irregular sources of funding to address meaningful scientific questions that can impact their communities.21 Few African countries have sustainable research funds to support competitive or pre-competitive R&D, and a pan-African fund does not exist at the present time. This situation has made it difficult for African scientists and institutions to engage in intraAfrican collaborations even for the most prevalent diseases and challenges in Africa. Where there is intra-African collaboration on a project, you will find that in several instances the project is under the “leadership” of a high- income country institution or reporting direction of an external donor. Lesson 2: Existing collaborations are largely North-South and in most cases the Northern partner leads the project because either the funding or the know-how or both come from there. While this approach has led to important results and outcomes, it has not resulted in the sustained development of a critical mass of African scientific leaders and institutions that can address scientific questions tailored to the needs of their communities. Furthermore, most scientists and institutions do not have the requisite support and mentorship to translate their ideas into products and services that address local problems. Processes associated with translational research, such as licensing, business development and  Schroeder D., Chatfield K., et  al. (2019) Equitable Research Partnerships: A Global Code of Conduct to Counter Ethics Dumping. https://doi.org/10.1007/978-3-030-15745-6. Springer. 21  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf; see also refs 15, 16. 20

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financing, technology transfer and intellectual property management, are poorly developed, and they are not systematically addressed in African R&D institutions and universities.22,23 This also means that biotechnology type of businesses and entrepreneurs have been slow to emerge from existing public institutions. A simplified “research to product to market” diagram is outlined in Fig. 2.12 to introduce the different types of product- or technology-based research. A detailed description of R&D, social and technological innovation and the innovation value chain, as well as specific project or portfolio examples through the work of ANDI and others, is presented in subsequent chapters. These chapters, including manufacturing, shed more light on the nature of research and innovation taking place in Africa and how they corroborate the principles of social innovation as the dominant innovation in Africa.

Idea

Discovery or Basic/Applied Research lab. Environment.

Development or Prototyping & Analysis Relevant Environment

Production, Analysis/Certification, Market launch/ penetration

Impact

Real World

Requires investment & management, public & private sector, transition from one phase to another, IP & tech transfer

Fig. 2.12  Simplified “research to product to market” diagram

 Africa Capacity Report 2017: Building Capacity in Science, Technology and Innovation for Africa’s Transformation. African Capacity Building Foundation. 23  Liotta C. D., Nwaka S., et al. (2018) North-South collaborations to promote health innovation in Africa. Emory Law Journal 67:619–653. 22

3 Research, Invention and Innovation: Social and Technological—What Do They Mean?

Over the years, various experts (economists, policy makers, scientists, engineers and business strategists) have debated how terms, suchs as research, development, invention and innovation are linked as well as the differences between them. A simplistic approach to understanding these terms is to first appreciate that they are different but closely linked. The Organization for Economic Cooperation and Development’s (OECD) Frascati manual divides research and development (R&D) into three activities—basic research, applied research and experimental development.1 Basic research is experimental or theoretical work undertaken to acquire new knowledge of the underlying foundation of phenomena and observable facts, without any immediate application or use in view; applied research is almost the same as basic research, except that it is directed toward a specific practical objective; experimental development is a systematic work drawing upon existing knowledge gained from research and/or practical experience, which is directed to producing new materials, products or devices; to installing new processes, systems and services; or to improving substantially those already produced or installed.  http://www.oecd.org/sti/inno/frascatimanualproposedstandardpracticeforsurveysonresearchande xperimentaldevelopment6thedition.htm.

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Product development, on the other hand, is the entire process of researching, designing, creating and marketing new products. Research and development (R&D) is essentially the first step in developing a new product, but product development is not exclusively research and development. It is the entire product life cycle, from conception to sale.2 Existing products can go through product development to revamp old features or add new ones, so that the product sells better or adds greater value to consumers (the concept of “me too” or reformulation of existing products). Research and early parts of product development are collectively also called “upstream research or development” while the later part of product development to commercialization is “downstream research or development.” Innovation is the implementation of a new or significantly improved product, good or service or process or a new marketing method or organizational method in business practices, workplace organization or external relations.3,4 Invention is an integral part of innovation. It is the occurrence or creation of an idea for a product or process that has never been made before.5 One prevalent trend in discussions on African R&D and innovation is that these concepts are often lumped together and therefore confused with each other. This is further confounded by the lack of clear transition points and processes, not to mention that these definitions are largely blurred in the practice of most African knowledge. Most African Science, Technology and Innovation (STI) meetings end up discussing activities focused on basic or fundamental research, policy and education without elaborating on the equally important downstream development and innovation components, even when the agenda for such events may feature important aspects of innovation and commercialization. Open and frank discussions on the corridors, during and after 2  https://www.investopedia.com/ask/answers/042815/what-difference-between-research-and-­­ development-and-product-development.asp. 3  https://read.oecd-ilibrary.org/science-and-technology/oslo-manual_9789264013100-en#page1. 4  Crossan M.M. and Apaydin M. (2010) A multi-dimensional framework of organizational innovation: A systematic review of the literature. Journal of Management Studies, 47 (6), 1154–1191. 5  Surbhi S. (2016) Difference between invention and innovation (https://keydifferences.com/ difference-­between-invention-and-innovation.html).

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such meetings, reflect these facts, and examples exist.6 This trend also reflects the status of true innovation activities, or rather the lack of them, in Africa. To be clear, aspects of manufacturing and commercialization, if any, are usually presented on a miniature scale, with critical challenges to be addressed, which rarely get addressed afterward. In the digital technology space, major mobile technology breakthroughs are taking place. While these can rightly be presented as African innovations, it is important to note that most of the initial funding and in some cases the ideas behind these innovations and their operationalization in Africa have originated from overseas partners. The history of the famous M-pesa mobile payment system in Kenya is consistent with this trend.7 Mobile money or payments have now spread across Africa and they are making a major difference, and many startups are being established based on this. Another example is in e-commerce—the Zipline drone delivery system for medical supplies—starting with blood and vaccines in Rwanda.8,9 A collaboration between Zipline (a Silicon Valley robotics company) and the government of Rwanda enabled Zipline to start dropping blood to hospitals in late 2016. This drone technology has now made it possible for hospitals to receive blood, medicines and essential supplies within 15 minutes of placing orders electronically from their desks, rather than hospital personnel making hours of multiple round trips to Kigali to procure essential samples frequently required for life-saving procedures. The United Parcel Service of America, Incorporated (UPS), initially financed Zipline through its charitable foundation. Rwandan authorities, including the civil aviation agency, became a critical stakeholder, providing the enabling environment for Zipline drones to operate in Rwanda. More importantly, Zipline is now in the process of assembling drones in  3rd African Forum on STI (2018). https://www.afdb.org/fileadmin/uploads/afdb/Documents/ Generic-Documents/Third_Africa_Forum_on_Science__Technology__and_Innovation__STI_-­_ eng.pdf. 7  History of M-pesa (https://en.wikipedia.org/wiki/M-Pesa#History). 8  Rosen J.  W. (2018) MIT Technology Review (https://www.technologyreview.com/s/608034/ blood-from-the-sky-ziplines-ambitious-medical-drone-delivery-in-africa/). 9  Tashobya T. (2018) Zipline to start assembling drones in Rwanda (https://www.newtimes.co.rw/ news/zipline-start-assembling-drones-rwanda). 6

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Rwanda to make this operation sustainable. This move should be commended, as it will create local jobs and train Rwandans and indeed Africans in drone engineering and logistics management. It is not a common occurrence for a relatively young firm to establish an assembly plant in sub-Saharan Africa. This is the type of sustainable and long-term North-South collaboration approach or investment that this book is advocating for innovation in Africa. Although this Zipline drone project in Rwanda is a technology project, it is stakeholders-driven, involves communities, hospitals, donors, investors but importantly, it provides access to poor communities in a manner that makes it a social enterprise or innovation. An impressive antimalarial drug discovery project at the University of Cape Town (UCT) that progressed into clinical-phase studies is being funded by the Medicines for Malaria—MMV (see Appendix C). In its early days, the project was supported by the Special Programme for Research and Training in Tropical Diseases (TDR) and ANDI at the World Health Organization (WHO), as an important African-led project in drug discovery. WHO/TDR, through the author, provided early chemical scaffold for optimization from its past drug screening campaigns with modest funding for the investigator at UCT (Dr K. Chibale—a brilliant African chemist), to progress the compound and train African scientists.10,11 A contractual agreement was also put in place for this and other related collaborations. Subsequently, the project was presented to MMV for broader funding by Dr Chibale and WHO/TDR through the author of this book. This subsequently opened the door for a broader collaboration between UCT and MMV, and continuing support by the South African government for the center, with companies also joining the partnership. The center was also recognized and promoted as a pioneer ANDI Centre of Excellence in Drug Discovery,12 and it has since evolved into a world-class drug discovery center called H3D. It is commendable  Nwaka S., et al. (2009) Advancing Drug Innovation for Neglected Diseases—Criteria for Lead Progression. PLoS Negl Trop Dis 3(8): e440. https://doi.org/10.1371/journal.pntd.0000440. 11  Ndakala A., et al. (2011) Antimalarial pyrido[1,2-a]benzimidazoles. J Med Chem 54(13):4581–9. https://doi.org/10.1021/jm200227r. Epub 2011 Jun 16. 12  Nwaka S., et  al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11. 10

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to see the progress being made by H3D, with drug candidate(s) entering clinical development funded by MMV and others.13 This again highlights the importance of partnership, and the H3D center at UCT is presently the only African institute that has transitioned a novel small molecule drug candidate from discovery to clinical development through the support of multiple stakeholders. In part this reflects the potential to realize the vision of African-led innovation. It provides hope for other African centers engaged in R&D-based innovation. Again, this discovery research project is stakeholders-driven—involving both public and private sector entities as well as local, philanthropic  and international funding to discover drugs without strong commercial incentives. It engages the community by building capacity and training students in Africa. These examples from digital technology and pharmaceutical research projects clearly demonstrate that the principles of social innovation are at play in these successful projects. Although most African-based projects are not as successful as these, they are still largely dependent on external funding and driven by the same principles of social innovation (see 3.1 below). This does not, and should not, exclude those programs, businesses or resultant products from making profit or creating market and wealth that benefit stakeholders and communities, rich or poor, in an equitable way. Parts of such profits (where they exist) should be channeled back into the projects to sustain their operation in the long term rather than depend solely on grants, which is not sustainable. Such projects can also leverage venture funding and support the development of research based biotechnology or pharmaceutical companies in Africa.

3.1 Social and Technological Innovation From the invention of the steam engine to electricity to X-ray to the internet and mobile phones, innovation have touched our lives and affected the way we work, our health and how we interact with each other. There is more to come as we imagine the future impact of emerging technologies on our lives. The world would be a different place today if some of the existing innovations were not transitioned from ideas and laboratories to society. Indeed, there are several stories of potentially 13

 H3D-UCT (http://www.h3d.uct.ac.za/home-197).

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viable inventions that have never progressed beyond the laboratory or early testing phases. These are largely stuck in the so-called valley of death—a metaphor for the transition between academic research and market commercialization (further explained in Chap. 7). While technology has helped to lift many people out of poverty, it has also left many of the society’s poor behind and poorer. This interplay between technological innovation and society has given rise to the concept of social innovation. Although social innovation appears to be linked to technological innovation, there is no consensus as to its definition. In Africa, the meaning of both social and technological innovation is blurred, but many, including scientists and policy makers, believe that any product-driven research qualifies as technological innovation. While technological innovation is often viewed as a driver of economic change and its many benefits, social innovation emphasizes the social impact of interventions that results in change, inclusion, equity and welfare.14 While both innovations support poverty alleviation, technological innovations largely target markets that create wealth and prosperity. A major difference between them lies in the fact that social innovations are manifested by changes in social practices that promote inclusion, accessibility and equity, whereas technological innovations are associated with products that impact society or organizations.15 We argue that the features of such products, the novelty introduced in them, how any intellectual property rights associated with them is handled, their financing and commercialization modalities as well as intended markets should be considered in determining whether a presumed technological innovation is more of a social innovation. The development and growth of social innovation are impeded by factors such as limited access to finances, poorly developed networks, limited skills and support structures.16 These challenges mirror those  Alijani, S. and Wintjes, R. (2017). Interplay of Technological and Social Innovation. SIMPACT Working Paper, 2017(3). Gelsenkirchen: Institute for Work and Technology. 15  Howaldt, J., Kopp, R. and M. Schwarz (2015). Social Innovations as Drivers of Social Change— Exploring Tarde’s Contribution to Social Innovation Theory Building. In: Nichols, A., Simon, J. and M. Gabriel (eds.), New Frontiers in Social Innovation. Palgrave Macmillan, Houndmills: 29–51. 16  TEPSIE, “Social Innovation Theory and Research: A Summary of the Findings from TEPSIE.” A deliverable of the project: “The theoretical, empirical and policy foundations for building social innovation in Europe” (TEPSIE), European Commission—7th Framework Programme, Brussels: European Commission, DG Research. 14

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described across this book in relation to innovation in Africa, whether they are presented as social or technological. Just like R&D and related early technological innovations in Africa, most social innovation activities on the continent are largely supported by external grant funding through philanthropic, public and private agencies. It is well known that the perceived lack of commercial incentives or purchasing power that drives investment in R&D and technological innovation is ever present in lowand middle-income countries. This phenomenon is well documented in the area of health and access to medicines,17 and has given rise to product development partnerships (PDPs—see Appendix C) to develop drugs and other health tools  for some diseases that disproportionately affect developing countries, using public and philanthropic financing and industry facility and participation.18 Whereas African countries want R&D that supports technological innovation and socio-­economic development, the structures to boost such innovations are weak, and the competition or regulation associated with export markets places the continent at a disadvantage. This clearly show that the current state of R&D and innovations in Africa is rooted in the principles of social innovation. Social innovation usually entails community involvement, network of actors, stakeholders and grant funding—in many cases leveraging technologies for operations in Africa. In fact most of the digital tech hubs in Africa start off as social enterprises, although some are now beginning to transition to independent profit-making structures, by incorporating various services and consultancies in their portfolio of activities. Individual entrepreneurs most times invest personal monies to establish small social businesses by leveraging emerging technology hubs and workspaces to develop their ideas. Based on all these features and the trends discussed all over this book, we suggest that most innovations in Africa, including organizations managing R&D, are practicing social innovation. This may create a unique opportunity and coherence to the African continent if it capitalizes on and leverages this trend to develop a scalable and sustainable innovation ecosystem that addresses the needs of everyone rather  Trouller P., et al. (2002) Drug development for neglected diseases: a deficient market and public-­ health policy failure. Lancet, 359: 2188–94. 18  Nwaka S. and Ridley R. (2003) Virtual drug discovery and development for neglected diseases through public-private partnerships. Nature Review Drug Discovery 2, 919–928. 17

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than making a few shareholders rich at the expense of the poor. Again, such  social innovation can create accessible markets and wealth that touches everyone. We have highlighted a donor-driven R&D agenda in Africa in different parts of this book. Perhaps focusing on and scaling up social innovation on the continent may encourage donors and development partners to consider realignment of their support toward sustainability of innovation in Africa, including manufacturing. This may allay the possible fears of some donors about investing in the creation of wealth just for  private entities  or a few individuals rather than investing in a public good. This will also mean that those donors will be focusing on implementing the agreed African agenda rather than helping to fuel the current fragmented strategies. It would therefore make sense for the continent to focus its limited resources on achieving scale and diffusion across the continent with this type of socially driven innovation. This is probably the most plausible route for Africa in the short-to-medium term to scale up and sustain its innovation programs to address immediate developmental needs. In the medium- to long-term, these programs with developed human, financial and infrastructural resources can jump-start the development and commercialization of indigenous technologies with well-developed value and supply chains, and clear trade and legal instruments. This is the first time this concept is described for African research and innovation, and it is hoped that this will trigger further research, academic and industrial work as well as policy dialogue in the spheres of R&D- and non-R&D-based social innovations for improving and sustaining the socio-economic development of Africa. This dominance of social innovation in Africa, its features, the need to scale it up, and leverage it to develop a sustainable innovation ecosystem is hereby referred to as the Nwaka “African Innovation Development (AfID) Theory”. The proposed social innovation in Africa fits with the broader concept of “stakeholder capitalism” that the World Economic Forum (WEF) has proposed, and which formed the theme of its January 2020 DAVOS meeting.19 Stakeholder capitalism may be defined as a system in which corporations are oriented to serve the interests of all their stakeholders, which include customers, suppliers, employees, shareholders and local  https://www.weforum.org/agenda/2020/01/stakeholder-capitalism-principle-practice-betterbusiness/.

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communities.20 The purpose is for companies, innovators or entrepreneurs to focus on creating value and markets for all stakeholders rather than maximizing profits that only enhance shareholder values at the expense of the poor. Shareholder value is what is delivered to equity owners of a company that results from the ability of the management to increase dividends and capital gains to shareholders. This concept becomes even more interesting if one considers the areas of research, development and commercialization in the pharmaceutical and healthcare sectors, for example. Most of the basic research that results in new ideas and products originate from public institutions. These product ideas are then transferred to corporations to develop and commercialize through technology transfer or other arrangements. In some cases, corporations find their product concept from publicly funded research that is available in the public domain. Many have therefore argued that most pharmaceutical innovations benefit from public funding, and that it is unfair for corporations to now develop products based on publicly funded research and sell them at an exorbitant cost to the general public.21 There is consensus that the know-how and resources available to companies are most ideal for addressing the expensive downstream product development, manufacture and commercialization; and that the companies should make reasonable profits to be able to sustain their operations and continuously bring innovations to the market. However, such should not be at the expense of taxpayers and the poor, who cannot afford the eventual high price tag on products. Most African countries have deficient markets that are unable to meet shareholders’ expectation for certain essential medicines for diseases that disproportionately affect them—hence, the emergence of the term neglected diseases due to the lack of innovation for those diseases. Over the years, this type of neglect has fueled the spread of substandard and falsified medicines in Africa, including through importations and local sources. This has also straddled most of the existing local generic producers. It sounds plausible that a  https://www.investopedia.com/stakeholder-capitalism-4774323.  Conti RM and David FS (2020).  Public research funding and pharmaceutical prices: do Americans pay twice for drugs? [version 1; peer review: awaiting peer review]. F1000Research, 9:707 (https://doi.org/10.12688/f1000research.24934.1); https://thehill.com/opinion/ healthcare/376574-pharmaceutical-corporations-need-to-stop-free-riding-on-publicly-funded. 20 21

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targeted social innovation mechanism that creates value and local markets for these pharmaceutical and health products in Africa is the way forward. This would be consistent with stakeholder capitalism, which aims to provide concerted solutions for global development. Clearly, the concept of African integration that promises common markets and closer collaboration, regulatory and oversight processes, and relevant investment is something that will further boost and sustain innovation on the continent. This will incentivize local or foreign direct investment and promote private sector development and exports. Some of these structures are being put in place both at the sub-regional and at the continental level, but more remains to be done, especially in relation to research and innovation. The Common Market for East and Southern Africa (COMESA),22 the African medicines regulatory harmonization initiative  and development of the African Medicines Agency23 and the new African Continental Free Trade Area (AfCFTA), which is now headquartered in Accra,24 are examples of initiatives that could be leveraged to advance innovation in Africa. The COVID-19 crisis (further discussed in Chap. 11) has further reinforced the criticality of innovations that create accessible products and markets for everyone. An integrated African market will create further opportunities for stronger collaboration in research and innovation. 

 https://www.comesa.int/overview-of-comesa/.  https://au.int/en/pressreleases/20180520/african-union-ministers-health-adopt-treaty-establishmentafrican-medicines. 24  https://au.int/en/ti/cfta/about; https://www.africa-eu-partnership.org/en/afcfta. 22 23

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The idea behind the establishment of ANDI and other regional innovation networks in Asia and the Americas emerged from the work of the genomics, drug discovery and innovation units of the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR), which the author headed at various times. A global and integrated network for drugs and diagnostics discovery was established and implemented.1 The illustrative nature of the integrated discovery research that is linked to partnerships, networks and capacity building initiatives is depicted in Fig. 4.1. This work led to the discovery of drug leads, some of which were transferred to product development partnerships and various investigators for further optimization, with some products

 Nwaka S. and Hudson A. (2006) Innovative lead discovery strategy for tropical diseases. Nature Reviews Drug Discovery 1, 941–955; Peeling W. R. and Nwaka S. (2011) Drugs and diagnostic innovations to improve global health. Infect Dis Clin North Am. https://doi.org/10.1016/j. idc.2011.06.002, 1

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021 S. Nwaka, Social and Technological Innovation in Africa, https://doi.org/10.1007/978-981-16-0155-2_4

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Fig. 4.1  Integrated Global Drug Discovery Platform for Neglected Diseases. From Nwaka and Hudson (2006)—Nature Review Drug Discovery

subsequently entering clinical development.2,3,4 It also provided the initial rationale for the establishment of ANDI. The development of ANDI involved extensive collaboration among African scientists, institutions and countries as well as the international community through dialogue at the World Health Assembly (WHA). Cognizant of the growing burden of diseases and health conditions that disproportionately affect developing countries, the WHA adopted the Global Strategy and Plan of Action (GSPOA) on Public Health, Innovation and Intellectual Property in 2008.5 A key element of the strategy is the formation of innovation networks in developing countries to ensure that existing capabilities are leveraged, identified gaps are filled more effectively and local priorities are driving the agenda. At around the same time, ANDI was initiated with the goal of supporting innovation and capacity building to address the public health needs of African populations and contribute to socio-economic development.6 ANDI subsequently grew into a pan-­African institution whose principal function is to support the  Nwaka S., et al. (2009) Advancing Drug Innovation for Neglected Diseases—Criteria for Lead Progression. PLoS Negl Trop Dis 3(8): e440. https://doi.org/10.1371/journal.pntd.0000440; and Nwaka S., et al. (2011) Integrated Dataset of Screening Hits against Multiple Neglected Disease Pathogens. PLoS Negl Trop Dis 5(12): e1412. https://doi.org/10.1371/journal.pntd.0001412. 3  Molette J., et al. (2013) Identification and optimization of an aminoalcohol-carbazole series with antimalarial properties. ACS Med Chem Lett 4(11): 1037–-41 4  Zhang Y., et al. (2010) Synthesis and structure-activity relationships of antimalarial 4-oxo-3-­ carboxyl quinolones. Bioorg Med Chem. 18(7):2756–66. 5  http://www.who.int/phi/publications/Global_Strategy_Plan_Action.pdf. 6  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf; and Mboya-Okeyo T., et al. (2009) African Network for Drugs and Diagnostics Innovation. Lancet 373: 1507–8 2

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progression of local health technologies from the laboratory to the market in a sustainable manner.7

4.1 R  ole of African Scientists and Institutions in the Launch of ANDI and Its Operations The global drug discovery network of WHO/TDR described earlier involved some excellent researchers and institutions from Africa who were doing as well as their peers from Europe, the Americas and Asia—an example is the University of Cape Town drug discovery center, which was described earlier. Through this network, and in coordination with the then Director of WHO/TDR, Dr Robert Ridley, and the African diplomatic group in Geneva, the author sent an email to a group of African scientists and heads of institutions just before midnight on 14 February 2008 about the possibility of establishing an “African Network for Drug Discovery and Innovation to support discovery and capacity building in Africa” (the name was later changed to the African Network for Drugs and Diagnostics Innovation (ANDI). That email resulted in an overwhelming support for the idea and led to the planning of the 1st stakeholders’ meeting in October 2008, where ANDI was launched. That original email and some of the responses and discussions that ensued from African scientists at home and in the Diaspora are documented in Appendix A. Just like the report of an external review of ANDI in 2012, which is discussed further in Lesson 3, Sect. 4.1.1 and presented in Appendix B, these communications in themselves provide some interesting perspectives about the landscape of research-driven innovation in Africa from those directly involved in trying to undertake and promote innovation. These authentic voices demonstrate a latent desire for Africans to fully engage in the discovery, development and commercialization of its own innovations, and they are often  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11; Facilitating Health Innovation in Africa— ANDI’s Five Year Strategy (http://andi-africa.org/ANDI_File/Strategic_Plan/Facilitating_Health_ Innovation_in_Africa_ANDI_Strategic_Plan(2016-2020).pdf ). 7

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not highlighted in broader African innovation strategies and action plans. These types of input will always be relevant in the innovation discourse of the continent, the better appreciation and the boosting of the African innovation ecosystem in the coming years. The momentum generated by the discussion with African scientists and heads of institutions led to the launch of ANDI as an initiative at the 1st stakeholders’ meeting held from 6 October to 8 October 2008 at the premises of the Economic Communities for West African States (ECOWAS) in Abuja, hosted by the Nigerian government. The event was attended by about 500 people, including senior government officials, policy makers, international organizations, researchers, scientists, the private sector and NGOs from over 25 countries around the world.8 This was the same trend observed in subsequent ANDI stakeholders’ meetings and events. Typical ANDI stakeholders’ meetings are shown in Figs. 4.2 and 4.3.

Fig. 4.2  More than 500 people at the ANDI stakeholders’ meeting, Nairobi 2010

 Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf; and Mboya-Okeyo T., et al. (2009) African Network for Drugs and Diagnostics Innovation. Lancet 373: 1507–8. 8

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Fig. 4.3  ANDI stakeholders’ meeting 2015. Left, right and bottom photos are Dr Tshinko Ilunga—Chairperson of the ANDI Board, Dr Solomon Nwaka—Executive Director of ANDI and Mr James Macharia—Cabinet Secretary for Health (Kenya) during the opening session

The first act of ANDI after the Abuja launch in 2008 was the identification of WHO, acting through TDR, as the interim secretariat for ANDI to implement the recommendations from the Abuja meeting. This was followed up with the establishment of a task force as recommended from the Abuja meeting to develop a strategic and business plan for ANDI. Members of the task force were drawn from African institutions, ministries of Health and Science and Technology, Africans in the Diaspora, the African Development Bank (AfDB), the WHO and others. Members of the task force, including representatives of other organizations mentioned earlier, are listed in Box 4.1.

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Box 4.1  List of Task Force Members Dr Tom Mboya-Okeyo—Kenyan ambassador to UN Geneva, chair of the task force; Dr Alex Ochem—ICGEB Cape Town, South Africa, secretary of the task force; late Dr Uford Inyang—National Institute for pharmaceutical Research and Development, Abuja Nigeria; Dr Anthony Mbewu—Medical Research Council of South Africa; Dr Sanaa Botros—Theodor Bilharz Research Institute, Cairo, Egypt; Dr Anastasia Guantai—University of Nairobi, Kenya; Dr Tshinko Ilunga—African Development Bank, Tunis, Tunisia; Dr Peter Atadja—Novartis, Boston USA (representing Africans in the Diaspora); Dr Albrect Yahn—representing the EU; Dr Robert Ridley and Dr Solomon Nwaka—director and leader of discovery and innovation respectively representing the WHO/TDR Secretariat.

In 2009, the first Five-Year Strategic Business Plan for ANDI was developed with the help of the task force, McKinsey and Company, and the Secretariat led by the author.9 The plan outlined the rationale for ANDI’s establishment, its mission and its operating and organizational framework. The strategic business plan was presented and endorsed at the 2nd ANDI stakeholders’ meeting hosted by the South African government at the Medical Research Council in Cape Town from 4 October to 7 October 2009.10 As highlighted in ANDI’s charter, which was subsequently developed, the first ANDI’s plan became a major founding document, as it describes the original thoughts and processes that guided ANDI’s development. The plan also helped to inform the development of other strategic and implementation plans for several other organizations on the continent, and it remains an important reference material for work on research and  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf. 10  Resolution of the 2nd ANDI stakeholders’ meeting, Cape Town October 2009. Available: http://meeting.tropika.net/andi2009/files/2009/10/andi-endorsement.pdf. Accessed 23 December 2019. 9

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innovation in Africa. Within the framework of this plan, ANDI succeeded in setting up an effective governance mechanism with a core secretariat to manage its day-to-day operations and enhance its visibility in Africa and globally. Following the Cape Town meetings in 2009 the task force concluded its work and helped to establish the ANDI Board and ANDI’s Scientific and Technical Advisory Committee (STAC). ANDI’s establishment was enthusiastically welcomed at regional and global levels. In 2009, through Resolution 62.16, the World Health Assembly (WHA) declared, “ANDI is a key initiative aimed at supporting and promoting African led health product innovation.”11 In October 2010, the governance organs of ANDI (Board and STAC) were announced at the 3rd ANDI stakeholders’ meeting held in Nairobi, Kenya. The meeting was very well attended as usual, with high-level representation across Africa and beyond.12 The stakeholders’ meeting was opened by the then Deputy Prime Minister of Kenya. Some ANDI programs, such as pan-African Centres of Excellence (COEs) in health innovation in Africa, and its first call for projects were announced at this event. Members of the ANDI Board and STAC were announced at the meeting and subsequently the Board and STAC met and elected their officials, and the Board has since evolved.13 Former and most recent members of the ANDI Board and ANDI’s Scientific and Technical Advisory Committee are listed in Box 4.2. The same year, the 4th African Ministerial Conference on Science and Technology (AMCOST 1V), held in Cairo in March 2010, welcomed ANDI and its anticipated contribution to science, technology and innovation in Africa.14 At the same time ANDI continued to advocate for the implementation of various global and regional strategies and declarations in health, innovation and development.

11  WHA 62.16. Available: http://apps.who.int/gb/ebwha/pdf_files/A62/A62_R16-en.pdf. Accessed 23 December 2019. 12  https://www.who.int/tdr/partnerships/initiatives/andi/meetings/andi_03_opening_ceremony.pdf. 13  https://www.who.int/tdr/news/2011/andi-inaugural/en/. 14  https://appablog.wordpress.com/2010/03/01/the-fourth-african-ministerial-conference-on-scienceand-technology-amcost-iv/.

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Box 4.2  List of Board and STAC Members Board Members: Hon. Dr Beth Mugo—former co-chair (former cabinet secretary, Health, Kenya); Hon. Ms Naledi Pandor—former co-chair (former minister for Science and Technology, S.  Africa); Dr Tshinko Ilunga—former vice chair, current chair of the board (former acting director human development, AfDB); Dr M.  Kaloko—former representative of the African Union and AU Commissioner for Social Affairs; representative of the European Commission; Dr Robert Ridley—former member representing TDR; Dr M.  Moeti—representing WHO/AFRO; Dr John Reeder—representing TDR; Mr Issa Matta— legal counsel representing WHO; Dr Zafar Mirza—representing WHO/EMRO; Dr Onyebuchi Chukwu—former minister for Health representing Nigeria; Dr Mahmoud Sakr—president of the Egyptian Academy of Scientific Research and Technology (ASRT), representing Egypt; Prof Maged Alsherbiny—former representative of Egypt; Prof Abegaz—former representative of the African Academy of Sciences; Dr Barthemey Nyasse—chair of scientific and technical advisory committee (STAC); Mr Kristoffer Gandrup-Marino—representative of UNICEF; Dr Linus Igwemezie—Novartis, former board member; Dr Solomon Mpoke—former representative of Kenya (Director of KEMRI); Ms. Worknesh Gonet—representing UNOPS (director UNOPS, Ethiopia); Mr Dele Ilebani— former representive of UNOPS; Ms Oley Dibba Wadda—representing AfDB (director, human capital, youth and skill development, AfDB). STAC members: Dr Charles Mgone—former chair of STAC, former executive director of the European developing countries clinical trials platform (EDCTP); Dr Barthelemy Nyasse—Professor, current chair of STAC, ex-officio member of the board, former deputy vice Chancellor Bamenda university Cameroon; Dr Bernadette Ramirez—representing WHO/TDR; late Professor Peter Ndumbe— representing WHO/AFRO; late Dr Uford Inyang—former CEO NIPRD, Abuja, Nigeria; Dr Peter Atadja—representing African Diaspora; Dr Anastesia Guantai—Professor, University of Nairobi; Dr Sanaa Botros—Professor at TBRI; Dr Martin Ota—WHO/AFRO; Dr Ivan Addae-Mensah—Professor, University of Ghana; Dr Ole Oleson—European Commission (EC); Dr Albrect Yahn—former member from EC; Dr Tewabech Bishaw—member, CEO Alliance for Brain Gain, Ethiopia; Dr Mohammed Hechmi—member, Institut Pasteur Tunisia; Dr Margaret Ndomondo- Sigonda—head of Health AUDA/NEPAD Agency.

Between 2011 and 2012, ANDI was transferred to Africa as a partnership within the United Nations Economic Commission for Africa (UNECA). During this transition period, ANDI successfully implemented its 4th stakeholders’ meeting in Addis Ababa in October 201115  http://www.globe-network.org/en/4th-andi-stakeholder-meeting-and-donors-conference-0.

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as well as several projects and pan-African Centres of Excellence. This meeting highlighted ANDI’s achievements and challenges during the previous year. It was very well attended just like other stakeholders’ meetings, by several African ministers of health, science and technology and ambassadors, as well as senior officials from the AU, UNECA, development agencies and donors. In 2012, the efforts to conclude the transfer of the ANDI Secretariat from WHO Geneva to UNECA failed due to a change of leadership at UNECA. ANDI staff already deployed at the ANDI Secretariat within UNECA were disengaged. From late 2012 to January 2013, the ANDI Board and WHO considered alternative hosting arrangement and settled for United Nations Office for Project Services (UNOPS) in Addis Ababa. Internal bureaucracy of WHO and UNOPS delayed the finalization of the hosting agreement for a year, but during this period the work of ANDI continued to be implemented from WHO but at a slow pace. This delay was caused by financing discussions as WHO needed approval from the European Commission (EC), the sole donor for ANDI at the time, to transfer the funds. In 2014, an MoU between WHO and UNOPS on the hosting of ANDI by UNOPS was signed. This enabled the transfer of ANDI to UNOPS in Addis in 2014 and the appointment of the ANDI Executive Director, who started at UNOPS on 1 December 2014. Under the MoU, UNOPS became the administrative host of ANDI (providing administrative support and oversight), while the ANDI Board provides programmatic oversight for the work of ANDI. During this same period, WHO transferred funds that had been received from the EC for the work of ANDI to ANDI through UNOPS. The initial phase of ANDI staff recruitment was completed, and staff members were in place at UNOPS between June and December 2014. From January 2014 till June 2018, ANDI operated its Secretariat at UNOPS and a detailed hosting framework was put in place. The 5th stakeholders’ meeting was held in Nairobi, Kenya, in November 2015. The meeting presented an update on the ANDI Board reform as proposed by an external review, its projects and pan-African Centres of Excellence as well as the continued implementation of the ANDI’s Innovation Awards.16 The ANDI’s Innovation Awards recognize 16  http://andi-africa.org/Meeting_Documents/5th%20ANDI%20Stakeholder%20Meeting%20 Provisional%20Agenda.pdf (Accessed 23 December 2019).

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institutions and/or individuals that embody the vision of promoting local technology development and access.17 The goal is to celebrate and inspire innovation in Africa, and at the same time create awareness about some of the transformative work going on the continent. This pioneer award program of ANDI on research and innovation started in 2009. The picture of some of the recipients of these awards is shown in Fig. 4.4 as an example. ANDI made contribution toward the Ebola outbreak in West Africa in 2014–2015. It also implemented workshops, and partnerships with UNICEF and the World Bank to mobilize the capacity of African researchers in support of research and development of tools for such

Fig. 4.4  Example of recipients of the ANDI Innovation Awards in 2015

 ANDI Newsletter—15 December 2015. ANDI Innovation Awards 2015. ANDI Innovation Awards Celebrate and Inspire Innovation in Africa! http://us8.campaign-archive2.com/?u=42 1d2157d01b6978248fa9ddeskampskamp;id=cc3011dfc4. 17

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emergency outbreaks.18,19 High-impact technologies that could transform healthcare delivery in Africa were prioritized at the conference, and seminal African initiatives on Ebola Virus Disease were presented and discussed. Prior to this, a report on a proposed platform to manage Ebola outbreaks and other emergent infections was published.20 The proposed platform remains relevant today, especially in the context of the onging global search for drugs, vaccines and diagnostics to fight COVID-19, which is caused by SARS-CoV-2. During the same period, a partnership was developed with the government of Egypt through the Egyptian Academy of Scientific Research and Technology (ASRT).21 The partnership involved co-funding of a training and mentorship program for African scientists, innovators and entrepreneurs on the translation of technologies from laboratory to market using a novel diagnostic tool discovered at the Theodor Bilharz Research Institute (TBRI) in Egypt—an ANDI recognized Centre of Excellence for the diagnosis of schistosomiasis. This initiative was the only ANDI project to be co-funded in concrete terms by an entity in an African country till 2019. Some other partnerships and MoUs such as the ANDIEmory University partnership was launched at the 5th ANDI stakeholders’ meeting held in Nairobi in November 2015 and initiated in 2016.22 This partnership is similar in many respects to the ASRT partnership, and both initiatives trained and mentored many African scientists, innovators and entrepreneurs, from intellectual property (IP) management to business development to financing to commercialization. This type of handson training fills a critical gap in the African innovation landscape and should be scaled up.  https://blogs.unicef.org/innovation/transforming-healthcare-technology-in-africa/.  Meeting Report: Transforming Health Care Delivery in Africa using Technology and Ebola Virus Disease Addis Ababa, January 20–22, 2015. https://blogs.unicef.org/innovation/ transforming-healthcare-technology-in-africa/. 20  Nwaka S., et al. (2014) Ebola Virus Disease: Platform for North-South Collaboration Urgently Needed. PLOS Speaking Medicines Blog. 21  http://mypr.co.za/africa-network-drugs-diagnostics-innovation-andi-partners-egyptianacademy-scientific-research-­­technology-asrt-promote-health-innovation-africa/. 22  http://www.andi-africa.org/ANDI_File/Newsletter_List/ANDI%20-EMORY%20 Partnership%20in%20Action.pdf; Liotta C. D., Nwaka S., et al. (2018) North-South collaborations to promote health innovation in Africa. Emory Law Journal 67: 619–653. 18 19

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These initiatives received overwhelming interest in Africa, as the training announcements were usually over-subscribed each time ANDI and its partners launched a call for the program. They also helped to highlight the opportunity of identifying, strengthening and equipping one or two regional technology hubs to provide technical support to suitable projects and institutions on business development, project management, finance, IP, technology transfer and entrepreneurship. The ANDI-Emory University partnership further helped to stimulate broad discussion regarding suitable approaches for North-South collaboration that overcomes the challenges of previous collaboration.23 It subsequently led to the establishment of a proposed joint initiative with Emory University called AHIA—Advancing Health Innovation in Africa. A relevant and concrete initiative toward the scaling-up of this type of mentorship and educational initiative for innovation and entrepreneurship in Africa is presented in Chap. 12. As with other sectors and technology areas in Africa, this type of mentorship and training is largely missing in the African innovation landscape, as stressed for the digital technology space in Africa.24 A disappointing part of the hosting of ANDI at UNOPS was the inability of UNOPS, acting on behalf of ANDI, to conclude funding agreement from AfDB (African Development Bank) for the implementation of a local manufacturing capacity-building program for health technologies. This happened a second time in 2017–2018, and a potential funding agreement with AfDB could not be finalized after nearly six months of negotiation. Some of the reasons for this range from the agreement template to be used to audit principles to be followed and intellectual property issues. Unfortunately, by the time these legal issues were agreed upon, the existing funding agreement between WHO/ANDI and UNOPS lapsed in June 2018 and the UNOPS was not able to provide bridging funds, pending the finalization of the AfDB agreement. The fact that ANDI was relatively new at UNOPS and working to diversify its  Liotta C. D., Nwaka S., et al. (2018) North-South collaborations to promote health innovation in Africa. Emory Law Journal 67:619–653. 24  Jumanne R. Mtambalike (2018) The facts and fictions about innovation and technology hubs in Africa (https://medium.com/@jumannerajabumtambalike/the-facts-and-fictions-about-africainnovation-and-technology-hubs-b46d46c61f75. 23

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funding base did not help matters. Following this issue, the ANDI Board decided that ANDI should move out of UNOPS and be registered as an independent legal entity in Nigeria to enable more flexibility with fundraising, including pursuit of the AfDB funding and others. The registration process was rapidly concluded in the beginning of 2019 in Nigeria, with ANDI temporarily nested next to its regional hub for West Africa, located in Abuja. During this period most of the activities of ANDI were temporarily suspended, and it was hoped that the registration of ANDI as an independent foundation will facilitate conclusion of the funding agreement with the AfDB, but this did not happen as the ANDI Board had hoped. The said temporary suspension of ANDI activities has continued as this manuscript was being finalized, even though the structures of ANDI remain intact and ready to resume. As has already been learnt through the ongoing COVID-19 pandemic, Africa and the world need more initiatives like ANDI that address health research and innovation issues. As the Africa Centre for Disease Control and Prevention (Africa CDC) and some country-level CDCs are addressing COVID-19 control issues, those research and innovation initiatives would have been at the forefront of the search for vaccines, treatment and diagnostics in Africa as well as in the fundamental understanding of the disease. Such initiatives(s) should be independent and accorded the flexibility to implement local innovation mandates of the continent, rather than those of the donors. That said, some of the investigators and institutions that ANDI supported over the years are working round the clock to contribute to the fight against COVID-19. Lesson 3: The lessons learned from all this is that resilience and patience are important for any innovation efforts in Africa. It is even worse in the absence of local sources of structured and sustainable financing to support pan-African innovation. Also, the challenges faced by initiatives that derive their legal personalities from organizations that are not able to provide financial support or at least bridging funds in times of need should be carefully considered. What also came through was that certain legal aspects of R&D and innovation, such as intellectual property management and ownership may not be fully understood by organizations that focus on other areas. It is recognized by many that ANDI will always have a special place in the history books of African research and innovation. From its launch at Abuja in October 2008 till the writing of this book, ANDI has contributed

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significantly to the innovation space in Africa despite the challenges of establishing the organization that it wants to be. As reported in the external review of ANDI in late 2012 (see Appendix B), “Despite being seriously under-resourced and understaffed, significant progress has been achieved in the organization and implementation of the ANDI framework. Most of the key performance indicators for both the European Union (EU) project and strategic business plan have been completed or are in progress.” Some of these achievements, including ANDI’s portfolio of initiatives and projects, are summarized below. Again, refer to the mention of the EU project above. Without the initial funding from the EU,25 ANDI would not have started operation in the first place, and when EU funding ended, ANDI struggled financially. This is the fate of most African initiatives. ANDI created awareness globally on the needs, opportunities and ongoing innovations in Africa. Through its extensive landscape analysis, needs assessment and reports, ANDI provided evidence and advocated for local innovation in Africa and other developing parts of the world. These findings are well documented.26,27 ANDI created fora for African and external institutions, researchers, entrepreneurs, donors and policy makers to share experiences and explore opportunities for win-win partnerships. Notable examples include the ANDI stakeholders’ meetings and the establishment of a network of panAfrican Centres of Excellence (CoEs).28,29 ANDI evaluated and  EU and EC have been used interchangeably in the book and annexes.  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf. 27  Nwaka S., et al. (2010) Developing ANDI: A Novel Approach to Health Product R&D in Africa. PLOS Medicine 2010; 7(6): e1000293. https://doi.org/10.1371/journal.pmed.1000293. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000293; Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https:// doi.org/10.1186/1472-698X-12-11. 28  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11; see also (ANDI pan-African Centres of Excellence in Health Innovation; http://www.andi-africa.org/ANDI_File/ANDI_COEs/ANDI_ pan_African_Centres_of_Excellence_2015_edition.pdf ). 29  Facilitating Health Innovation in Africa—ANDI’s Five Year Strategy (http://andi-africa.org/ ANDI_File/Strategic_Plan/Facilitating_Health_Innovation_in_Africa_ANDI_Strategic_ Plan(2016-2020).pdf ). 25 26

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recognized over 45 pan-African CoEs through a competitive process and encouraged them to partner on different initiatives (Fig. 4.5). These CoEs show the potential of African institutions as potential engines for technology research, development and capacity building. As part of its annual stakeholders’ meetings since 2008, ANDI brought together various stakeholders to network and forge a path for health innovation in Africa. It facilitated the setting-up of several high-profile partnerships, projects and initiatives. For example, major partnerships have been established among several ANDI CoEs as well as with other institutions in Africa and overseas, with millions of dollars raised in support of these partnerships.30 Also, the AUDA-NEPAD and the European Developing Countries Clinical Trial Partnership (EDCTP) have identified other important centers of excellence and networks31 (see also Appendices C and D).

Fig. 4.5  ANDI pan-African Centres of Excellence as of 2016. ANDI implements regular reviews and calls to update, add or remove centers based on criteria

30  ANDI Newsletter—11 December 2015. 2015 ANDI Stakeholders Meeting in Pictures. http:// us8.campaign-archive2.com/?u=421d2157d01b6978248fa9ddeskampskamp;id=49f051fb0c. 31  www.nepad.org; www.edctp.org.

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4.1.1 Initiation of Regional Hubs in Countries ANDI initiated the identification of regional hubs to drive home innovation activities within countries of the various regional economic communities. Through a competitive process and a set of criteria, some countries were identified as hosts or potential hosts for the regional hubs. Nigeria was selected for West Africa, and based on financial pledge and in-kind support from the National Institute for Pharmaceutical Research and Development (NIPRD), Abuja, ANDI established its West African hub at NIPRD, pending the release of the pledge made by Nigeria to facilitate operationalization of the hub. Kenya was selected to host the East African hub at the Kenyan Medical Research Institute (KEMRI), and South Africa was selected to host the Southern African hub at the Medical Research Council (MRC) in Cape Town, subject to resolution of the exact funding amount that will be committed by the country as well as issues related to governance of the hub in the application which were not consistent with the criteria established by the ANDI Board for the hubs. As part of its strategy, ANDI started working closely with the CoEs and potential regional hubs (as they were established) to support project implementation and capacity building. As indicated in the report of the external review of ANDI in 2012, the enthusiastic support from the various African countries has not translated into concrete financial support for the initiative from the continent till date. While ANDI funded its stakeholders’ meetings, events, projects and training programs held in countries, some of the host countries provided important in-kind support. Egypt through its ASRT (the Egyptian Academy of Scientific Research and Technology of the Ministry of Higher Education, Science and Technology) was the only African country to co-­ fund a project or training with ANDI that cuts across African countries. Also, ASRT hosted and co-funded the 5th ANDI board meeting held in Cairo. This type of support is a win-win for countries, and any sustainable African-led research and innovation must secure reasonable funding from within Africa. The Nigeria Ministry of Health and ANDI signed an MoU in 2012 for hosting the hub at NIPRD with the associated funding pledge of

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USD 2 million over five years to support the work of ANDI and the hub. The release of the funds by Nigeria became difficult after the Minister of Health who signed the agreement left the ministry. Thereafter, with a new ministerial leadership, and despite effort by NIPRD and ANDI, work on having the fund released failed. The proposed funding and governance of the Southern African hub were not addressed by South Africa, and subsequently South Africa established an initiative called SHIP— Strategic Health Innovation Partnership—at MRC to support projects in South Africa. Regarding the Kenyan hub at its Medical Research Institute (KEMRI), efforts to secure funding from Kenya to operationalize the hub is yet to materialize. Like NIPRD and other ANDI pan-­African Centres of Excellence, KEMRI has been one of the strong partners of ANDI on various projects. Subsequently, Egypt expressed interest in hosting the Northern African hub through the ASRT, and also, discussion started with Cameroon about the Central African hub.

4.1.2 S  everal Collaborative Projects Were Supported and Implemented Some of these projects are: (1) a respirator (continuous positive airway pressure or pumani) and a phototherapy machine projects being implemented as part of the Maternal, Newborn and Child Health (MNCH) portfolio of ANDI. These potential life-saving technologies for newborns in resource-poor settings, are partnership with ANDI, the Queen Elizabeth Hospital in Malawi and Rice university. The Clinical Evaluation of Pumani with the Queen Elizabeth Hospital, Malawi was one of the early projects supported by ANDI—as acknowledged in these publications32,33; (2) the reformulation of NIPRISAN for treatment of sickle cell anemia in partnership with the National Institute for Pharmaceutical Research and Development (NIPRD) in Nigeria; and (3) the development and scale-up of a new diagnostic tool for schistosomiasis  Kawaza K., et al. (2014) Efficacy of a Low-Cost Bubble CPAP System in Treatment of Respiratory Distress in a Neonatal Ward in Malawi. PLoS ONE 9(1): e86327. https://doi.org/10.1371/journal. pone.0086327. 33  Machen H., et al. (2015) Outcomes of Patients with Respiratory Distress Treated with Bubble CPAP on a Pediatric Ward in Malawi. Journal of Tropical Pediatrics, 61, 421–427. https://doi. org/10.1093/tropej/fmv052. 32

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linked to a unique capacity-building program for young African researchers and entrepreneurs, in collaboration with the Egyptian Academy of Scientific Research and Technology (ASRT) and the Theodor Bilharz Research Institute (TBRI) mentioned earlier.34 Some of these projects and the initiatives described below further demonstrate the status, opportunities and challenges for African innovation. A collaboration between ANDI and South Korea’s Science and Technology Policy Institute (STEPI) started around 2011, with a focus on capacity building for good manufacturing practices (GMP) and regulation for neglected diseases in Africa. The project focused on Tanzania and Nigeria. Later, the African Development Bank (AfDB) joined the collaboration with funding from its South Korean Trust Fund. In 2012–2013, a study and a capacity-building program undertaken in Nigeria and Tanzania, as part of the project, helped to create awareness on the urgent need to support selected local manufacturers to meet WHO’s Good Manufacturing Practice (GMP) standards, as well as to enhance local entrepreneurship for health technologies. Subsequently, about four pharmaceutical companies in Nigeria independently received the WHO GMP certification—the only ones in West Africa at the time.35,36

4.1.3 Implementation of the World Health Assembly (WHA) Demonstration Project Following the WHA Resolution 66.22 in 2013,37 ANDI’s project titled “Development of Easy to Use and Affordable Biomarkers as Diagnostics for Types II and III Diseases,” in collaboration with Chinese partners and relevant ANDI CoEs, was selected for funding as part of the demonstration projects for a period of five years (2016–2021) at about USD 20 million. ANDI had high hopes for the funding as a further catalyst for its  https://us8.campaign-archive.com/?u=421d2157d01b6978248fa9ddeskampskamp;id= 0e24e4e07b. 35  http://www.who.int/biologicals/vaccines/good_manufacturing_practice/en/. 36  http://dailyindependentnig.com/2014/10/four-nigerian-pharmaceutical-firms-get-certification/. 37  http://www.who.int/phi/resolution_WHA-66.22.pdf. 34

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activities and other funding but unfortunately, the project was only funded for two years (2016 and 2017) at a much lower budget. Despite this funding shortfall, ANDI and partners implemented successful biomarker screens and analysis that identified promising leads for schistosomiasis and malaria (Plasmodium vivax and falciparum). The project also trained several investigators from Africa in screening, genomics and proteomics processes as well as in sample collection and biobank development management.38 Through this project, ANDI and partners also promoted open innovation, technology transfer and capacity building as well as South-South and North-South collaborations in support of diagnostics development, production and access for neglected diseases in Africa. Some of the WHO member states that provided funding for the demonstration projects made part of their contribution conditional on matching contributions from developing countries. In fact, only India, South Africa and Brazil committed funds from developing countries, but these countries had projects that were part of the demonstration projects (some with higher project budgets than the funds they pledged). It turns out that several millions of US dollars or euros that could not be matched by developing countries may have been returned to the countries that provided them by WHO. Another partnership between ANDI and EASE Medtrend Biotech, Shanghai resulted in the development of a mobile application to support point-of-care testing, supply chain management and surveillance. The mobile app has wide-ranging uses in human health, particularly in peripheral health facilities where access to tests, laboratory equipment and highly trained technicians is limiting. The app can facilitate mobile diagnostics, including the integration of multiple rapid diagnostics tests (RDTs), such as for malaria, HIV, syphilis; epidemiology and surveillance; procurement; and supply chain management. A pilot study in Nigeria using the mobile app for supply chain management and tracking

 Kassegne K., et al. (2017) Study roadmap for high-throughput development of easy to use and affordable biomarkers as diagnostics for tropical diseases: a focus on malaria and schistosomiasis. Infect Dis Poverty, 6, 130. https://doi.org/10.1186/s40249-017-0344-9 38

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of medicines has been published.39 The importance of this type of digital innovation in African has become pronounced in the management and control of COVID-19. This partnership also resulted in another initiative focusing on the local production of RDTs in Nigeria and Kenya in partnership with Chinese companies. The goal was to build capacity and transfer technology to produce RDTs in Nigeria and Kenya. Landscape analysis and project concept notes that informed the development of business plans were shared with the countries and some donors. Consideration was also given to obtaining loan for the project through various sources, including through the African Development Bank. ANDI contributed toward the development of the Pharmaceutical Manufacturing Plan for Africa (PMPA) Business Plan40 and continued working closely with the African Union Commission (AUC) to assist in operationalizing the plan. These examples are testimonies to ANDI’s unique and strategic role in supporting the transformation of the health innovation landscape and as a platform that not only supports African institutions to work together, but also fosters South-South and North-South collaborations. As the report of the external review of ANDI in 2012 showed (Appendix B), ANDI set ambitious agenda for itself, and despite various challenges, that agenda has helped to create awareness about the criticality of Africanled innovation, and to contribute to some of the movement in the field that we see in Africa today. Nelson Mandela once said: “there is no passion to be found playing small and settling for a life that is less than the one you are capable of living.” This is a message for all Africans—think big and work hard for the good of the continent. The status quo is unacceptable. Following the report of the external review of ANDI and the subsequent transfer of ANDI to UNOPS, the Board refocused ANDI’s work and implemented a Board reform. This also laid the foundation for a new  Egharevba H. O., et al. (2019) Piloting a smartphone-based application for tracking and supply chain management of medicines in Africa. PLoSONE 14(7): e0217976. https://doi.org/10.1371/ journal.pone.0217976. 40  Pharmaceutical Manufacturing Plan for Africa Business Plan; http://sa.au.int/en/sites/default/ files/pmpa%20bp%20ebook.pdf. 39

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Five-Year Strategic Plan for ANDI: Facilitating Health Innovation in Africa (2016–2020).41 As this book was being written, these efforts were yet to translate into new funding from within Africa, despite efforts of the ANDI Secretariat and the Board. Furthermore, financing from philanthropic foundations and development partners has not been easy to secure probably due to the product focus of the work of ANDI. The European Commission (EC), which provided the initial funding support for ANDI through WHO/TDR, has not provided new funding since ANDI moved to Africa. Moreover, it appears that the EC saw ANDI as a competitor to its own European Developing Countries Clinical Trials Partnership (EDCTP) initiative—which in fact is not the case, because the EDCTP focuses on clinical trials for neglected diseases, while ANDI addresses the translation of technologies from the laboratory to the ­market. In anycase, Africa needs far more of these activities that are sustainable than is currently available. The result of all this is that promising local technologies that emerge from African universities and research institutions do not even have the opportunity of reaching the traditional proof of concept and “valley of death,” not to mention going to scale and commercialization. A suitable description for the current location of most local African product concepts is either “valley of stagnation” or “valley of hope.” Africans have always been hopeful even in the face of excruciating hardships, but hope alone is not enough to solve the continent’s challenges. Children are dying of preventable diseases and many young graduates have no hope of securing jobs or securing funds for entrepreneurship activities. In 2010, an article by Singer and colleagues described stagnant health technologies in Africa.42 When we look at some indices, such as the decreasing child mortality, and the progress with digital technologies over the past decade(s), one may agree that things are getting better in African countries and that good foundation is being laid for further progress through the SDGs, for  Facilitating Health Innovation in Africa—ANDI’s Five Year Strategy (http://andi-africa.org/ ANDI_File/Strategic_Plan/Facilitating_Health_Innovation_in_Africa_ANDI_Strategic_ Plan(2016-2020).pdf ). 42  Simiyu K., et al. (2010) Stagnant Health Technologies in Africa. Science, 330, pp. 1483–1484. https://doi.org/10.1126/science.1195401. 41

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example. Clearly people in Africa are divided on the question of progress, as I found out during a field trip in preparation for this book in 2018. In Nigeria, for example, many people feel that things are worse than they were decades ago. They feel that their politicians have let them down. People are concerned about their safety, the next meal on the table, education and jobs for their children, lack of electricity, healthcare challenges and so on. A middle-age high school teacher with three children and a breadwinner in her family in Imo State Nigeria told me that the cost of a bag of rice has more than doubled since the past few years and that she had not been paid salary since the past four months. She had to sell her car two years earlier to make ends meet and felt that the situation has now become desperate. The COVID-19 pandemic has surely made things harder for the African poor and the hope is that the post COVID-19 era will see sustained support and investment in innovation and entrepreneurship along the lines of what has been proposed in this book. The work of Christensen and colleagues provides additional context to poverty in sub-Saharan Africa: “Over the past three decades, more than 1 billion people have lifted themselves out of extreme poverty. The rate of global poverty is down from 37% in 1990 to approximately 10% today. But a vast majority of the people who have escaped poverty are from China (approximately 800 million people) and to a lesser extent, India (approximately 200 million) … Poverty in many countries in sub-­Saharan Africa is actually on the rise, with no signs of slowing down …. We are awash in data, and we do need this information. But data, metrics and statistics are simply representations of particular phenomena and are not the phenomena themselves.”43 Lesson 4: We shared a few country-specific stories to make the point that collaboration among African institutions and countries vis-à-vis research and innovation will require sustained financial investment from countries. This financial investment will support the desire for Africa to own, lead and control its research and innovation. These desires will unfortunately not materialize only with external funding, official  Christensen C. M., et al. (2019) The Prosperity Paradox: How Innovation Can Lift Nations Out of Poverty (Harper Collins). See also a linked short article by the same authors published at the World Economic Forum 2019 (https://www.weforum.org/agenda/2019/01/poverty-data-never-tellsthe-whole-story/). 43

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development assistance and personal attendance of African leaders at meetings. The concept of African integration will depend on collaboration among countries and institutions, through trade, ease of mobility, innovation, regulatory harmonization and so on. The reversal of the lack of intra-African collaboration, by African governments, which ANDI has been advocating for, could unleash major progress on the continent across many sectors. After all, no one African country on the continent today can do it all on its own, especially in research, development, manufacturing and commercialization of essential products that are desperately needed in Africa. Achieving the scale and successes needed to drive innovation into the market to reach the about 1.35 billion Africans will require true integration, trust and sustainable financing. The ratification and initiation of the implementation of the African Continental Free Trade Area (AfCFTA) is a step in the right direction44, and the African Medicines Agency (AMA) should be rapidly implemented. The hope is that African countries will commit enough resources for the implementation of these and related innovation activities. ANDI managed to put most of the moving parts of product innovation for health in place within a reasonably short time, but financing was a challenge. The various ANDI activities, governance and stakeholders described here as well as financing are consistent with the concept of social innovation, which is one of the running themes of this book. The continent should now strengthen and strategically scale up this dominant innovation modality on the continent.

 https://www.cfr.org/blog/africas-free-trade-deal-signed-kigali; https://www.nytimes.com/2018/03/21/ world/africa/trade-nigeria-south-africa.html, https://www.africa-eu-partnership.org/en/afcfta.

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Consistent with the information discussed on how African countries are faring in R&D investment and human resources for research and innovation rankings, no African university makes the top 100 ranking of universities globally. According to the 2019 Times University ranking, which rates universities using different indicators that measure teaching, research impact, innovation and international outlook, South Africa is the only African country with one or more universities in the top 500.1 The University of Cape Town is in the 156th position, followed by the University of the Witwatersrand at the 201–250th position, Stellenbosch University between 301–350, KwaZulu-Natal University 401–500, Makerere University at 501–600, then three universities in Egypt at 601–800 (American University of Cairo, Benha University and Beni-­ Suef University). In the same range are two universities from Nigeria (Covenant University and University of Ibadan), then several other universities from Egypt and South Africa. Other rankings show some minor

 Times Higher Education World University Ranking (2019) https://www.timeshighereducation. com/student/best-universities/best-universities-africa#survey-answer. 1

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variations, for example, the QS 2019 World University ranking placed the University of Cape Town at the 200th position.2 Achieving excellence in health research or the broader area of Science, Technology and Innovation requires strong, competitive and sustainable institutions, including public and private sector institutions. This also means availability of a critical mass of human capacity and sustainable financing. Weak and poorly resourced institutions cannot compete or contribute meaningfully to development. Some African institutions work without a regular supply of electricity, and some depend on the intermittent use of power generators, which comes with its own challenges. While a small number of universities in several African countries are highly ranked within the continent in terms of scientific output, it is known that many universities and research institutions in Africa do not receive meaningful basic research funding from their governments, thereby making it difficult for research collaboration to occur even within a country.3 The National Research Foundation and Medical Research Council of South Africa, the Egyptian Academy of Scientific Research and Technology (ASRT), and a few others are doing well in providing some local research funding and fostering international collaboration. The relatively new Nigerian TET Fund (Tertiary Education Trust Fund) supports research in Nigerian universities. ANDI’s collaboration with a major Nigerian research institute and its regional hub for West Africa—the National Institute for Pharmaceutical Research and Development (www.NIPRD.net)—shows that excellent scientists and professors at the institute are not fully supported to perform cutting-edge R&D work that they were established to do. NIPRD discovered the first drug for the treatment of sickle cell anemia from herbal medicines,4 and the institution claims to have other discoveries on the shelf but lack funding to advance them. Such latent capacity is spread   QS World University rankings https://www.topuniversities.com/university-rankings/ world-university-rankings/2019. 3  Nwaka S. (2017/2018) Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review, pp. 76–80. Paula Park (2015) Funding Research in Africa (https:// www.the-scientist.com/news-analysis/funding-research-in-africa-36435). 4  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11. 2

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across the African continent, and with proper funding from government, mentorship and linkages, they can support the development of spin-off companies and be at the forefront of addressing health and other developmental challenges of the continent.5 The existence of several medical research institutions in Africa, including those established with support of development partners, such as the Noguchi Medical Research Institute in Ghana (www.noguchimedres.org), Ifakara Health Institute in Tanzania (www.ihi.or.tz), the Malaria Research and Training Centre in Bamako and several Pasteur Institutes could form the nucleus for medical research collaboration across Africa. Some of these institutions and other laboratories with a track record of securing external funding do perform competitive health research, subject to available resources. The same is true for major clinical trial sites in Africa, which largely focus on studies planned and sponsored by external donors, collaborators or companies. Many universities and research institution in sub-Saharan Africa have non-functional laboratories both for training of students and for answering important research questions. This situation must change if the continent is to make progress towards the Sustainable Development Goals (SDGs),6 AU Agenda 2063 and related health and STI strategies.7 The report of the 2015 global conference on financing for development underscored the importance of international and domestic financing to drive development. The report highlights the importance of infrastructural development, concerted capacity building and investment in research and development in all essential sectors.8

 http://theconversation.com/how-africa-can-close-its-continent-wide-science-funding-­ gap-55957; Nwaka S.  Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review 2017/2018, pp.  76–80; Nwaka S., et  al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi. org/10.1186/1472-698X-12-11. 6  https://sustainabledevelopment.un.org/post2015/transformingourworld. 7  AU Agenda 2063—The Africa We Want. Second edition, 2014. Popular Version. https://archive. au.int/assets/images/agenda2063.pdf; https://www.nepad.org/publication/health-research-and-­ innovation-strategy-africa-hrisa-2018-2030; Science, Technology and Innovation Strategy for Africa 2024. http://hrst.au.int/en/sites/default/files/STISA-Published%20Book.pdf. 8  https://www.tralac.org/images/docs/7732/report-of-the-third-international-conferenceon-­financing-­for-development-addis-ababa-july-2015.pdf; https://unctad.org/meetings/en/ SessionalDocuments/ares69d313_en.pdf. 5

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The emergence of some new externally funded projects that emphasize networks or consortia led by African institutions is a move in the right direction. These include the World Bank’s pan-African Centres of Excellence initiative targeting universities,9 and Wellcome Trust DELTAS and the joint Wellcome/US National Institute of Health H3Africa initiatives, both of which have been transferred to the African Academy of Sciences (AAS) for implementation.10 Also, the ongoing implementation of the Grand Challenges Africa with support from the Gates Foundation and Institute Pasteur is a welcome development.11 These initiatives are helping to build important basic and discovery research capacity, and it is very clear that major gaps remain across the innovation value chain. The translation of local technologies and knowledge from the laboratory to the market and the processes associated with it have not received much attention.12 This also reflects the poorly developed small- and mediumscale enterprises that can support product development and commercialization in Africa. Lesson 5: Another important lesson learned through the work of ANDI is the immense difficulty that many African institutions have in providing timely accounting for the funds they receive through agreed timely financial and technical reports. In some cases, it was not possible, at all, to receive financial reports from some institutions, and there cannot be any good reason(s) for the lack of transparency and accountability. This challenge is not solely the responsibility of the investigators or researchers, but it is a broader problem with institutional governance and accountability. Strong institutions are accountable, and perhaps targeted training should be put in place for institutional administrators and financial officers on how best to work or support their investigators in managing and  http://projects.worldbank.org/P126974/strengthening-tertiary-education-africa-through-africacenters-excellence?lang=en; Nwaka S. Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review 2017/2018, pp. 76–80. 10  See  9; https://wellcome.ac.uk/press-release/centre-gravity-african-research-funding-shiftscloser-africa. 11  Nwaka S. Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review 2017/2018, pp. 76–80; http://gcgh.grandchallenges.org/challenge/grand-challengesafrica-innovation-seed-grants. 12  http://www.andi-africa.org/ANDI_File/Newsletter_List/ANDI%20-EMORY%20 Partnership%20in%20Action.pdf. 9

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accounting for funds received both from within their country and from external sources. Having said this, it will be an omission not to mention that there are many African institutions that are on top of their game— they are timely with their reporting, and the accountability they demonstrate is as good as it can get. Human resource development and capacity building in research and various innovation areas in Africa have indeed been the subject of many projects, fora and strategies. However, the utilization of available capacity as a stimulus for building more capacity, promoting intra-­African collaboration and implementing project-based training needs to be prioritized for sustainability.13 It is the alignment of these parameters that resulted in several ANDI initiatives, such as the pan-African Centres of Excellence (CoEs) in health innovation and various project-based capacity building and utilization programs. This integrated project-based approach to capacity building is important in addressing some of the identified gaps in Africa. Some of the existing public-private and product development partnerships (PDPs), such as the Medicines for Malaria Venture (MMV) and Drugs for Neglected Diseases Initiative (DNDi), have made significant progress in supporting drug development for a few diseases that disproportionately affect developing countries (see Appendix C for further details). They have, however, not sufficiently emphasized capacity building as part of their strategy and they are largely headquartered in developed countries.14 Several multinational companies are now establishing global health initiatives and technology hubs in Africa—GSK is implementing its Open Lab initiative for non-communicable diseases, Johnson and Johnson have announced a new Global Public Health Strategy in Africa and support for fellowships, and GE, Philips, IBM and others have established African initiatives. It is hoped that these initiatives will forge true local partnerships that supports sustained human resource development, technology  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf; see 4, 11. 14  Tucker T. J. and Makgoba M. W. (2008) Public Private Partnerships and scientific Imperialism. Science 320, 1016–1017; see also 46. 13

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transfer and access to health or other technologies, rather than just interest in testing sights for their products in Africa.15 A broader discussion of North-South and South-South partnerships is presented in Sect. 5.1.

5.1 N  orth-South, South-South Partnerships and Official Development Assistance According to the World Bank’s classification, “the North” means high-­ income or developed countries and the “the South” means low- and middle-­income or developing countries.16 Therefore, North-South collaboration is a cooperation between countries or their institutions (public or private) in high-income and low- or middle-income regions, while South-South collaboration involve two or more countries or their institutions in a low- or middle-income region. Historically, the idea of geographically grouping countries by their economic and developmental status began as a result of a political “Cold War” definition, with the Soviet Union and China representing the East while the United States and its allies representing the West. At the time, this was a political division between capitalism and communism and had nothing to do with development. Subsequently, states that were not directly involved in the capitalist-communism divide of the West and East were in a third category of states termed the “Third World,” or the Non-Aligned Movement.17 These countries were generally less economically developed than their First World (West) and Second World (East) counterparts. As some Second World countries joined the First World, and others joined the Third World, a new and simpler classification emerged—the First World became the “North” and the Third World became the “South.” The Sustainable Development Goals (SDGs) recognize the critical importance of both South-South and North-South cooperation and partnerships in various sectors, such as the environment, education;  Nwaka S. (2017/2018) Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review, pp. 76–80; see also 21. 16  World Bank Country and Lending Groups, WORLD BANK, https://datahelpdesk.worldbank.org/ knowledgebase/articles/906519-world-bank-country-and-lending-groups. 17  https://en.wikipedia.org/wiki/North%E2%80%93South_divide. 15

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Science, Technology and Innovation (STI); health and others. For example: SDG 17.6 states—“Enhance North-South, South-South and triangular regional and international cooperation on and access to science, technology and innovation and enhance knowledge sharing on mutually agreed terms.” SDG 17.8 further states—“fully operationalize the technology bank and science, technology, and innovation capacity-­building mechanisms for least developed countries by 2017 and enhance the use of enabling technology, in particular information and communications technology.” It is important to note that the Technology Bank for Least Development Countries (to strengthen STI capacity) has been established with initial funding support from Turkey and other countries and is located in Gebze, Turkey, making it the first SDG target to be achieved.18 The Turkish government offered to fund and provide infrastructure for the organization and host it. In the context of capacity building SDG 17.9 states: “Enhance international support for implementing effective and targeted capacity building in developing countries to support national plans to implement all the sustainable development goals, including through North-South, South-South and triangular cooperation.” North-South partnerships have long played a dominant role in official development assistance (ODA) strategies intended to address essential needs of the south. Africa has been the center piece of North-South collaboration in research, as it is home to the majority of least developed countries as well as low- and middle- income countries.19 Until recently, these North-South collaborations have been largely designed, financed and controlled by the Northern partners, with a concentration of R&D and decision making in the North. In addition, these collaborations have not addressed capacity issues in a sustainable way,20 consistent with the often-biased North-South pattern of health R&D collaboration discussed earlier (see also Figs. 2.4–2.10).

 http://unohrlls.org/custom-content/uploads/2018/06/04.06.18-Technology-Bank-for-least-­­ developed-countries-inaugurated-in-Turkey-Gebze_1.pdf. 19  About LCDs (http://unohrlls.org/aboutldcs/). 20  Nordling L. (2015) Africa’s Fight for Equality, 521 NATURE 24, 25; Binka F. (2005) Editorial, North-South Research Collaborations: A Move Towards a True Partnership, 10 TROPICAL MED. & INT’L HEALTH 207. 18

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A recent article has discussed North-South Collaboration to promote health innovation in Africa in some detail.21 The paper shows that traditional North-South collaborations to combat diseases prevalent in Africa have generally taken one of the following forms: (1) non-profit product development partnerships (PDPs); (2) funding mechanisms to supply and procure drugs and vaccines; the examples are the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM), Global Alliance for Vaccine Initiative (GAVI), UNITAID and UNAID, which address market dynamics for malaria, HIV and tuberculosis; (3) research institutes and platforms devoted to research on neglected diseases, for example, Tres Cantos Open Lab Foundation created by GlaxoSmithKline to support research on neglected diseases, and other non-profit institutes; (4) pharmaceutical philanthropy, for example, Merck & Co., Inc., Mectizan donation program of 1987 for river blindness and elephantiasis, and the donation of praziquentel for schistosomiasis; and (5) overseas scientific training and technical assistance programs, for example, through development partners. As indicated earlier, while these approaches are making great strides in the study of neglected diseases and in providing access to intervention, they remain tied to a developed economy model of health product discovery, development and delivery, relying primarily on public and philanthropic funds, Northern capacity for the development of new medical therapies, and donor decision making about where to focus efforts and resources.22 As a result, there has been a neglect of region-specific R&D and access needs imposed by Africa’s growing chronic disease burden and emergent infections as well as a failure to adequately invest in the potential of local resources, traditional knowledge and local markets. Additional interconnected limitations of traditional North-South collaborations include: (1) the neglect of local decision making and capacity, (2) the failure to connect research efforts with downstream processes for

 Liotta C. D., Nwaka S., et al. (2018) North-South collaborations to promote health innovation in Africa. Emory Law Journal 67: 619–653. 22  BMC INT’L HEALTH AND HUM. RTS. SUPP. 2010 (series of 12 articles that discuss African health innovation systems); Liotta C. D., Nwaka S., et al. (2018) North-South collaborations to promote health innovation in Africa. Emory Law Journal 67: 619–653. 21

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development and commercialization, and (3) the absence of mechanisms to ensure long-term program and financial sustainability.23 Lesson 6: Rather than transplant R&D strategies that have worked well in developed markets, North-South collaborations supporting African capacity building initiatives should find ways to optimize the existing African infrastructure and work to address its limitations. The strategies must be designed with local institutional, legal, cultural, and political contexts and domestic market realities in mind. While recognizing the limitations in Africa, it is equally important to harness the unique opportunities that the African continent offers, not just in scientific capacity, but also through natural remedies and indigenous knowledge. Perhaps most importantly, the strategies must involve decision making by African stakeholders, building on African strategies to foster self-reliance and sustainable development of the continent. While government and philanthropic sources of funding have helped to boost the pipeline for several neglected diseases in Africa, they are often limited to short-term research or seed funding for earlystage ideas, with a dearth of such funding for commercialization efforts.24 There are both formal and informal barriers that limit the use of public funds to support perceived or potentially profit-making efforts of private companies, thereby making it difficult to fund the small- and medium-sized companies interested in taking products to the market. In some of the developed economies, concerted efforts have been made by government funders to adapt public funding programs to the needs of emerging businesses. The Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) programs in the United States and the Innovative Medicines Initiative in the European Union are few examples.25 Such efforts are  Liotta C. D., Nwaka S., et al. (2018) North-South collaborations to promote health innovation in Africa. Emory Law Journal 67: 619–653; Laura Diaz Anadon, et al. (2015) Making Technological Innovation Work for Sustainable Development, 113 PROC. NAT’L ACAD. SCI. 9682, 9683. 24   Butler D. (2010), Neglected Disease Fund Touted, NATURE  465: 277  https://doi. org/10.1038/465277a.; see also 23. 25  About SBIR STTR Ameria’s Seed Fund, https://www.sbir.gov/about/about-­sttr#sttr-program (last visited Dec. 28, 2018); The IMI Story So Far, INNOVATIVE MEDS. INITIATIVE, http:// www.imi.europa.eu/about-imi/history-imi-story-so-far. 23

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largely absent in developing economies and should be developed as part of a concerted social innovation enterprise in Africa. On the other hand, South-South cooperation started from the mid-­ 1950s to early 1960s following the independence of several Caribbean and African countries from their colonial masters. With independence, political, trade, education and scientific partnerships still existed between these countries and their colonial masters in the North. The terms of these relations were largely unfavorable to the developing countries, and they started efforts as independent states to explore alternatives. An obvious consideration was fostering cooperation among developing countries, who have a lot in common.26 The reason being that developing countries have a similar set of circumstances and it may be easier to adopt and adapt programs or share lessons among them in a more balanced way to support development. In 1955, the Indonesian Bandung Conference formalized the start of South-South cooperation with many developing countries from Africa and Asia in attendance.27 Since then, the world has witnessed significant emphasis in the promotion of South-South cooperation to address the socio-economic development of low- and middle-income countries. In support of this ideal, several UN and multilateral agencies, including UNCTAD, UNESCO, UNDP and development banks, have established programs on South-South cooperation. Notwithstanding these initiatives, North-South cooperation remains very important for developing countries and the conditions for such collaboration have continued to evolve. It is a fact that African countries have a lot to learn among each other but also from other developing and emerging economies like China, India, Brazil and South Korea as it relates to socio-economic development. In the 1960s and 1970s, some of these countries were at similar levels of economic development with some African countries. Understandably, South-South collaboration is not as developed,  Rath A. Lealess S. (2000) The Forum on South-South Cooperation in Science and Technology— An Overview Document. Policy Research International Inc., UNDP Seoul; Thorsteinsdóttir H., et al. (2010), South-South entrepreneurial collaboration in health biotech. Nature Biotechnology, 28, 407. 27  https://en.wikipedia.org/wiki/South%E2%80%93South_cooperation#History. 26

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especially in the areas of technological and social innovation, despite several collaborative agreements and strategies. This is largely due to the lack of dedicated resources to fund such collaborations and the unclear innovation policy frameworks in or among African countries. This challenge is more striking with the weak intra-African collaborations that have already been discussed. Countries like India and China have partnered with some regional and national African governments and entities to adopt frameworks for greater regional cooperation that include investment in African health, science and technology capacity, and manufacturing. The China-Africa Science and Technology Partnership Program (CASTEP) and the Africa-­ India Framework for Cooperation are recent examples. South Africa and China have signed MoUs on a variety of science- and technology-related initiatives. The two governments have also signed a letter of intent to establish China-South Africa Joint Research and Innovation Fund to provide funding on a competitive basis for researchers and develop new technologies and innovations, among other activities.28 Although North-South and South-South collaborations among private sector participants are growing, local investments in infrastructure and human resources are needed to ensure that the collaborative activities build local industrial capabilities. Indeed, North-South, South-South and triangular cooperation with the associated public-private, private-private and public-public partnerships should be strengthened as part of the innovation activities in Africa. The unprecedented global COVID-19 pandemic, the 2014–2015 Ebola crisis in West Africa and other recent epidemics like the Ebola outbreak in the DRC and Lassa fever in Nigeria are stark reminders of the importance of such partnerships, to support developing and sustaining disease surveillance, diagnostics, vaccination and treatment capacity in Africa. The recent technology transfer arrangement between Johnson and Johnson (J&J) and Aspen Pharmacare South Africa for the manufacture of the J&J’s COVID-19 vaccine is a step in the right direction and it is further discussed in Chapt. 11.

28  https://www.iol.co.za/business-report/opinion-multinationals-still-dominate-the-africantech-space-11945830.

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5.2 F inancing, Official Development Assistance and Proposed African Innovation Fund Just like the availability of sustained human resource capacity, access to financing and appropriate infrastructure are key challenges in all African R&D and innovation activities. The work on the pan-African Centres of Excellence (CoEs)29 helped to shed some light on the trend in financing for R&D and innovation on the continent. Although the work focused on health, the issues identified are similar to research in all sectors—be it in agriculture, environment or others. Previous work by the African region of the World Health Organization (WHO/AFRO) shows that the current funding streams for health research in Africa are fragmented and characterized by small and short-­term grants, which are not always contributing to the longterm development of the health research system.30 It has particularly been argued that donor-driven science can lead to biased research agendas toward donor interests in certain countries, activities or specific diseases.31 In addition, there is a lack of reliable data on capacity for health research as well as limited knowledge about where the bottlenecks are, further underlining the need for a more institutional and system-wide capacity evaluation and implementation. Indeed, analysis by UNESCO, showed lack of data on R&D trend for some African

 Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11. 30  World Health Organization Regional Office for Africa: Expenditures on Health research in African Countries. Report 3 of Algiers ministerial conference on research for health in the African region. Algiers: 2008; see also World Health Organization Regional Office for Africa: The State of Health Information in the African Region: Data Sources, Information Products and Health Statistics. Report 9 of the ministerial conference on research for health in the African region. Algiers: 2008. 31  Uthman O.A. (2009) Performance, priorities, and future of biomedical research publications in Africa: Need for networks between scientists in developed and developing countries. Pan Afr Med J. 1:5; see also Uthman O.A. and Uthman M.B. (2007) Geography of Africa biomedical publications: an analysis of 1996–2005. Int J Health Geogr 2007 6:46. 29

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countries.32 Subsequently, ANDI argued that these observations, while factual, may  paint too pessimistic a picture about the prospects of implementing a robust health product R&D in Africa, if the root causes of the challenges are not systematically analyzed and presented. Following several systematic mappings of the health R&D landscapes in Africa, ANDI showed that capacity for product R&D and innovation exists in the continent.33 However, this capacity is not effectively utilized to fill gaps and solve Africa’s health problems due to the lack of collaboration within Africa, lack of coordination of existing research efforts and governance; all caused by the lack of sustainable investment and funding on the continents research and innovation. Other reports have also reached similar conclusions.34,35 Lesson 7: While these conclusions are still true today, it has become clear that what is needed to address identified challenges is political will and leadership that supports (1) access to sustainable financing for R&D and innovation, (2) building of a critical mass of capacity across the innovation value chain, (3) private sector development and public/private partnerships, (4) strengthening and building of the African R&D infrastructure, (5) a higher education system that promotes innovation and entrepreneurship, and (6) enhanced collaborations among African scientists across African countries. Analysis of the health R&D funding between 2008 and 2010 based on the work of ANDI’s pan-African Centres of Excellence36 shows that, on  See Global Investments in R&D (2018) http://uis.unesco.org/sites/default/files/documents/ fs50-global-investments-rd-2018-en.pdf; see also various UNESCO data as it relates to R&D http://uis.unesco.org/en/news/rd-data-release#slideoutmenu. 33  Strategic and Business Plan for the African Network for Drugs and Diagnostics Innovation, 2009. http://www.who.int/tdr/publications/documents/sbp_andi.pdf; Mboya Okeyo T., Ridley R., Nwaka S. (2009) The African Network for Drugs and Diagnostics Innovation. Lancet, 371:1507–1508. 34  NEPAD and COHRED: Strengthening Pharmaceutical innovation in Africa. Designing strategies for national pharmaceutical innovation: choices for decision makers and countries. 2010. http://www.nepad.org/system/files/str.pdf. Accessed on November 16, 2011. 35  Irikefe V., et al. (2011) The view from the front line—Africa’s nations are achieving some success in building their science capacity, but the foundations remain unsteady. Nature, 474:556–559. 36  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11. 32

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average, 65% of R&D funding for those CoEs is coming from external funding sources outside the African continent. When you include funding from the CoEs that are manufacturers to the R&D funding, the picture changes to 57% of internal funding, suggesting that manufacturers secure their own funding largely through non-grant mechanism. Similarly, analysis of frequent funders of health R&D in Africa based on data from the ANDI pan-African Centres of Excellence shows that only the National Research Foundation of South Africa makes the list of top 20 funders and the rest are non-African donors. Preparing the various chapters of this book that touched on financing for research and innovation in Africa constantly reminded me of books and commentaries about overdependence of African countries on foreign aid. Some have called out international development and aid agencies that implement official development assistance (ODA) without accountability to Africans as benefiting external players, rather than helping to build and leverage domestic capacity in a manner that strengthens available instruments to implement Africa-defined and -driven strategies and programs.37 A book by Anand Giridharada, titled Winners Take All—The Elite Charade of Changing the World,38 describes how the efforts of some global elites to “change the world” preserve the status quo and obscure their role in causing the problems they later seek to solve. The book goes on: “Rather than rely on scraps from the winners, we must take on the grueling democratic work of building more robust, egalitarian institutions.” The Dambisa Moyo’s controversial book Dead Aid: Why Aid Is Not Working and How There Is a Better Way for Africa also comes to mind. As a practitioner of international development, the author knows that international development and aid to developing countries have made a lot of positive impact and saved lives. However, the way that some of the aid (if not most) are structured or implemented can be counter-productive, and in the process fuel the challenges that they seek to address. A recent open letter to international funders of science and development in

 Mavhunga C. C. (Editor) (2017) What Do Science, Technology, and Innovation Mean from Africa? The MIT Press, Cambridge. 38  Giridharada A. (2018) Winners Take All—the elite charade of changing the world. Penguin Random House. 37

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Africa  also speaks to this issue.39 Some of the lessons that have been shared in this book about research and innovation speak to some of the constructive ways of improving aid. As Figs. 2.4–2.10 show, there is a collaboration bias for African scientists and institutions toward Europe and the United States in clinical trials and in most research areas studied. The message here is not that North-South collaboration is bad, in fact to the contrary, but such collaboration should be more equitable, ethical and more balanced. The fact is that funding that promotes intra-African and intra-country collaborations to address local questions is important and very much needed. For clinical trials, it should be noted that most of the trials are undertaken with products discovered overseas and there are little or no examples of purely local products or innovations that have undergone extensive clinical development with the required funding support. Support should be provided to build locally grown and sustainable innovation ecosystem in Africa. As discussed earlier, focusing on scaling up and harmonizing the already dominant social innovation approaches for African innovation (which recognize all stakeholders) could trigger a new wave of financing both from local and from international sources. This approach will go a long way in the defragmentation of the landscape for research and innovation in Africa and boost outcomes. It is understood that many African countries are stepping up local funding for research and development, but a lot of work remains. In 2013, for example, average national budgets for health was about 9.8% (with some countries investing 2%), but the African Union (AU) target was 15%.40 Also, since 2006, the AU’s target of 1% of health expenditures for research has not been achieved by most countries. As alluded to earlier, investment in infrastructure, capacity building and utilization, coherent policy framework and strong regulatory systems are essential to stimulate local research and manufacture.41 Perhaps the poor investment  Erondu N. A., et al. (2021) Open letter to international funders of science and development in Africa. Nature Med. https://doi.org/10.1038/s41591-021-01307-8. 40  Musango L., et  al. (2013) The State of Health Financing in the African Region, AFRICAN HEALTH MONITOR, Mar. 2013, at 9, 12. 41  Nwaka S., et al. (2010) Developing ANDI: A Novel Approach to Health Product R&D in Africa. PLOS Medicine 2010; 7(6): e1000293. https://doi.org/10.1371/journal.pmed.1000293. http:// journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000293; Ameenah Gurib39

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in research and innovation in most African countries is not entirely their fault, as they struggle with limited resources to address competing priorities. It is known that the payment of salaries of workers easily takes up to 70% of the annual budgets of some countries, not to talk of infrastructure, energy, health, education, defense and so on. Also, the GDP of some of these countries is smaller than the value of some medium-sized multinational companies in developed countries. Therefore, investing more than 1% of GDP of some African countries in R&D will be like a drop in the ocean. Perhaps an important pathway to support meaningful research and innovation for some of these countries should be through a pan-African approach that pools resources to support promising innovation across the continent. This also means a bigger pan-African market for any product(s) that results from R&D. Again, Christensen and his colleagues suggested that with the hundreds of billions of dollars spent yearly on ODA, the focus should be on supporting countries to tackle the root causes of poverty and create equitable wealth, rather than focus on peripheral data for temporary poverty alleviation. “Countries can reliably and sustainably overcome poverty and, indeed many have; however, they did not do it mainly by trying to eradicate poverty. They did it by focusing on creating prosperity. On the surface, the difference between the two strategies may seem like mere semantics, but that couldn’t be farther from the truth.”42 Over the years, several African organizations, including ANDI, have proposed the establishment of one type of African R&D and innovation fund or the other, but unfortunately little has materialized. As part of its 2009 strategic and business plan, ANDI proposed the establishment of an African Innovation Fund that will be housed and managed through the African Development Bank (AfDB). Ways to enable accountability and oversight of the Fund as well as the mechanism for its sustainability, Fakim, African Governments Must Urgently Invest in Science and Research, GUARDIAN (Sept. 30, 2015, 5:34 AM), https://www.theguardian.com/global-development-­professionalsnetwork/2015/ sep/30/african-governments-must-invest-in-science-and-research; Dong J. & Mirza Z. (2016) Supporting the Production of Pharmaceuticals in Africa, 94 BULL. WORLD HEALTH ORG. 71. 42  Christensen C.  M., et  al. (2019) The Prosperity Paradox: How Innovation Can Lift Nations Out of Poverty (Harper Collins). See also a linked short article by the same authors published at the World Economic Forum 2019 (https://www.weforum.org/agenda/2019/01/ poverty-data-never-tells-the-whole-story/).

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were proposed and accepted by stakeholders. This was proposed to be sustained through three mechanisms: the first is the traditional donor-­ based funding to be realized through regular or periodic campaigns to raise funds from donors. The second option was an innovative financing mechanism, through government-controlled streams: for example, indirect taxes to airline travel, currency transaction taxes and government-­ backed bonds schemes, such as with UNITAID; performance-based commitments from public and private donors, such as “cash-on-delivery schemes” or paying a fixed amount for every child vaccinated, as implemented by GAVI’s Immunization Services Support. A third approach is the endowment approach, which has proven to achieve sustainability and with the capacity to be managed in a “through cycle” approach. The establishment of an endowment fund has been the prevalent model for leading research institutions and private foundations. It was thought that a combination of these approaches would be helpful for the success of an African Innovation Fund. While several global initiatives have had success with these sorts of financing, there appears to be little or no examples of an African regional product innovation initiative that has succeeded. Indeed, other pan-African organizations and strategies have proposed the establishment of a pan-African fund, for example, the UNECA, AUDANEPAD through STISA and other programs. Unfortunately, this is yet to materialize. A recent effort toward an African Fund was discussed at the World Economic Forum in January 2017 through the efforts of a former President of Mauritius and the African Academy of Sciences (AAS).43 The idea was to establish the Coalition for African Research and Innovation (CARI) as part of the AAS, with initial support from the Wellcome Trust, Gates Foundation and US National Institutes of Health. While it is likely that such effort will not succeed without external funding support, it is very important for some of the funding to come from within Africa. The contribution of the African Union (AU) toward the Africa CDC (in addition to support from development partners) is encouraging.  https://www.weforum.org/agenda/2017/01/africa-s-future-depends-on-its-scientists-time-to-­ stop-the-brain-drain/; Nwaka S. (2017/2018) Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review, pp. 76–80.

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It should also be mentioned that the efforts by the World Health Assembly to establish a voluntary pooled product R&D fund for diseases that disproportionately affect developing countries has not materialized.44 The Special Programme for Research and Training in Topical Diseases at WHO (TDR) and ANDI were considered for hosting such fund, and TDR was prioritized and requested to produce a business plan. All relevant documentations were produced, but the project has not been supported.45 This again highlights the complexity of establishing a fund for research that extends to product innovation to support developing countries through voluntary granting approach. It should also be mentioned that a previous discussion on an R&D fund to be hosted by TDR started at around 2008 alongside discussion on the global strategy and plan of action on public health, innovation and intellectual property, and regional innovation networks such as ANDI. A series of framework documents were also produced at the time, but the project did not materialize. Lesson 8: An important lesson learned is that grant funding alone cannot support scale-up, registration and commercialization of innovations in Africa, and that a type of venture financing, coupled with sustainable pooled/endowment funding, will be required. Unfortunately venture financing for science-based innovations is not as well developed in Africa as it is in developed and some emerging economies.46 An interesting development is the establishment of the Transform Fund of $500 million by the Islamic Development Bank (IDB) to support Science, Technology and Innovation efforts in its member countries. The initiative is said to be aligned to the SDGs and provides seed money for innovators, startups and SMEs to develop their ideas and compose a strong business proposal.47 The Fund has mechanisms to provide grants, venture or equity financing depending on the stage of the innovation. It gives room for pooling of funds from other investors. We had previously proposed that a suitable pan-African innovation fund would have  http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_BCONF6-en.pdf?ua=1.  Potential new pooled fund for health product R&D. https://www.who.int/tdr/capacity/gap_ analysis/global-prioritization/en/. 46  Masum et al. (2010) BMC International Health and Human Rights, 10(Suppl 1): S12. http:// www.biomedcentral.com/1472-698X/10/S1/S12. 47  https://www.isdb-engage.org/en/challenge/call-for-innovation-via-transform-fund. 44 45

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elements of this approach, although such a program should be well structured, and managed professionally and transparently. The author was attracted to the opportunity to serve as the founding director of the Science, Technology and Innovation Department that houses this fund and other initiatives at the Islamic Development Bank. However, what sounded nice and interesting on paper was different from the realities on the ground at the Bank. Several unacceptable  incidences were experienced, but they will not be discussed in this book. It appears that most development banks focus on lending through governments and perhaps a group of countries can work with such banks to establish a significant African Innovation Fund that will have both a granting and a venture arm for R&D and manufacturing. Several development and commercial banks manage their own venture financing windows that extend to startups, SMEs and individual entrepreneurs in Africa; however, such funds are yet to be extended to R&D. We are aware that the AfDB, African Export and Import Bank (AFREXIM), the World Bank through its International Finance Corporation (IFC) and others have private-sector-targeted financing and are increasingly looking for ways to make the lending conditions more favorable for startups and SMEs in developing countries. This type of funding should be extended to product-focused R&D. The challenge for SMEs and startups in the past has been that the condition for accessing such funds is complex and not favorable for young companies with little or no collateral to support their borrowing. Moreover, it appears that some of the development banks will not lend less than USD 5 million, even though some of the small firms require less than that amount for a start. Hopefully, the post-­ COVID-­19 pandemic experiences will make funding and lending for local innovation easier. Recently, the AfDB and the European Investment Bank (EIB) teamed up to establish a program called Boost Africa which seeks to support innovation and entrepreneurship by addressing the financing gap at the earliest and riskiest stages of enterprise creation. The initiative proposes to invest in developing and strengthening skills and expertise and in

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launching SMEs in Africa.48 It is also good to see some progress between individual countries and the development banks in establishing innovation funds and initiatives. Rwanda is working with AfDB to establish an innovation fund in the country.49 Rwanda is also developing a multi-­ billion Dollar Kigali Innovation City for the development of technological advancements.50 This is part of Rwanda’s National Strategy for Transformation 2017–2024, and it is being implemented as a public-­ private partnership of the government with Africa50—an infrastructural financing initiative of the AfDB. The Centre is planned to attract universities, technology companies, biotech firms, agriculture, healthcare and financial services. Also, Nigeria is working with AfDB for the establishment of a $500-million Innovation Fund.51 It is hoped that these developments will help to realize the broader pan-African Fund(s). It is also good to see the signing of a USD 1.24 billion agreement between AFREXIM Bank and Nigeria on the development of industrial parks and special economic zones.52 On the health sector, the AFREXIM bank has taken a bold step toward the development of the Health and Medical Tourism Program (HMTP) in Africa, to address the rising demand for medical services and the poor capacity of existing medical facilities to meet those needs. The program is structured in two parts: (1) the Construction and Medical Tourism Relay (CONMED) Facility, which will inject financing into the African medical services industry in support of the development of world-class facilities and upgrading of existing ones, and (2) the African Medical Centres of Excellence (AMCE) Initiative, which facilitates the establishment of a   Boost Africa—empowering young African entrepreneurs (http://www.eib.org/en/projects/ regions/acp/applying-for-loan/boost-africa/index.htm); (https://www.afdb.org/en/news-and-­ events/african-development-bank-invests-us-7-5-million-in-africa-tech-ventures-to-boostinnovative-­start-ups-18878/). 49  https://www.afdb.org/en/news-and-events/rwanda-innovation-fund-project-to-receiveus-30-million-loan-from-african-development-­bank-­17956/. 50  https://medium.com/@nickyverdz/r wanda-is-building-africas-ver y-own-siliconvalley-known-as-kigali-innovation-city-kic-­d3330975d2ec. 51  h t t p s : / / w w w. va n g u a rd n g r. c o m / 2 0 1 8 / 1 1 / f g - a f d b - t o - c re a t e - 5 0 0 m - i n n ova t i o n fund-for-tech-creative-sector/. 52  https://afreximbank.com/afreximbank-launches-1-billion-programme-to-promote-nigeriaafrica-trade-signs-mou-for-­1-235-billion-for-industrial-parks/. 48

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network of world-class tertiary healthcare facilities across Africa.53 These programs will address clinical, diagnostics and manufacturing services as well as training and research into healthcare solutions in Africa. A few private foundations are also promoting innovation and entrepreneurship in Africa: (1) the Tony Elumelu Foundation is seeding entrepreneurship and SME development across Africa with a USD 100 million fund.54 The foundation was founded in 2010 with the vison to help “unlock the obstacles that Africa’s entrepreneurs face as they grow their start-ups into small to medium enterprises (SMEs), their SMEs into national growth companies, and their national growth companies into African multinationals.” (2) The Aliko Dangote Foundation enhances opportunities for social change through strategic investments that improve health and well-being, promote quality education and broaden economic empowerment opportunities. Its primary focus is child nutrition, with wraparound interventions centered on health, education and empowerment, and disaster relief. It collaborates with the Bill and Melinda Gates Foundation to eradicate polio and strengthen routine immunization in Nigeria. It is hoped that these important initiatives and new ones will emerge to support research-driven product innovation on the continent. Considering the needs and urgency for Africa to focus, scale and sustain efforts in social innovation as proposed in this book, a blended and flexible financing mechanism that incorporates an impact investing approach would be one of the appropriate approaches. The most recent strategic plan for ANDI55 suggested a blended pathway for the African Innovation Fund that comprises—(1) a pooled fund that is made of grants and contribution from subscription, and (2) an impact investing or social venture fund that will be professionally managed for growth and impact. While the pooled/grant financing approach is more suited for upstream R&D, the translation of the upstream R&D outcomes into  https://www.afreximbank.com/afreximbank-picks-nigeria-to-host-healthcare-centreof-excellence/. 54  Tony Elumelu Foundation http://tonyelumelufoundation.org/about-us. 55  Facilitating Health Innovation in Africa—ANDI’s Five Year Strategy (http://andi-africa.org/ ANDI_File/Strategic_Plan/Facilitating_Health_Innovation_in_Africa_ANDI_Strategic_ Plan(2016-2020).pdf ). 53

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products and services through scaling up, manufacturing and commercialization can be supported by impact investments  and other suitable modalities. Impact investing refers to investments made into companies, organizations and funds with the intention to generate a measurable and beneficial social or environmental impact alongside a financial return.56 Impact investments can be made by governments, organizations, companies and funds with the goal of a social and environmental impact, and some financial return. They direct capital to address these issues and can occur through various investment modalities. Funds can be placed in businesses, NGOs, technologies and manufacturing as required. Impact investing has been adopted by the United Nations to support the implementation of the SDGs with the establishment of the Impact Investment Initiative.57 Its application therefore extends to health, research and innovation infrastructure. A report by the Africa Private Equity and Venture Capital Association (AVCA), though focusing on venture capital (VC) financing for African startups, corroborates most of the financing trends presented in this book for research-driven innovation in Africa.58 It shows that South Africa, Kenya and Nigeria, attracted USD 3.9 billion in VC deals between 2014 and 2019, with companies in South Africa being responsible for 21% of the financing, while Kenyan and Nigerian accounted for 18% and 14%, respectively. It noted that information technology and fintech companies accounted for the bulk of the deal (38%) compared to other sectors, including consumer discretionary, utilities, industrial and so on. While this is promising, it should be noted that research-based biotechnology activities had little or no documented VC financing in the said report. Consistent with the dependence of a significant part of African innovation on external financing, 80% of the VC financing came in from  2017 Annual Impact Investor Survey by the Global Impact Investing Network. https://thegiin. org/assets/GIIN_AnnualImpactInvestorSurvey_2017_Web_Final.pdf; https://en.wikipedia.org/ wiki/Impact_investing; https://www.mckinsey.com/industries/private-equity-and-principal-investors/our-insights/a-closer-look-at-impact-investing. 57  https://www.unops.org/about/investing-for-impact. 58  https://www.avca-africa.org/research-publications/data-reports/venture-capital-in-africa-mapping-africastart-up-investment-landscape/. 56

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non-­African investors, and 21% of these VC deals went to African-linked companies with headquarters overseas. About 44% of VC financing in Africa saw participation from at least one impact investor—suggesting that impact investment is a growing investment vehicle in Africa. The said fund should be managed professionally, and then leveraged by a suitable African R&D and innovation organization or institute to implement calls for proposals to transparently identify and fund projects. Such an institute should be non-political in nature and should be well resourced with the best technical and managerial minds on the continent to ensure delivery of its mandate. Such a pan-African organization can establish dedicated centers or institutes within it that address research and innovation in the area of health, water and sanitation, nutrition, agriculture, environment and energy, as examples. In doing so, these individual institutes will recognize the power of multi-sectoral and multi-­ disciplinary approaches as an engine for innovation and should provide a platform for cross learning, maximizing resources and sustaining impact. The establishment of such institutions will go a long way in scaling up African innovations, thus minimizing fragmentation through interface with external R&D centers and donors.

6 African Traditional Knowledge, Other Technologies and Emerging Areas

The research, development and utilization of African traditional knowledge, especially traditional African medicines (TAM) and biodiversity, to address the challenges of the continent is of major strategic and developmental interest for the continent.1,2,3,4 African countries are keen to leverage TAM to address the various developmental challenges of the continent, including health and well-being, and economic growth. Unfortunately, R&D in the area is highly fragmented and suffers from

 Abuja Declaration of the African Summit of Heads of State and Government of April 2001 on research on traditional medicines used for the treatment of malaria, TB, HIV/AIDS and other infectious diseases as a priority. 2  Gurib-Fakim A. (2017) Capitalize on African biodiversity—Under-exploited plants offer untold medical and economic promise that should be pursued. Nature, 548, 7; Ameenah Gurib-Fakim, African Governments Must Urgently Invest in Science and Research, GUARDIAN (Sept. 30, 2015, 5:34 AM), https://www.theguardian.com/global-development-professionalsnetwork/2015/ sep/30/african-governments-must-invest-in-science-and-research. 3  Nwaka S. et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11. 4  Addae-Mensah I, et al. (2011) Traditional Medicines as a mechanism for driving research innovation in Africa. Malaria Journal, 10 Suppl 1: S9. 1

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poor strategic investment and coordination.5 In addition, of the ­approximately 4800 patents filed on TAM in 2014, only 0.08% represent those filed by African innovators (see Fig. 2.3). African traditional medicines and traditional African medicines (TAM) have been used interchangeably here, even though there may be subtle difference between them. The goal is to demonstrate the use of TAM in managing and controlling diseases, as source of drug leads, in agriculture/nutrition and business development. Evidence points to a significant contribution of traditional African herbal preparations to reduce mortality, morbidity and disability due to diseases such as HIV/AIDS, malaria, tuberculosis, sickle cell anemia, diabetes, hypertension and mental disorders.6 Accordingly, the World Health Organization (WHO) estimates that about 70% of the population in developing countries use traditional medicine, as the first line of treatment.7 Based on the accessibility, affordability, acceptability and presumed efficacy of TAM, WHO encourages African member states to promote and integrate traditional medical practices into their health systems. On the other hand, some of these traditional plants are used as vegetables, food additives, spices and mineral supplements. Some also produce essential oils and compounds that can be used in food, pharmaceuticals and cosmetics industry as well as in vector control. Most of these plants grow in the wild and are being lost at an unprecedented rate due to increasing habitat destruction, deforestation and other forms of human activities.8 A systematic agricultural development and cultivation of these plants should be the starting point for a sustainable and environmentally friendly exploitation of TAM. Considering all these points, ANDI and the African Development Bank (AfDB) discussed a project that uses a multi-sectoral and multi-disciplinary approach to systematically prioritize and demonstrate sustained agricultural  Nwaka S. (2012) Harness local knowledge, Nature 484 (Part of combined article on special edition on malaria by Crabb, B., Beeson, J., Amino, R., et al. Perspectives: The missing pieces. Nature 484, S22–S23 (2012). https://doi.org/10.1038/484S22a). 6  Elujoba A. A., et al. (2005). Traditional Medicine Development for Medical and Dental Primary Health Care Delivery System in Africa. African Journal of Traditional, Complementary and Alternative Medicines 2 (1): 46–61. http://www.bioline.org.br/request?tc05007. 7  WHO Traditional Medicine Strategy 2014–2023. 8  Gurib-Fakim A. (2017) Capitalize on African biodiversity—Under-exploited plants offer untold medical and economic promise that should be pursued. Nature, 548, 7. 5

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development and use in health and well-being, nutrition and SME development. A proposal with the title “Leapfrogging African Traditional Medicines for SME Development in Agriculture, Health and Nutrition” was developed by ANDI and submitted to the AfDB for action. After developing the project, a relevant article by the former President of Mauritius (a scientist) appeared in Nature on the medicinal and economic potential of African biodiversity.9 The proposed multi-sectoral approach to the development of TAM is feasible, as a similar approach has been used in China to develop the well-­ known Chinese traditional medicines (TCM). TCM has yielded several drug and drug candidates, including the active ingredient of the Artemisinin plant, the subject of the 2015 Nobel Prize in Medicine.10 The same plant has also spurred massive agriculture in China and parts of Africa, and it should be noted that China boasts of several dedicated universities, hospitals and SMEs for TCM. This area of work was included in ANDI’s collaboration with Chinese institutions, with the goal to work with relevant Chinese and African agricultural universities to establish good agricultural practices (GAP) for TAM, and then initiate a pilot research and evaluation of few herbal products. The project also proposed to implement country surveys and landscape analysis of available TAM to prioritize its uses in health as well as in the development of a knowledge platform for TAM (Fig. 6.1), to facilitate the development and documentation of use, processes for research, capacity building and partnerships. Initial analysis with the ANDI Board and the scientific advisory committee identified Moringa oleifera as a plant that meets the characteristic of TAM presented above.11 The plant is a medium-sized evergreen tree that is native to Asia and Africa, and is also known as horseradish or miracle tree. It is believed to have been used for generations to treat and prevent diseases such as diabetes, heart disease, anemia, arthritis, liver disease, and respiratory, skin and digestive disorders. Its nutritious profile  Gurib-Fakim A. (2017) Capitalize on African biodiversity—Under-exploited plants offer untold medical and economic promise that should be pursued. Nature, 548, 7. 10  “The Nobel Prize in Physiology or Medicine 2015.” Nobelprize.org. Nobel Media AB 2014. Web. 28 April 2016. http://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/. 11  Moringa oleifera (https://www.mindbodygreen.com/0-22401/10-powerful-benefits-of-drinking-­­ moringa-every-day.html, https://aduna.com/pages/moringa-oleifera). 9

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Fig. 6.1  Prototype TAM knowledge platform (database) designed by ANDI and partners as part of the initial formulation of this project

and anti-inflammatory properties, among other benefits, are also ­recognized. In Western countries, dried leaves are sold as dietary supplements in either powder or capsule form. A few small businesses have started in Ghana and Zambia based on the Moringa plant.12 There is a fascinating story of how a young Ghanaian—American aerospace engineer—left a career at the Massachusetts Institute of Technology (MIT) and NASA (the United States National Aeronautics and Space Administration) to co-create businesses that range from MoringaConnect (an effort that empowers rural Ghanaian farmers to plant and earn a living from Moringa tree), to truemoringa.com (a skincare product company based on Moringa), to mingafoods.com (as various Moringa-based foods are rich in protein and antioxidants).13  https://www.cnbcafrica.com/news/west-africa/2016/03/28/ghanaian-moringa-plant-­ entrepreneur/; (http://www.bbc.com/news/business-30504720). 13  Kwami Williams—From Aerospace to Agriculture: Why I left MIT & NASA for a Miracle Tree https://ghanatalksbusiness.com/aerospace-agriculture-left-mit-nasa-miracle-tree/; https://tony12

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While the use of suitable and validated traditional African medicines (TAM) in the management of various diseases, and their potential as source of new treatments are well known, any such treatment should be systematically evaluated in the laboratory and the clinic to define safety, efficacy and quality. In other words, such use should be supported with data and backed with proper regulatory procedures. There are several dedicated institutes within and outside African universities that focus on research into traditional herbal medicines and natural products both as a source of new drugs and as a source of other biotechnological applications.14 Again nearly, all those institutions suffer from poor funding and inability to translate their research into clinically evaluated products that pass through regulatory approval and scaled-up commercialization. The same fragmentation that has been discussed elsewhere in this book applies to this area. The pattern of research collaboration in this area is also largely North-South, with limited intra-African collaboration (see Fig. 2.10). This is another consequence of financing, and yet this area is at the heart of African indigenous knowledge. The COVID-19 pandemic has once again highlighted the sentiments around the use of TAM in Africa. Within weeks of the pandemic, several TAM researchers, herbal practitioners and African leaders started promoting various herbal products and mixtures as potential cures for the disease—some without any form of evidence. This type of unsupported pronouncements from leaders and scientists causes confusion and is further discussed in Chap. 11. The good news here is that TAM is an area of strength for Africa and it presents an unprecedented opportunity to further the discovery and development of new treatments. Again, the communal and social pattern of the indigenous use of TAM in treating diseases, and the nature of ongoing research, as well as its financing and the involvement of local communities in its exploitation, are all consistent with the features of social innovation.

loyd.com/148-kwami-williams-moringaconnect-unlocking-the-value-of-moringa-to-end-poverty/. 14  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published: July 2012. https://doi.org/10.1186/1472-698X-12-11.

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6.1 D  igital, Bio- and Chemical Technologies in Africa We have witnessed the development of digital or ICT technology hubs and incubators in the past one or two decades from grants, government support and venture financing. The World Bank’s work on tracking technology hubs and incubators in 2014 paved the way for monitoring progress within the digital entrepreneurship space.15 The World Bank defines technology hubs as spaces mainly focused on developing a digital entrepreneurship ecosystem, or a network of engagement between digital entrepreneurs, designers and potential investors. It defines incubators as organizations that predominantly offer targeted, time-bound activities and resources through application-based “go-to-market” programs for early-stage digital and tech entrepreneurs. As a global association of mobile communication industries (GSMA) put it—it is not only about offering space and services to startups, it is also about creating a large community of stakeholders (partners, startups, investors, etc.). The GSMA Ecosystem Accelerator Program and Fund is one such investor.16 Since 2016, the number of tech hubs have more than doubled in Africa, with South Africa, Nigeria, Kenya, Egypt and Morocco leading the way.17 In terms of cities—Lagos currently accounts for more hubs and programs than any other city on the continent, with several other fast-­ growing ecosystems in countries like the Democratic Republic of the Congo (DRC), Zimbabwe, Zambia, Ivory Coast, Ghana, Rwanda, Tanzania, Ethiopia and others. Several international technology giants and others have had some interest in this growth with announcement and visits of Google’s Sundar Pichai and Facebook’s Mark Zuckerberg to Lagos’ CcHub and Nairobi’s iHub, and Alibaba’s Jack Ma’s visit to East Africa. The French President Macron and Dutch PM Rutte visited Accra’s Impact Hub and iSpace. Twitter recently announced the establishment of its African hub in Ghana.  http://blogs.worldbank.org/ic4d/importance-mapping-tech-hubs-africa-and-beyond.  https://www.gsma.com/mobilefordevelopment/programme/ecosystem-accelerator/ ecosystem-accelerator-innovation-fund-round-3-findings-from-the-top-200-start-up-­ applications/. 17  (https://www.gsma.com/mobilefordevelopment/programme/ecosystem-accelerator/ africa-a-look-at-the-442-active-tech-hubs-of-the-continent/). 15

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Recent reports have also shown a high degree of uncertainty for these hubs and the need to integrate sustainability, as numerous hubs are shutting down, while many more are opening their doors.18 As with other R&D areas like biotechnologies, many of Africa’s tech hubs have initially  been  privately or grant funded (by either governments, foundations, or both) and are mainly oriented toward co-working spaces. Many of the hubs are more social venture focused, while some have been moving toward for-profit, self-funding and/or startup accelerator models; for example, the Kenya’s iHub founded in 2010 by Erik Hersman has been moving in this direction. iHub is also engaged in consulting, events and corporate partnerships. In 2016, Nigeria’s CcHub launched its Next Economy accelerator program and Growth Capital fund, both of which take equity in early-stage startups while offering business support. CrunchTech (an American online publisher of technology industry) also noted that it is important for the hubs to collaborate with each other based on specialty and to share lessons among themselves. Many of these hubs focus on ICT-related activities, especially in the areas of fintech, agritech and m/eHealth. It would be good to see the hubs get involved in R&D and forge ties with local universities and centers of excellence that have some R&D facilities that will facilitate robust startup development similar to what is done in the United States, with Silicon Valley, for example, working closely with Stanford, and MIT/Harvard working with other local hubs. Perhaps the biggest challenge is to determine how best to scale up as fast as possible, and again this is related to financing and market size. An article about technology hubs in Africa summarized the picture nicely:19 “I don’t want to be that guy who spoils the party, but we have done enough counting of the innovation and technology hubs in Africa. The focus should be moved to the outcome and impact of having these hubs … Many hubs are still operating without clear business models, services offered to the entrepreneurs are still average, very few have been  https://techcrunch.com/2016/12/09/africas-tech-hubs/; https://vc4a.com/blog/2017/06/19/ how-african-hubs-can-reach-financial-sustainability/. 19  Jumanne R. Mtambalike (2018) The facts and fictions about innovation and technology hubs in Africa https://medium.com/@jumannerajabumtambalike/the-facts-and-fictions-about-africainnovation-and-technology-hubs-b46d46c61f75. 18

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able to attract investment … Most are still surviving on grants and founders bootstrapping their way out …. I really like the way the hubs ecosystem has been growing but don’t confuse the growth with progress.” The ongoing COVID-19 pandemic has further reinforced the importance of digital technologies and connectivity not only in fighting diseases but also in sectors like education, fintech and so on, especially under lockdown and social distancing conditions. These technologies found important roles during the COVID-19 pandemic, such as in tracking the hot spots of disease transmission and in prompt sharing of useful information through social media. These needs will become the norm in a post COVID-19 economy of the world and will certainly create opportunities for several digital platforms in Africa. Unfortunately, digital technologies have also supported the spread of all sorts of misinformation and conspiracy theories about the disease, and we hope that this aspect will be greatly curtailed. Like many businesses and technology platforms, there is no doubt that the COVID-19 pandemic has negatively impacted many African technology startups and hubs—many have closed their doors and lost critical employees and funding due to the pandemic. With recession looming in most African countries and no foreseen support for most of these startups by governments, the full extent of the impact of COVID-19 will only be known in the coming months and years. Biotechnology is the broad area of biology involving living systems and organisms to develop or make products, or “any technological application that uses biological systems, living organisms, or derivatives thereof, to make or modify products or processes for specific use.”20 The role of biotechnology in enabling the socio-economic development of Africa has been discussed for the past three decades.21 Agriculture, health, environment and nutrition are other sectors that have benefited or promise to benefit from biotechnology around the world. An important point to note is that digital technologies have become an indispensable tool in biotechnology—examples include in the areas of data generation  and analysis using bioinformatic tools, automated and robotic machines, as  https://en.wikipedia.org/wiki/Biotechnology.  Juma C. and Seragildin I. (2007) Freedom to Innovate Biotechnology in Africa’s Development Report of the High-Level African Panel on Modern Biotechnology https://www.belfercenter.org/ sites/default/files/files/publication/freedom_innovate_au-nepad_aug2007.pdf. 20 21

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well as in management and commercialization. Apart from some of the discussion on digital technologies that are not health focused, most of the R&D- and product-related innovations discussed in this book have drawn lessons from work on health in the context of R&D, manufacturing and commercialization of medicines and devices. It should be noted that R&D and commercialization of pharmaceuticals appear to be more resource intensive, with longer timelines, than some of the other technology areas discussed here. In the area of agricultural biotechnology, for example, a lot has been written and said about its potential in supporting food security on the continent. Several international research organizations, including the CGIAR group of institutions (https://www.cgiar.org/), such as the International Institute for Tropical Agriculture (IITA), as well as several pan-African initiatives like those driven by the AUDA-NEPAD, African Agricultural Technology Foundation, A Green Revolution in Africa (AGRA) and others, are active on the continent. There are several dedicated national institutions and universities that are engaged in agricultural R&D and related biotechnology questions. The outcome of these activities will be better harnessed for development if the various institutions collaborate effectively to exploit and scale up the outcome of the work that they are doing. The outcomes of various research projects focusing on crop improvements using various technologies and methodologies have not been adequately scaled up and promptly disseminated to farmers across the continent or commercialized to enhance food security in Africa. Where are those improved cassava, rice, yam, plantain or maize species that have been developed through the work of various institutes since the 1980s? Many African countries still import canned tomatoes, rice and other agricultural products that can be grown in abundance, processed and made available at reasonable costs within Africa. The cocoa beans that are produced in abundance in several West African countries are first exported overseas, where they are processed and turned into chocolates and other valuable food products. These are then re-imported into Africa at high prices, which makes it impossible for most Africans to afford. It is a known fact that many cocoa farmers in Africa have not tasted

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chocolates in their entire lives. Several automated machines from China are now available in Africa for processing of cassave for starch and garri production based on very simple engineering. These machines should be produced in Africa. It is heartwarming to see the integrated agricultural development and training work going on at Songhai Centre, with headquarters in Benin (http://www.songhai.org/index.php/en/qui-­s ommes-­n ous-­e n/historique-­en). This highly productive agricultural center is founded and managed by Rev Dr. Godfrey Nzamujo, who trained abroad with degrees in electronics, microbiology and development science. According to Dr Nzamujo, he “joined forces with a group of Africans and friends of Africa who shared the vision of giving back to Africa its dignity, which has been scorned for far too long.” The project is a success story and should be a good model to support agricultural development in Africa. The project has spread across Africa and many African farmers have been trained. I attended a seminar organized by the Federal Ministry of Science and Technology of Nigeria in 2017 as part of its Technology and Innovation Exposition week. Some of the major R&D parastatals under the ministry were showcasing the innovation and commercialization work in which they are involved in the session on commercialization of R&D results and inventions. The session was very well attended by scientists, innovators, policy makers and, to my pleasant surprise, many politicians. I was scheduled to speak in that session, and when the workshop eventually started, there were lots of opening remarks and goodwill messages from several dignitaries and politicians who attended. Most of the remarks were not on the agenda, and interestingly they were largely talking about how great the work of certain institutes was and people were congratulating themselves even before hearing the presentations. When the workshop eventually started, everything was running about 2 hours late and even lunch time was not observed. One of the premier institutes in Nigeria—the Federal Institute for Industrial Research Oshodi (FIIRO)— which employs many PhD-level researchers, presented some of the projects that it is involved in. It immediately became clear that the institute has a lot of potential in delivering some important innovations, but is severely underfunded and requires infrastructural support. One of the major products that the FIIRO showcased at the meeting was the production of a “nutritious” biscuit that can be used in schools. Clearly, it

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sounded like the product is very useful and important in Nigeria based on the fanfare that surrounded the presentation of this product by the institute. However, I thought that it would have been more fruitful for the institute if it took advantage of the politicians in the room to emphasize its challenges and argue that it can do far better than the product under discussion if it were better resourced. When I look at the excellent name of this institute—Federal Institute for Industrial Research—the first thing that comes to mind is how Nigeria can use this institute to support the development of small- and medium-­ scale enterprises (SMEs) and industries to address the challenges that we have been discussing all over this book. This and other similar institutes in Nigeria, like the National Biotechnology Institute, can serve as innovation hubs that bring private and venture mechanism to support innovation. They can create important links with universities and the private sector internationally. This approach can bring in more resources to the institutes and scale up their productivity multiple folds compared to what they are doing presently. They can support the development of local value chains for most of the natural resources of the country. In the context of chemical technologies, consider the billions of dollars that will be saved and used for development if the various precious and essential mineral resources produced in countries like the Democratic Republic of Congo (DRC) or crude petroleum from Nigeria were first processed within the country before they are exported? The 2012 share of world production of certain minerals from African soil includes bauxite 7%, aluminum 5%, chromite 38%, cobalt 60%, copper 9%, gold 20%, iron ore 2%, steel 1%, lead 2%, manganese 38%, zinc 1%, cement 4%, natural diamond 56%, graphite 2%, phosphate rock 21%, coal 4%, mineral fuels (including coal) and petroleum 47%, uranium 18% and platinum 69.4%.22 Presently, most of the crude products are exported overseas for processing at a much lower value than if the full value for the minerals were created through local processing. African countries stand to gain if they can start adopting and adapting the technologies and knowledge required to process these products before they are exported. Another challenge is the corruption that has resulted across the value chain of these minerals, 22

 https://en.wikipedia.org/wiki/Mineral_industry_of_Africa#cite_note-MIA_p1.1-4.

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including the export of the crude forms of the products. It is estimated the Nigeria loses about USD 20 billion annually due to petroleum theft.23 The 2006 film Blood Diamond—directed by Edward Zwick—tells the story of how diamonds fuel conflict and wars in Africa. In a speech, another President of Ghana (Nana Akufo-Addo)24 reiterated the urgency for African countries to build economies that are not dependent on charity and handouts: “I do understand that there are nations who have built their industrial complex around the value chain of our raw commodities … it is time we are responsible for processing our resources, it is time we Africans manage our resources well to generate wealth for our population … A new paradigm of leadership is called for … leaders who are looking beyond commodities to position their countries in the global market-place.” This statement is in many ways complementary to the statement of the late Dr Nkrumah in 1963, and both are consistent with the challenges that have been highlighted all over this book, including those of leadership and ownership of research and innovation in Africa, financing, overdependence on aid, a lack of collaboration within and among countries as well as a lack of implementation of approved strategies. Several years ago, I had the chance to visit Ogoni and other riverine areas near Port-Harcourt, Nigeria, where several multinational oil companies have operations. In some of the places, what struck me the most was how oil spills have completely changed the otherwise beautiful marine coastline that the villagers depend on for livelihood—especially fishing and transport. Some of the spills result from pipes broken by frustrated and jobless youth, who resort to stealing oil as a way of getting their share of the national cake, as well as un-maintained pipelines by multinational companies. Despite this challenge, the villagers were still in good spirits, as they used their wooden boats to sail on top of the dark and glossy oily waters to search for fishes and other sea creatures further down the waters. As if this was not enough, the sight of multiple flaring oil stations was another stark reminder of the  potential  environmental impact of such flaring. I immediately started thinking about environmental biotechnology and remediation approaches.  https://allafrica.com/stories/201405300250.html.  https://www.youtube.com/watch?v=zMmh9N3lpVg&feature=youtu.be.

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As a scientist and biotechnologist, this immediately got me thinking about environmental technology projects and research that can be established to help with cleaning the polluted waters. Apart from conventional cleaning methods, I remembered that certain bacteria and microbes can be deployed to help clean the waters, and I wondered why nothing was being done about this. A bacterium called Alcanivorax borkumensis that lives in oceans and feeds on hydrocarbon molecules is known, and its genome has been sequenced by a German biotechnology research center.25 Other researchers, including those in Canada, have gone further to identify the enzyme within the bacteria that breaks down crude oil and gases.26 It will be surprizing if suitable remediation efforts have not been put in place to address these challenges, but such efforts present an opportunity for sustained collaboration and innovation to address the challenges. In course of the research for this book and earlier work on the identification of centers of excellence for research and innovation in Africa, the author learnt that a group of oil-producing companies in Nigeria—Shell, Agip and Total in collaboration with the Nigerian National Petroleum Cooperation (NNPC) and the United Nations Environmental Programme (UNEP)—have pooled about USD 900 million to support environmental cleanup, training and entrepreneurship in the Ogoni region through the establishment of a center of excellence to support these initiatives. Hopefully something positive will come out of this effort.

6.2 E  merging Technologies and the Future of Innovation in Africa From the first industrial revolution, which used water and steam to mechanize production, to the second, which used electric energy to enable mass production, to the third, which used electronics and  https://blog.arcadiapower.com/bacteria-that-clean-up-oil-spills/; https://oilprice.com/The-­ Environment/Oil-Spills/The-Oil-Eating-Bacteria-That-Can-Clean-Up-Oil-Spills.html. 26  Kadri T., et al. (2018) Ex-situ Biodegradation of petroleum hydrocarbons using Alcanivorax borkumensis enzymes. Biochemical Engineering Journal, 132, https://doi.org/10.1016/j. bej.2018.01.014; https://phys.org/news/2018-04-oil-eating-bacterium-pollution.html. 25

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information technology to enable automation, the world is today witnessing a fourth industrial revolution, which is building upon the third and its digital revolution.27,28 It is fair to say that Africa has been on the receiving end of these revolutions—consuming the products that emanate from them rather than being at the forefront of their development. Perhaps that will change in the twenty-first century with the fourth industrial revolution, which is driven by the emergence of the internet and characterized by several new technologies that are seamlessly integrating physical, digital and biological systems to impact industrialization, economies, management and governance. This is best described by the number of new and emerging breakthrough technologies in various fields, such as the Internet of Things (IoT),  nanotechnology, artificial intelligence (AI), robotics, biotechnology, 3D printing, quantum computing and fifth-­generation wireless communities’ technologies (5G). While these technologies promises to provide enormous benefits to mankind, they pose threats that need to be analyzed, managed and mitigated. There is no other place on earth where the challenges that can be solved by these technologies are greater than the continent of Africa. Many believe that many available technologies and the emerging ones provide an opportunity for Africa. Indeed, African countries are keen to take advantage of these technologies to support their socio-economic development programs and propel themselves as major players in the knowledge economy. However, the challenge is whether the leadership of the continent will make the necessary investment required to harness the technologies’ positive impact and proactively address any potential risks associated with them or will they wait for aid from overseas. The AU has rightly established a High-Level Panel on Emerging Technologies (APET) to provide advice and identify potential areas where Africa can take immediate advantage of these technologies. It has made recommendations considering the capacity strengthening needs, regulatory and ethical considerations, and requirements for domestic and international investment. APET argues that Africa cannot afford to play the “waiting game” in putting together regulatory requirements for  The 4 industrial revolutions. https://www.sentryo.net/the-4-industrial-revolutions/.  Schwab K. (2016) The fourth industrial revolution.

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technologies that are on the horizon, but should be actively involved in designing and harmonizing policies, guidelines and standard operating procedures, taking advantage of its regional integration agenda.29 As with hundreds of other recommendations and approved strategies over the years, the challenge is with implementation. The continent needs a unique and forward-looking approach tailored to its needs—considering that everybody and every profession requires innovation and the fruits that come from it. All African government’s ministries—including education, health, environment, economy, finance, industries, energy, STI, communications, transport, defense, foreign or home affairs and judiciary—require one form of innovation and technology or the other to achieve its mandate. Rather than working in silos with their limited resources, a small percentage of the budget from every ministry could be pooled together and used to establish an inter-ministerial network or partnership that addresses issues related to technology and training in their country. This will be a powerful tool to stimulate collaboration in various areas, including at African universities and R&D centers. This same approach can be used to manage and address the risks associated with technology. At the pan-African and regional economic levels, a similar collaborative framework could be established to address specific challenges. Most African-based initiatives, especially those involved in R&D, struggle to work together because most of their funding comes from overseas and thus the organizations focus more on meeting the needs of their donors. To be successful in post COVID-19 recovery and reconstruction efforts, African countries and institutions must work together to maximize resources and impact.

 https://www.nepad.org/news/reports-emerging-technologies-officially-launched-africainnovation-­summit; https://www.nepad.org/publication/african-union-commission-appointshigh-level-african-panel-emerging-technologies.

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7 Technology Readiness Levels, the Valley of Death and Scaling Up Innovations

The term technological “valley of death” is further explained by certain articles and blogs.1 In 1974, NASA developed a technology maturity metrics on a scale of 1–9, called technology readiness levels (TRLs), with level 9 being the most mature technology.2 These levels have gained broad acceptance across industry, government and academia. The nine levels are: (1) basic principles observed and reported, (2) technology concept formulated, (3) experimental proof of concept, (4) technology validated in the laboratory, (5) technology validated in a relevant environment, (6) technology demonstrated in a relevant environment, (7) system prototype demonstrated in an operational environment, (8) system complete and qualified, and (9) system deployed in an operational environment. Figure 7.1 shows the innovation value chain with parts of the nine RTLs and proposed responsibilities of academia and public R&D institutions, public-private collaborations and industry. The “valley of death” or  Rossini A. (2018) Bridging the technological “valley of death” https://blogg.pwc.no/digital-­ transformasjon/bridging-the-technological-valley-of-death; Herbert M. (2016) The Innovation Challenge and the Valley of Death. https://www.uk-cpi.com/blog/the-innovation-challenge-andthe-valley-of-death. 2  https://www.nasa.gov/pdf/458490main_TRL_Definitions.pdf. 1

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Indicative levels of risk, cost & value

Risk

Cost Value

RTL1

2

Basic Tech. Research

Responsibility

Financing

3

Feasibility Research

Universities, R&D Institutes

Government, Philanthropy, Companies.

4

Develop./ Validation

5

6

Demonstration

Start-ups Companies

Venture/Investors, Big Companies/Corporations, Technology Transfer,

7

8

System Develop./Pr -ototype

9

RTL

Testing, Launch, Operations

Big companies/ Corporations

Venture, Investors, Corporations

Fig. 7.1  Illustration of the Valley of Death (RTLs 4 –6). The illustration also shows the types of institutions involved in the different RTLs in terms of the work and financing. The overlap in the boundaries is important as those boundaries are increasingly becoming blurred. In all cases, government policies and incentives are important. Diagram is not drawn to scale.

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“innovation gap” is defined between RTL 4 and 7. The figure also highlights typical funders of the various parts. The innovation gap is even more significant and challenging for African innovation for several reasons. In advanced economies, clear processes for addressing resource needs that bring concepts into development and commercialization exist. Also, academia and R&D centers that are constantly transforming themselves from being mere traditional basic or knowledge generators into technological research and entrepreneurial institutions that address real societal problems are increasing in developed and emerging economies (see Chap. 12). Different types of companies are also at hand to license viable technologies from academia, including those with in-house R&D.  Furthermore, public and private institutions with access to venture financing and capacity to develop startups and incubators are also available as a mechanism to advance promising technologies in developed countries. In Africa however, such sequential transition processes and mechanisms rarely exist, and where they do, they are in their infancy. Consequently, numerous technologies that come out of African laboratories with the potential to support socio-economic development and create jobs are not further developed due to a lack of suitable mechanisms to support rigorous proof of concept, validation, scale-up, commercialization and marketing.3,4 Furthermore, local mechanisms for addressing the transition of technologies from laboratory to industry, including IP and financing issues, are not well established. Available local manufacturing and commercialization instruments are not research based (Chap. 8). It is known, for example, that the Grand Challenges of the Gates Foundation, the Canadian government, the USAID, the DFID  (UK  Department for International Development which has been changed to Foreign, Commonwealth & Development Office (FCDO)),  Nwaka S., et al. (2010) Developing ANDI: A Novel Approach to Health Product R&D in Africa. PLOS Medicine 7(6): e1000293. https://doi.org/10.1371/journal.pmed.1000293. http://journals. plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000293; (ANDI Newsletter—15 December 2015. ANDI Innovation Awards 2015. ANDI Innovation Awards Celebrate and Inspire Innovation in Africa! http://us8.campaign-archive2.com/?u=421d2157d01b6978248fa9dde&id= cc3011dfc4. 4  Mackintosh M. (Ed), et  al. (2016). Making Medicines in Africa: The Political Economy of Industrializing for Local Health; Nordling L. 2014. Changing Council. Nature Medicine 20, 113–116 https://doi.org/10.1038/nm0214-113. Published online 6 February 2014. 3

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and others have invested in many promising early-stage projects in Africa and other parts of the world, including those based on frugal innovations. However, the challenge is to identify the most promising technologies and invest on their proof of concept, validation, scale-up and commercialization. As discussed in various parts of this book, the future of true technological innovation in Africa, which creates local markets and touches everyone, will depend to a good extent on how the continent bridges this gap in the coming years and how sustainable industries are developed to put the technologies into the marketplace. Again, all the features of ongoing African research and discoveries, their academic focus, grant financing modalities, partnership and stakeholder modalities and limited IP and technology transfer modalities make them socially driven. Even when African discoveries make it out of the valley of death, the mechanisms that will address further development, large-scale manufacturing and marketing and access will still largely be driven by social principles, at least in the short-to-medium term. This is because the follow up processes will still involve external support, grants, government support and procurement intervention. Wealth and jobs will be created, but the principles will largely be driven by stakeholders, rather than a few shareholders and investors. This does not mean that shareholdersdriven technologies will not be available—they will, but they will not be dominant. To be clear, we have learned that not every technology or product that makes it out of the valley of death ends up in the market, but at least those technologies would have gone through the process to enable some GO/NO decisions to be made on them. We know that “killing” or discontinuing non-promising projects as fast as possible is as important as progressing promising ones. This is particularly important in Africa, where resources are limiting, and every effort should be made to maximize scarce resources. The simple fact is that there are little or no truly local African technology that has systematically progressed through the valley of death and made it to the market on a large scale. Several ANDI-supported projects provide clear examples of the scenario that we have been describing. The bubble continuous positive air pressure (bCPAP) or Pumani for newborns with respiratory distress, the phototherapy light for children with jaundice, the diagnostic kit to support the control and elimination of schistosomiasis, the cell-phone-based

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coding system for diagnosis and monitoring of disease, and the reformulation of NIPRISAN for sickle cell disease in Africa are such projects which require innovative financing to further support validation, proof of concept, regulation, scale-up, and sustained market access in Africa. Some of the major developmental and commercialization  progress made on those projects were due to the involvement of a non-African companies, partners or stakeholders that engaged in the product. In most cases, the industrial partner or external donor agency (where they exist) that licensed the product takes charge of further development and commercialization. An example is the licensing of Pumani to a Californian company by Rice University, and because of this, the local production of the device in Africa that was envisaged is yet to materialize.5 In other cases, such licensing agreements have not worked out due to a lack of clarity on intellectual property issues—one example is the NIPRISAN from the National Institute for Pharmaceutical Research and Development (NIPRD), Nigeria, which was initially licensed to a US company,6 and has more recently been supported by ANDI. The product has since reverted to NIPRD and further development and commercialization has been arranged between NIPRD, the Ministry of Health and a local company—May & Baker Nigeria Ltd.7 A focus on social innovation in Africa will also help to chart a successful part for a suitable intellectual property regime on the continent. The dominant and expensive patent filing approaches may not be sustainable for African innovation. Arguably, most potential African technologies, especially in health and other biotechnology space, end up at the experimental proof of concept  Kawaza K., et al. (2014) Efficacy of a Low-Cost Bubble CPAP System in Treatment of Respiratory Distress in a neonatal Ward in Malawi. PLOS One 9(1): e86327. https://doi.org/10.1371/journal. pone.0086327; Falk M., et al. (2018) Infant CPAP for low-income countries: An experimental comparison of standard bubble CPAP and the Pumani system. PLOS One 13(5): e0196683. https://doi.org/10.1371/journal.pone.0196683. 6  Wambebe C. (2007) NIPRISAN Case, Nigeria A Report for GenBenefit https://www.uclan. ac.uk/research/explore/projects/assets/cpe_genbenefit_nigerian_case.pdf; http://addyshams. blogspot.com/2012/08/niprisan-pains-of-sickle-cell-remedy_14.html; Ameh S.J., et  al. (2012) Traditional herbal management of sickle cell anemia: lessons from Nigeria, Anemia. 2012:607436. https://doi.org/10.1155/2012/607436. 7  https://www.businessamlive.com/may-baker-partners-nigerias-niprd-to-manufacture-sicklecell-drug/. 5

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(TRLs 2 and 3) or generation of early validation data (between TRL 3 and 4), before the actual “valley of death” (TRLs 4–7). We have described this outcome of most African innovations as the “valley of stagnation” or “valley of hope.” These connotations indicate that most local African technologies do not have the opportunity to benefit from those processes that help technologies to enter the valley of death, not minding an assessment of whether they can make it through it. On the other hand, the “valley of hope” signifies the hope and the long-standing aspiration of African scientists, innovators, entrepreneurs and even African policy makers, for a better future or for a miracle to happen that allows these processes to be financed and undertaken. These aspirations are constantly highlighted in pan-African and country-level strategies and policy documents, which unfortunately suffer from a lack of implementation. The development of biotechnology hubs and companies in Africa is lagging the digital tech hubs’ development, probably due to such hubs’ expected focus on R&D, the length of time and resource requirement (human and financial) to realize an impactful product. The lack of critical mass of technical capacity, infrastructure and suitable financing in R&D institutions, for translating early-stage research into marketable products, means that many good product ideas are not advanced. It should be noted that as part of the ANDI pan-African Centres of Excellence, some of the promising biotechnology companies or SMEs are either no longer operational or have significantly scaled back operation. Examples include the iTEMBA Biotech, South Africa and Lagray Pharmaceuticals in Ghana.8 The lack of significant domestic funding for biopharmaceutical R&D and infrastructure by most African countries, for example, makes attracting private sector capital difficult.9 This is further compounded by the lack of mature capital markets and poor commercial incentives, which encourages private sector investment due to the risk that R&D cost may  Nwaka S., et al. (2012) Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent. Published July 2012. https://doi.org/10.1186/1472-698X-12-11. 9  Liotta C. D., Nwaka S., et al. (2018) North-South collaborations to promote health innovation in Africa. Emory Law Journal 67:619–653; Katherine Bagley, Home-Base Biotech: African and International Efforts Are Boosting the Continent’s Biotech Industry—For Now, SCIENTIST (January 1, 2010), http://www.the-scientist.com/?articles.view/articleNo/27903/title/Home-Base-Biotech/. 8

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not be recovered by return on investment. In developed economies the private sector is the largest biotechnology investor, but in developing economies most of the investment in health research, for example, is sponsored by the governments, philanthropic and development organizations and is carried out in public and non-profit institutions. Where private sector investors are present, they often concentrate their investments in sectors where projects have shorter time horizons and are less risky and costly. Young entrepreneurs in Africa usually establish an overseas liaison office purely for fundraising purposes. This is because it is very difficult to secure funding for a purely African company, or a researcher in Africa, without a foreign affiliation. This is a fact that is not often discussed, but most young African entrepreneurs highlight this as a challenge when they are interviewed. Perhaps, the proposed scaling-up of social innovation will address these challenges.

7.1 Scaling Up Innovations The term “scaling-up” often refers to the expansion of programs, technologies or projects from pilot experiences to larger enterprises. It is used across a range of fields, including R&D, innovation and natural resource management, but the term lacks ontological consensus as to its actual definition and where it is best applied.10 The term is popular in the international development arena due to the importance attached in wide-scale coverage or market penetration of interventions, processes, outcomes and impact. In 2017, several organizations came together in a Working Group on Scaling Innovation under the International Development Innovation Alliance (IDIA) facilitated by the Results for Development Institute.11  Frake A. N. and Messina J. P (2018) Toward a Common Ontology of Scaling Up in Development. Sustainability, 10, 835; Menter H., et al. Scaling Up. In Scaling Up and Out: Achieving Widespread Impact through Agricultural Research; Pachico, D., Fujisaka, S., Eds.; CIAT: Cali, Colombia, 2004; pp.  9–22, ISBN 958-694-064-0.; Wu, J. and Li, H. (2016)  Concepts of Scale and Scaling. In Scaling and Uncertainty Analysis in Ecology: Methods and Applications; Springer: Dordrecht, The Netherlands, 2006; pp. 3–15d ISBN 1-4020-4664-2. 11  Insights on scaling innovation and other reports (https://static.globalinnovationexchange.org/ s3fs-public/asset/document/Scaling%20Innovation%20DIGITAL%20COPY.pdf?C719lAFtMTh 10

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The group identified six high-level stages of scaling innovation from idea stage to R&D stage to proof-of-concept stage to transition-to-scale stage to scaling-up stage and sustainable scaling. These steps mirror the technology readiness levels (TRLs) and valley of death discussed earlier, of which the individual activities require scaling. Some of the points of departure identified by the group include: (i) “Innovation, learning and scaling are closely linked in an iterative, non-linear, process of delivering development impact at scale.” It needs systematic planning, implementation management and learning. (ii) “Scaling is more than only the growth of an organization, which is the dominant model pursued by those in the venture capital world.” (iii) “Sustainability and scaling of innovations are closely related and need to be considered jointly.” If an innovation is scaled up without adequate attention to sustainability, its impact will be undermined. (iv) Scaling-up takes time and requires long-term engagement. These starting lines of thoughts about scaling innovations are very relevant to innovation in Africa and reinforce a model of partnerships and stakeholders that emphasizes sustainability. As the report rightly said, even “if an innovation is scaled up without adequate attention to sustainability, its impact will be undermined, and the outcome will be futile.” Perhaps this is the fate of certain products and services that are shipped to Africa as aid, which have not considered the unique environment and circumstances where they will be used. It should be mentioned that scaling is relevant in different parts of the innovation value chain. For example—in drug development, before a drug lead or candidate enters clinical development, the chemistry and process development departments involved in the project perform scale­up work to ensure that the molecule can be produced in quantities required for clinical evaluation and can eventually be produced at a large scale if successful with other downstream evaluations. At the same time, this process will help to determine the “cost of goods” for the drug, if or when it gets to the market. There are instances when projects are discontinued in this scale-up phase, and the reasons may include technical inability to scale up the product or high cost of scale-up, which will eventually make the drug unaffordable when produced. Also, the concept of wNbUpdcs4TeYl5vYa2u9p).

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high throughput screens using small molecules is based on creating hundreds to thousands of drug-like molecules in a form of library that increases the chances of getting robust hits during a screen, rather than screening one or a few compounds. Another example is based on natural products chemistry—a major challenge for chemist is that natural products, as opposed synthesized compounds, have complex structures that sometimes makes modifying them or creating derivatives from them impossible. This means that, depending on the mode of production, some promising natural products with complex structures cannot be easily scaled up, and even when some of them make it to the market, they may be expensive. We have heard a lot of about the test for SARS-CoV-2 (which causes COVID-19) using PCR (polymerase chain reaction). This test basically amplifies or scales up (if you will) minute amounts of viral RNA molecules to make it easy to detect the virus or study it in the lab. In terms of businesses, a book by Reid Hoffman (co-Founder of LinkedIn) and Chris Yeh (General Partner at Wasabi Ventures) describes the scaling-up phenomenon even for the most successful technology companies of today. “Contrary to the popular narrative, it’s not their superhuman founders or savvy venture capitalists. Rather, it’s that they have learned how to blitzscale”—a specific set of practices for igniting and managing dizzying growth, and accelerated path to the stage in a startup’s life cycle, where the most circles are created. It prioritizes speed over efficiency in an environment of uncertainties and allows a company to go from “startup” to “scale-up” at a furious pace that capture the market.12 In Africa, scaling up local technologies, be it in terms of relevant parts of the R&D process, or large-scale evaluation of the technology after pilot analysis, or market penetration, remains a challenge. An important part of addressing this challenge will be through an improved educational system that integrates innovation processes as well as strong industry-­ academic collaboration and concerted investment.

 Hoffman R. and Yeh C. (2018) Blitzscaling—The Lightning-Fast Path to Building Massively Valuable Companies. Currencybooks.com. 12

8 Manufacturing in Africa

When we look at the indicators of industrial development, especially the two focusing on manufacturing (manufacturing value added [MVA] and manufacturing export), the African continent lags the rest of the world, even among developing countries.1 The United Nations Industrial Development Organization (UNIDO) defines MVA of an economy as the total estimate of net output of all resident manufacturing activity units obtained by adding up outputs and subtracting intermediate consumption.2 On the other hand, manufacturing export relates to manufacture of goods at one’s premises or company under one’s brand name, and then exporting them to other countries with one’s export license. Most of the Africa’s production or manufacturing are natural-resource-based, due to the natural resource wealth of the continent. This sector accounts for nearly half of the total MVA and manufacturing exports, with about 70% of the continent’s

 Signe L. and Johnson C. (2018) The potential of manufacturing and industrialization in Africa— Trends, opportunities and strategies (https://www.brookings.edu/wp-content/uploads/2018/09/ Manufacturing-and-Industrialization-in-Africa-Signe-20180921.pdf ). 2  https://stat.unido.org/content/learning-center/what-is-manufacturing-value-added%253f. 1

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manufacturing activities concentrated in South Africa, Egypt, Nigeria and Morocco.3 Notwithstanding these trends, manufacturing in Africa has grown 3.5% annually from 2005 to 2014, faster than in some other parts of the world, with countries like Nigeria and Angola experiencing an increase in output of over 10% per year.4 There is therefore significant potential for growth in African manufacturing, and the establishment of the African Continental Free Trade Area (AfCFTA) presents an enormous opportunity to facilitate manufacturing, industrialization, sustainable growth and jobs. As an example, the local manufacture from the context of essential health products, like pharmaceuticals and devices, including vaccines and diagnostics, is presented in some depth. This healthcare manufacturing industry, where it exists, is not R&D based, and there is little or no interface between local research institutions and manufacturers. Ongoing activities focus on generic drug production or packaging based on imported raw materials and intermediates. Indeed, the manufacturers face the same challenges described for research institutions, such as limited access to capital, weak infrastructure, critical mass of capacity as well as regulatory and limited incentives from the government. Several unique challenges of the industry include weak supply and value chains for intermediate products and overdependence on imported intermediates and know-how. The manufacturing firms are usually SMEs in nature producing on a small scale and for local consumption at a modest profit margin. Usually, the operations of these companies are initially financed by personal funds, loans, joint venture or by overseas subsidiaries as well as by some grants and national or international procurement, which is largely short term in nature. These features once more highlight the social trends in African pharmaceutical manufacturing. Clearly, robust and sustainable R&Ddriven manufacturing cannot be implemented with grants and a donordriven research agenda. The period from 1930 to 1960 marked the beginning of local manufacturing in several African countries from an industrialization perspective. Banda and colleagues have summarized how local pharmaceuticals  See 1; KPMG. 2015. Manufacturing in Africa: Sector Report. (https://assets.kpmg.com/content/ dam/kpmg/br/pdf/2016/09/fast-movingconsumer-goods.pdf. 4  See 1; Balchin N., et al. (2016) “Developing Export-Based Manufacturing in Sub-Saharan Africa”. Supporting Economic Transformation. 3

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manufacturing in South Africa, Nigeria and Kenya, started with multinational European companies establishing subsidiaries in their colonies5— Glaxo established in Kenya in 1930, Abbott established in South Africa in 1935, and May and Baker established in Nigeria in 1944. These happened about the same time with other industrial sectors like mining and agricultural processing, and they were driven in part by pre-war supply chains of colonies and the disruption of supplies during World War II. The early years of independence of many African countries from around 1960 till 1970 were characterized by efforts to address the discrimination that came with colonialization. They also witnessed active growth and efforts to tackle the challenges associated with industrialization, with several public and privately owned companies starting to produce medicines. The economic crisis in the mid- and late 1970s—marked by oil glut, inflation and a lack of foreign exchange—resulted in a decrease in industrial investments in the 1980s. Industrial and economic growth declined in many countries till early 1990s, and at the same time health and education suffered.6 This decline coincided with the time that most of the multinational pharmaceutical companies in Africa discontinued their operation and left the continent. Globally most companies also discontinued their tropical diseases R&D programs, such as for malaria, due to a lack of commercial incentives to support the discovery, development and delivery of new tools to fight diseases that are predominant in developing countries. The Special Programme for Research and Tropical Diseases (TDR) at WHO was established in 1975, in part to help in filling the gap, and the further widening gap resulted in the neglect that the world appreciated in the late 1990s, which led to the establishment of product development partnerships to fill the gap.7 This period also witnessed the gradual re-emergence  Banda G., et al. (2016) Making Medicines in Africa: An Historical Political Economy Overview. In Mackintosh (eds.), et al. Making Medicines in Africa—The Political Economy of Industrializing for Local Health. Palgrave Macmillan, UK. 6  See 5; Cornia G.  A., et  al. (eds.) 1987, Adjustment with a Human Face, UNRISD, Oxford University Press, Oxford. 7  Nwaka S. and Ridley R. (2003) Virtual drug discovery and development for neglected diseases through public-private partnerships. Nature Review Drug Discovery 2, 919–928; Nwaka S. (2005) Drug discovery and beyond—the role of public-private partnerships to improve access to malaria medicines. Transactions of the Royal Society of Tropical Medicine and Hygiene, 995, 520–529. 5

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of some investors, subsidiaries of multinational and local entrepreneurs that have set up production facilities. Most of these entities have struggled to remain competitive with imported alternatives from other overseas markets, such as China and India, as well as with globally procured products for the continent developed largely by multinational companies in the developed and emerging economies. These dynamics have led to major academic and policy debates about the rationale, feasibility and desirability of local production of medicines in Africa both from a public health and from an industrialization and economic perspective.8 Opponents of local production in Africa argue that the quality of such medicines will not be guaranteed due to weak, fragmented or non-­ existent technical, regulatory and ethical infrastructures and systems. They further argue that such locally produced products may in fact be more expensive than currently imported or procured products due to economies of scale, and further deny the poor access to medicines. On the other hand, proponents of local production argue that it will improve access to essential products and reduce cost in the long term. They believe that it provides a positive pathway to industrialization, job creation and socio-economic growth, but importantly it is the prerogative of African countries to invest and secure the health of their people through the production of quality-assured health tools as part of building sustainable health systems. Yes, “it is the prerogative of African countries to invest and secure the health of their people through production of quality assured tools…,” but the required investments have been very slow to come. The lessons learned from the ongoing COVID-19 pandemic is yet another critical reminder for African countries to prioritize investment in research, development and manufacture of essential products and technologies and local health systems (see Chap. 11). It has become imperative for African countries to invest in systems to facilitate R&D and the production of medicines (drugs, vaccines and devices) on the continent. The Pharmaceutical Manufacturing Plan for Africa (PMPA) and the subsequent business plan approved by African heads of state outlined the  See 5; Kaplan W. and Laing R. (2005) Local Production of Pharmaceuticals: Industrial Policy and Access to Medicines. An Overview of Key Concepts, Issues and Opportunities for Future Research (https://openknowledge.worldbank.org/bitstream/handle/10986/13723/320360KaplanLocalProd uctionFinal.pdf?sequence=1&isAllowed=y). 8

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pathway for local pharmaceutical production on the continent.9 A strategic direction for the PMPA was also developed,10 but implementation has not progressed so much due to a lack of financing and coordination. African leaders have called for a strengthening of South–South cooperation, including collaboration with the BRICS countries, to scale up investment in Africa’s pharmaceutical manufacturing capacity. Analysis of the primary, secondary and tertiary levels of pharmaceutical production has helped to better understand the landscape of manufacturing of medicines in Africa. Primary-level manufacture uses basic chemical or biological substances to manufacture intermediates called active pharmaceutical ingredients (APIs). Secondary manufacture involves the production of finished products, such as tablets or syrups from APIs. The tertiary level involves packaging and labelling of finished products. Evaluation undertaken by the WHO African region in 2005 in sub-Saharan Africa shows that only one country had limited capacity for primary-level production, while about half had some level of secondary-­ level production and tertiary production. In 2014, the heads of WHO, UNAIDS and UNIDO published a paper titled “Commodities for Better Health in Africa—Time to Invest Locally.”11 The paper urged partners to support the local production and access to quality health commodities in Africa, and states—“The goal is to address health inequities and build capacity to meet supply shortages for essential health commodities that cannot be sourced reliably and sustainably from outside the continent. Africa remains dependent on imported medicines and other health technologies—a risky situation in a continent.” As this book was being finalized in 2020, little has changed on the ground regarding local production of medicines. Again, driven by the lessons of the COVID-19 pandemic and associated challenges with access to vaccines and health tools, the African Union (AU) and the Africa Centre for Disease Control (Africa CDC), organized an impressive virtual high-level meeting in April 2021  https://au.int/sites/default/files/documents/30219-doc-pmpa_bp_ebook.pdf.  https://au.int/web/sites/default/files/newsevents/workingdocuments/28095-wd-­pmpa_strategic_framework_1.pdf. 11  Sidibe M., et al. (2014) Commodities for better health in Africa—time to invest locally. Bulletin of the World Health Organization 92:387–387A. http://www.who.int/bulletin/volumes/92/6/14-140566.pdf. 9

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on the Expansion of Africa’s Vaccine Manufacturing.12 The meeting attracted many players that needed to be at the table for those discussion from Africa and overseas, and the consensus was that Africa should work to fast-track research and the production of COVID-19 vaccines based on available and the new mRNA technology. A Partnership for African Vaccine Manufacturing (PAVM) was launched with the goal of initially establishing operations or leveraging existing infrastructure in South Africa, Senegal and Rwanda.13 The hope is that this results in something concrete. There is renewed momentum on a proposed COVID-19 vaccine patent waiver to boost the global production and access to vaccines with the recent announcement of the US in support of such a waiver.14 Time will tell if all countries will support this through the WTO. While this could advance rapid COVID-19 vaccine production in countries with the relevant manufacturing infrastructure and value chains, it is unlikely that such a waiver will have immediate impact on local COVID-19 vaccine production in many African countries due to the same infrastructural, value chain, financing, and regulatory challenges. This could explain part of the reason that many African countries have not been able to exploit certain flexibilities in the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) for essential health products that they need.15 Concerted technology transfer and voluntary licensing to Africa plus the patent waiver would be helpful. An analysis by McKinsey and Company summarized the current picture:16 About 80% of the drugs consumed in Africa are imported from overseas and the majority of Africans privately source and pay for their medicines. Compare this with China and India with similar populations

 Irwin A. (2021) Nature (News Explainer), How COVID spurred Africa to plot a vaccines revolution https://www.nature.com/articles/d41586-021-01048-1. 13  AU, Africa CDC launch Partnerships for African Vaccine Manufacturing (https://www.herald. co.zw/au-africa-cdc-launch-partnerships-for-african-vaccine-manufacturing/). 14  https://www.yahoo.com/news/biden-administration-commits-waivingvaccine-195133851.html. 15  Nicol D and Owoeye O. (2013) Using TRIPS flexibilities to facilitate access to medicines. https://www.who.int/bulletin/volumes/91/7/12-115865/en/. 16  Conway M., Holt T., et al. (2018) Should sub-Saharan Africa make its own drugs? https://www. mckinsey.com/industries/public-sector/our-insights/should-sub-saharan-africa-make-itsown-drugs. 12

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that only import 5% and 20% of their medications, respectively. The African continent has about 375 drug producers, largely in North Africa, and those in sub-Saharan Africa are mostly located in only 9 of 46 countries. These sub-Saharan African operations are at their earliest stages of pharmaceutical development and are small, with operations that do not largely meet international standards. Again, compare this with China and India, with about 5000 and 10,500 drug manufacturers, respectively. Furthermore, the sub-Saharan market value is still relatively small, at roughly $14 billion compared with roughly $120 billion overall in China and $19 billion in India based on 2017 data. Only South Africa, Kenya and Nigeria have dozens of companies that produce for their local markets and, in some cases, for export to neighboring countries. Only one or two companies in South Africa (and perhaps also in Ghana) produce APIs to a reasonable scale (as further explained below), although no African company is prequalified for API production by the World Health Organization as of 2019. Almost all the companies purchase active pharmaceutical ingredients (APIs) from overseas and formulate them into finished pills, syrups, creams, capsules and other finished drugs. Nearly 100 manufacturers in sub-Saharan Africa are limited to packaging—they purchase pills and other finished drugs in bulk and repackage into consumer-­facing packs. At the 2019 African Business Forum in Addis Ababa, the Executive Secretary of the United Nations Economic Commission for Africa stated that the lack of capacity for local production of pharmaceuticals results in spending about USD 14 billion annually on importation.17 On the other hand, the health and wellness sector in Africa has the potential to create 16 million jobs if properly developed and harnessed. Where does the continent go from here? The McKinsey analysis shows that enhanced local pharmaceutical production is feasible in about six sub-Saharan African countries at current and projected demand levels. The analysis shares five lessons that could help these countries do so in a way that contributes to the health of their people and to their economies. These include: (i) focus on quality; (ii) scale up production capacity by building robust plants, create regional manufacturing hubs and include smaller countries; (iii) focus on drug-product formulation from API and gradually progress into API production using new technologies; and (iv) 17

 https://allafrica.com/stories/201902130428.html.

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upgrade the value chain beyond manufacturing to also address fragmented distribution, wholesale and retail chains. I would add the integration of R&D, enhanced technology transfer and broader stakeholder engagement that paves the way for a sustained social innovation system that creates value and accessible markets, wealth and jobs for all. Strong regulatory and quality assurance frameworks and enforcement in Africa lag global standards. The WHO prequalification program (PQP) assesses the quality, safety and efficacy of medicinal products based on international pharmaceutical standards. It also assesses producers of active pharmaceutical ingredients (APIs) and pharmaceutical quality control laboratories. The goal is to increase the availability of quality medicines by assisting manufacturers to comply with WHO standards and by supporting regulatory authorities in countries to implement them.18,19 It is a global (UN) quality assurance program managed by WHO and does not replace national regulatory authorities for local production or importation of medicines. As of June 2019, the WHO prequalification program lists only four African companies as having successfully achieved prequalification in their own right or have submitted or are in the process of submitting a product for prequalification. The companies are Universal Corporation Limited from Kenya (Strides Pharma Sciences Ltd., an Indian company, has now acquired a majority stake in the company), Egyptian International Pharmaceutical Industries Co. (EIPICO) from Egypt, European Egyptian Pharmaceuticals Industries Co. from Egypt and Aspen Pharmacare Ltd. from South Africa.20 In addition, four Nigerian companies are indicated as achieving pre-submission audits for GMP (good manufacturing practice) designation. These companies are (i) CHI Pharmaceuticals Ltd. (8 May–10 May 2014) Oshodi, Nigeria; (ii) Evans Medical Plc (5 May–7 May 2014) Agbara, Nigeria; (iii) May & Baker Nigeria Plc. (5 May–7 May 2014) Ota, Nigeria; and (iv) Swiss Pharma Nigeria Limited (15 April–17 April 2011) Lagos, Nigeria. Regarding quality control laboratories, only about 10 laboratories have been pre-qualified in Africa21—3 in South Africa,  https://www.who.int/news-room/fact-sheets/detail/prequalification-of-medicines-by-who.  https://extranet.who.int/prequal/. 20  https://extranet.who.int/prequal/key-resources/prequalification-reports/whopars. 21  https://extranet.who.int/prequal/sites/default/files/documents/PQ_QCLabsList_26.pdf. 18 19

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2 in Kenya, 1 in Algeria, Ghana, Zimbabwe, Tanzania and Uganda. There are no companies prequalified for the manufacture of active pharmaceutical ingredients (API), and no prequalified contract research organizations to undertake bioequivalence and other clinical studies. Local production of quality medicines in Africa will help the fight against counterfeit, expired and substandard drugs on the continent. In December 2018, the Nigerian police identified a massive fake drug manufacturing facility in the Ikotu area of Lagos State, Nigeria.22 This unfortunately is a regular occurrence in several African countries. ANDI invested efforts in promoting the local production of drugs, vaccines and devices, including diagnostics, through some of its pan-African Centres of Excellence (public and private entities) that are involved in manufacturing. Another organization that is/was promoting vaccine manufacturing is the African Vaccines Manufacturing Initiative (AVMI), and like ANDI, it has suffered from lack of funding, and its present operational status is unclear. AVMI’s mission is to “promote the establishment of sustainable human vaccine manufacturing capacity in Africa.”23 The same picture described for drug manufacturing earlier is true (if not worse) for vaccines and diagnostics production in Africa.24 UNICEF accounts for about 60% of vaccines sales in Africa. Over 99% percent of vaccines used in Africa are externally sourced, while less than 1% is produced locally. The three types of vaccine manufacturing are like what was described for drugs—API or antigen manufacture, formulation and filling, and packaging/distribution. The few African countries that are currently ­ involved in the production of vaccines include: (i) Senegal, which produces yellow fever vaccine; (ii) Egypt, which produces DTP—Diphtheria, Tetanus and Pertussis—vaccines and some filling; (iii) South Africa, which is engaged in filling and recently COVID-19 vaccine; and (iv) Tunisia,  http://www.nta.ng/news/20181214-police-bursted-fake-drugs-manufacturers-in-lagos/; see also https://www.pulse.ng/news/local/police-uncover-fake-drugs-factory-arrest-4-in-lagos/y63q9w1. 23  http://www.avmi-africa.org/. 24  Presently, it is estimated that 1.37 billion doses of vaccines are used/needed in Africa annually, representing 25% of the global demand. In dollar terms, Africa’s public-market for vaccines stands at about USD 1.3 billion (about 25% of the global market of USD 33 billion), and this is projected to increase to between USD 2.3 and USD 5.4 billion by 2030 (Gennari A., et al. (2021) Africa needs vaccines. What would it take to make them here? https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/ africa-needs-vaccines-what-would-it-take-to-make-them-here). 22

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which produces limited BCG and rabies vaccines. A few other countries such as Ethiopia are initiating vaccine production. The AVMI would have probably played an important role in securing COVID-19 vaccine for Africa if it were fully empowered. Africa’s medical device market, including diagnostics, is estimated to grow at a compound annual growth rate (CAGR) of 6.3%, which will amount to about USD 7.07  billion by 2023—an increase from USD 4.9 billion in 2017.25 Again, this market is dominated by big and small foreign ­companies that mainly distribute and market their products. ANDI’s analysis show that the same barriers, regulatory challenges, lack of critical mass of expertise, infrastructure, a lack of commercial incentives and uncertain sustainability of manufacturing prevent local production of these tools for diseases and health conditions that are predominant in Africa. The local production and regulation of devices and rapid diagnostic tests is a good place to start local production in Africa because the investment is relatively low and the return is extremely high—good treatment and disease management depends on accurate diagnosis, as has been reinforced by the COVID-19 pandemic. However, this area has not received much attention in Africa. ANDI suggested that achieving rapid success in Africa will involve the development of systems which allow leapfrogging to occur. An example is by integrating digital or mobile technologies, and ANDI identified a few of its pan-African Centres of Excellence that could collaborate with companies in developed and emerging economies like China and India to build capacity and infuse technical capability, good manufacturing and regulatory expertise for easy-to-use and affordable rapid diagnostics tests. Indeed, partnerships focusing on the local production of rapid diagnostics tests in Nigeria and Kenya with Chinese companies were put in place, leveraging a mobile platform developed as part of such partnerships. Landscape analyses were concluded, project plans developed and technical partners mobilized, but little progress was made at country level due to financing. These projects were initiated years prior to the COVID-19 pandemic and have reinforced the critical need

 Africa Medical Devices Market Expanding Tremendously to Make Great Impact in Near Future by 2023 https://www.medgadget.com/2018/06/africa-medical-devices-market-expanding-­­ tremendously-to-make-great-impact-in-near-future-by-2023.html; https://www.marketresearchfuture.com/reports/africa-medical-devices-market-2845. 25

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for such structures that support research, development, manufacture and deployment of simple diagnostics and other health products in Africa. At a recent G20 Global Health Summit in Rome, largely focused on the COVID-19 pandemic and vaccine access, the EU announced over Euro 1 billion support to Africa to address the continent’s manufacturing and R&D capacity to boost access to health products (https://ec.europa.eu/ commission/presscorner/detail/en/ip_21_2594). This is a welcome approach to aid that could help to prepare Africa to do it themselves. The President of the European Commission, Ursula von der Leyen, said: Local health capacities and institutions are the foundation of global health, but today Africa imports 99% of its vaccines and 94% of its medicines. This has to change. Team Europe will support Africa with over €1 billion and expertise to help develop its own pharmaceutical, biotech and medtech industries, and ease equitable access to quality and safe products and technologies.

The hope is that other similar initiatives will emerge and that African countries and entities will complement those resources to create a sustainable R&D and manufacturing infrastructure that supports local access to health tools, consistent with the social innovation principles outlined in this book. Since then the Mastercard Foundation has announced the donation of USD 1.30 billion over three years to support COVID-19 vaccination, prepare for vaccine manufacturing in Africa and strengthen the Africa CDC (https://africacdc.org/news-item/ mastercard-foundation-to-deploy-1-3-billion-in-partnership-withafrica-cdc-to-save-lives-and-livelihoods/). The recent advancement towards the development of a malaria vaccine through the work of Oxford University is encouraging. The hope is that the novel mRNA technology can be explored to advance the development of vaccines and therapies for the many diseases that are predominant in Africa. It will be important for some of the R&D and manufacturing to be done in Africa.

9 Adopting and Adapting Innovations: Frugal, Leapfrogging and Open Innovation Approaches

Many argue that rather than going through the complex and expensive processes of creating new products and services from scratch to meet there needs, low- and middle-income countries should: (a) focus on leveraging and improving upon existing technologies, and (b) focus on areas where they have comparative and/or competitive advantage within their countries. This of course is conditional on respecting and adhering to intellectual property rules and does not exclude negotiating suitable technology transfer and licensing agreements. Several terms have been used to describe these innovation processes, including frugal innovation, leapfrogging, adopting and adapting technologies as well as incremental improvement on existing products. These terms have some things in common, that is, delivering value to more people with enhanced ease of use, simplicity, lower cost and good quality. These principles, in conjunction with the broader engagement of stakeholders, partners, financing modalities and the intent to reach resource-poor communities and promote equity, are consistent with social innovation.

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9.1 Frugal Innovation Wikipedia defines frugal innovation or frugal engineering as “the process of reducing the complexity and cost of a good and its production. Usually this refers to removing nonessential features from a durable good, such as a car or phone, in order to sell it in developing countries.” Radjou and Prabhu describe it as a new mindset and a flexible approach that perceives resource constraints not as a debilitating challenge but as a growth opportunity.1 Nesta, a UK charity, says that it responds to limitations in resources, whether financial, material or institutional, and turns constraint into advantage.2 ANDI argued that this approach can create jobs, businesses and venture mechanism while addressing the social and economic needs of Africa, and other developing parts of the world. Certain assembly plants in Africa for foreign automotive, mobile phones and pharmaceutical packaging, for example, are based on this concept.

9.2 Leapfrogging Innovation The term leapfrogging is often associated with Africa.3 It is also used to describe the path taken by India, which is believed to have leaped to a technology-driven economic model without the intensive manufacturing that spurred growth in Japan, China and South Korea. Digital and mobile technologies have been the key drivers for leapfrogging in Africa. The development and spread of mobile phone have helped to leapfrog landline telephones and the broader access to banking, for example. In the 1980s and 1990s access to landline telephone connections in Africa was only a dream for a small percentage of the population. Today, landline telephone connections are practically non-existent and have been overtaken by robust access to mobile phones. In 2001, it was estimated that Nigeria had about 100,000 functional landlines, but by 2020 the country has over 190 million mobile subscribers. The Economist showed that  Radjou N. and Prabhu J. (2014) Frugal innovation—how to do more with less. The Economist Books.  https://www.nesta.org.uk/feature/frugal-innovations/. 3  https://www.ft.com/content/052b0a34-9b1b-11e8-9702-5946bae86e6d. 1

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in much of sub-Saharan Africa, access to mobile phones is more common than access to electricity, and that many people walk several kilometers to have their phone charged in places with electricity or power generators.4 Several public parks and shopping malls with mobile charging outlets are now available in several African cities. However, it is not everything that can be leapfrogged, and digital technologies cannot substitute for the development of a robust innovation ecosystem. We cannot leapfrog hunger, leadership, basic education and health infrastructure. There is the need to develop and sustain the infrastructure that will make leapfrogging easier, for example, building solid infrastructure for manufacture of essential medicines, increased productivity in agriculture, robust access to energy and policies that support the environment. More importantly, digital technology is not a substitute for strengthening the struggling educational and health systems in most African countries, as well as the development of the human resource capacity. As Bill Gates once said, “I certainly don’t think giving everyone computers help their malaria or solves the problem of the teacher not being there or not having a school room.” As we are beginning to see, including through the COVID-19 pandemic, certain  digital technologies are easily prone to abuse by a few bad people and institutions that use certain platforms for “misinformation,” bullying and all sorts of unacceptable acts. The emergence of the internet and the early days of the emails helped to astronomically increase the use of emails for dubious activities and scams, for example, the famous advance-fee scam letters that originate from Nigeria and other places, soliciting businesses and money transfers (also called 419 letters).5 The unfortunate progression from “information technology” to “misinformation technology” has serious implications for resource-limited settings of Africa that have little or no means of protecting themselves from technology abuse. This again raises questions on how best to regulate digital technologies in developing countries. 4  https://www.economist.com/graphic-detail/2017/11/08/in-much-of-sub-saharan-africamobile-­phones-­a re-more-common-than-access-to-electricity; https://www.economist.com/ special-­report/2017/11/09/what-technology-can-do-for-africa. 5   Advance-fee scam (https://en.wikipedia.org/wiki/Advance-fee_scam); https://ag.ny.gov/ consumer-­frauds/nigerian-advance-fee-scam).

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As with leapfrogging or frugal innovations, technology adoption and adaption techniques are very successful innovation methods. In his article “Adopt and Adapt Ideas to Drive Innovation,” Paul Sloan provided further examples of this concept.6 In 2014, George de Mestral, a Swiss engineer, was walking his dog in the forest of mount Jura when he noticed that Burdock spikes clung to his clothes and the body of his dog, and they were difficult to remove. He had a closer look at them under the microscope and noted that they contained little hooks that could have useful applications. He patented the idea in 1955, established a company and started developing what is today known as Velcro. The inventors of roll-on deodorants were inspired by using ink in ball pen for writing as they were looking for other ways to apply liquid. Indeed, a useful innovation does not need to be based on  a completely novel invention—it should be something that is beneficial and accessible in a community. A consideration in adopting and adapting innovation is the wealth of natural resources in Africa, which range from petroleum to minerals to rich biodiversity. As indicated earlier, most of these minerals are exported overseas without processing and when the finished goods become available on the market, they are re-imported at high prices, which are often unaffordable to a good part of the African population. Another example is how the cocoa produced in West Africa is used to make the best chocolates in Switzerland, Belgium and other Western countries but not in Africa. African countries stand to gain if they invest in improving the local value and supply chains of their natural resources by adopting and adapting existing technologies that advance the local processing of such natural resources both for local consumption and before they are exported. Aliko Dangote, Africa’s richest Nigerian business giant, is taking advantage of this opportunity. He is close to launching a multi-million-dollar petroleum refinery near Lagos, Nigeria to handle the processing of a big part of the crude oil and gas produced in Nigeria.7 These approaches present an unprecedented opportunity and hope for Africa. Whereas the continent faces many constraints, there is a wealth of 6  http://www.innovationmanagement.se/imtool-articles/adopt-and-adapt-ideas-to-driveinnovation/. 7  https://www.bloomberg.com/news/articles/2018-07-06/billionaire-dangote-readies-refinery-for-2020talks-with-vitol.

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natural resources, biodiversity and growing population that are all engines for innovation. As we always say, “necessity is the mother of invention.” The challenge with these approaches is that technologies are constantly evolving—making it difficult for low- and middle-income countries, which are always trying to catch up. It is, therefore, necessary for African countries to start upgrading their infrastructure such as for enhanced internet connectivity, energy, investment in quality education, and R&D and training, and to build sustainable platforms that can support global competitiveness. In simple terms, African countries need to put processes in place to better manage, control and create value and market around their resources to the benefit of their populations. ANDI promoted several projects that embody some of these principles. Examples include a project with Chinese institutions and companies to leapfrog the development of rapid diagnostic tests in Africa. As part of this, a mobile application was developed that can integrate and apply multiple tests in rural communities. The mobile app was piloted in Nigeria for tracking medicines and supply chain management,8 and these projects are yet to be exploited. African countries and institutions should raise funds locally to take advantage of some of these sorts of projects rather than await grant donations or companies coming in with funding for such projects.

9.3 Open Innovation In 2003, Henry Chesbrough coined the term “open innovation” to describe how companies progress from closed innovation to more open innovation processes.9 He described it as combining internal and external ideas as well as internal and external paths to market to advance the development of new technologies. He further described it as “the use of purposive inflows and outflows of knowledge to accelerate internal innovation, and expand the markets for external use of innovation, respectively.” He  Egharevba H. O., et al. (2019) Piloting a smartphone-based application for tracking and supply chain management of medicines in Africa. PloS One 14(7): e0217976. 9  Chesbrough, H. (2003), “Open Innovation: The New Imperative for Creating and Profiting from Technology,” Harvard Business School Press. 8

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goes on to say that it is a more distributed, more participatory, more decentralized approach to innovation.10 Samsung defined the four parts of its collaborative open innovation activities as: partnerships, ventures, accelerators and acquisitions. The pros and cons of open innovation have been widely discussed.11 Through the participation of diverse partners and stakeholders that bring different expertise, it reduces the cost and perhaps the time required for product R&D and commercialization. At the same time, it also incorporates customers’ needs and desires earlier on in the product design process. This approach has benefited initiatives and SMEs with limited financial and human resources. For diseases or conditions that disproportionately affect low- and middle-income countries, where there are little or no market incentives to drive innovation by firms, the open innovation model has been the preferred approach in incentivizing innovation to products and services for those conditions. These approaches are more consistent with the principles of social innovation. The basic principle for ANDI’s open innovation and business model (Fig.  9.1) lies in the realization that a more integrated and holistic partnership approach that shares lessons across diseases and technology platforms promises to be more successful and impactful in the African context, where resources are very limited.12 The model leverages the available local capacity to support technology development and market entry to improve healthcare delivery in Africa. This means that capacity is built around projects and outcomes, and its impacts are measurable. Lesson 9: The ownership of the intellectual property (IP) that results from such open innovation efforts has been debated. The experience 10  https://www.forbes.com/sites/henrychesbrough/2011/03/21/everything-you-need-to-know-aboutopen-innovation/. 11  Man A.-P. and Duysters G. (2005) Collaboration and innovation: a review of the effects of mergers, acquisitions and alliances on innovation. Technovation 25, 1377–138; Ullrich A. and Vladova G. (2016) Weighing the Pros and Cons of Engaging in Open Innovation. Technology Innovation Management Review, volume 6, issue 4. 12  Facilitating Health Innovation in Africa—ANDI’s Five Year Strategy (http://andi-africa.org/ ANDI_File/Strategic_Plan/Facilitating_Health_Innovation_in_Africa_ANDI_Strategic_ Plan(2016-2020).pdf ).

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Fig. 9.1  ANDI integrated operational and business framework

gained through the work of product development partnerships and ANDI is that such issues are easily resolved, but it often requires a neutral coordinating body to manage the contractual aspects for the partners involved in order to define ownership of intellectual property (IP) that is acceptable. Furthermore, linked to the IP is the fear of revealing information that is not intended to be shared more broadly. In the area of health products, while initial signs are promising, it is still early days to determine how successful and sustainable the “open innovation” approach will be in putting products on the market and ensuring broad access in developing countries. Perhaps the world would not have been able to develop COVID-19 vaccines in record time without this approach, which started with the sharing of the sequence of the SARS-CoV-2. These are all potential new areas of research and investment as Africa scales up social innovation that is stakeholders-driven.

10 Brain Drain, the African Diaspora and Innovation in Africa

The term brain drain or human capital flight has been used to describe the emigration of trained or skilled workers to other countries. An example is an African graduate who because of lack of opportunities in his or her country has emigrated to another country to seek a job and practice his or her profession. This scenario is seen as a loss to Africa and is most common with scientists, researchers, engineers, doctors, nurses and other professionals. Such brain drain is partly blamed for the shortage of human resources in these professional fields. For example, in sub-Saharan Africa, the average number of researchers per 1 million inhabitants is about 100 researchers.1 As regards specific African countries, Nigeria has about 39 researchers per million inhabitants while South Africa has about 492 researchers per million inhabitants. This contrasts with over 4000 researchers per million inhabitants in Europe and North America. China and Argentina have over 1000 researchers per million inhabitants. This is consistent with the level of investments in R&D discussed earlier in this book. The benefits of such human capital flights to the receiving country are sometimes referred to as brain gain or reverse brain drain. Reverse  http://uis.unesco.org/en/news/rd-data-release.

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brain drain also explains the movement of human capital in reverse order from a more developed country to a less developed country. The African Union (AU) estimates that every year, approximately 70,000 professionals emigrate from Africa.2 There are several push and pull factors that are responsible for the brain-drain phenomenon. The push factors include the unfavorable situation of the country such as unemployment, the absence of research or innovation facilities, poor wages and political instability. The pull factors include the favorable conditions in the developed countries that the individual migrant would like to benefit from, such as better conditions of employment, stability, availability of essential personal and professional infrastructure. A good number of such skilled African workers and professionals who stay in Africa end up in jobs or opportunities that are outside their trained profession, such as banking, trading, politics and so on. While this cross-­ fertilization of professions is good, the challenge is that it should not be driven by a lack of appealing opportunities in the STEM, research or medical fields in Africa. In the late 1980s and 1990s, many friends of mine who trained as engineers and scientists but could not find suitable jobs in their sectors went on to train as accountants and as MBAs, and subsequently became top managers in local banking, insurance and consultancy firms. These folks help to make major improvements in their adopted professions. We see similar trends in various sectors in the developed world, especially in multinationals and consultancy firms. The message here is that while cross-fertilization of professions is a great thing, no professional should accept jobs outside one’s training because there is nothing in their sector. It should be because that is what one wants, especially with a growing multi-disciplinary and multi-sectoral approach to solving daily challenges. Brain circulation is believed to be an ideal form of brain drain that involve a circular movement of workforce across national borders. It is also used to describe the benefit of international training or exchange of skilled workers from different countries who return to their countries to apply their new knowledge for development.  https://au.int/sites/default/files/newsevents/workingdocuments/32718-wd-­english_revised_au_ migration_policy_framework_for_africa.pdf.

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Relating these terms to the current mode of training of African scientists overseas, one can say that this fuels brain drain in the short term, but in the long term it supports brain circulation. The recipients of training fellowships or study opportunities abroad may have limited opportunities to put their experience into immediate practice when they return to Africa. Consequently, they settle overseas to practice their profession, earn a living and gain experience. In the medium-to-long term they may contribute to development by returning to their native country or through remittances or by other means. On balance, the legal migration of skilled workers to different parts of the world is a good thing, but it should not be such that a country has no suitable professionals to support its development. People from developed countries work in developing and emerging economies too. The operation of multinational companies or international NGOs or bilateral or multilateral cooperation depends on the legal migration of workers.

10.1 A  frican Diaspora and Innovation on the Continent The AU defines the African Diaspora as “peoples of African origin living outside the continent, irrespective of their citizenship and nationality and who are willing to contribute to the development of the continent and the building of the African Union.”3 A lot has been said about the potential of the African Diaspora to support the different facets of the continent’s development. Indeed, many Africans in the Diaspora have acquired education and training from the more developed parts of the world, and many have remained and become naturalized in those countries, contributing to the development of those countries in different ways. On the other hand, many African Diaspora have struggled to adjust in their adopted countries. History has taught us how African slaves helped in building America and other parts of the world, and the racial inequality that their descendants still fight today.  African Union. 2005. “Report of the Meeting of Experts from Member States on the Definition of the African Diaspora.” Addis Ababa, April 11–12. 3

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Many of these African Diaspora still relate to Africa and want to contribute to the continent’s development. The hearts and souls of many Africans Diaspora are still in Africa. As an African Diaspora put it, “the diaspora is Africa’s secret weapon.”4 The World Bank estimates that the number of African Diaspora by region is: North America, 39.16 million; Latin America, 112.65 million; Caribbean, 13.56 million; and Europe, 3.51 million.5 In 2018, the estimated annual African Diaspora remittances to subSaharan Africa were about USD 46 billion, and about USD 84 billion for the continent. Even at the heart of the COVID-19 pandemic, when nearly all countries were affected with negative economic impact and job loses, many African Diaspora networks mobilized through social media and organized relief and palliative support for families back in Africa. There are already reports that COVID-19 is negatively affecting foreign remittances with the shrinking of remittances by about 7% in 2020 and 14% in 2021.6 The AU, some African countries and several international development partners have established Diaspora initiatives to support the development of Africa using their expertise. However, it is unclear to what extent the objectives of those initiatives are being realized. One such program is the UNDP TOKTEN (Transfer of Knowledge through Expatriate Nationals). As a young PhD student in Europe in the early 1990s, the author was recruited by UNDP as a consultant to contribute to the TOKTEN program in Nigeria to help in building capacity in biotechnology. It was an exciting opportunity for me but unfortunately the receiving institution in Nigeria was not as prepared as I had expected (perhaps due to no fault of the institution because it was difficult to access certain reagents required for the training locally). In the end everything worked out very well for the trainees, trainers, the local institution and UNDP, and we all achieved our objectives and many more despite the initial challenges. Following that experience, I wanted to do more for Nigeria and the African continent,   Africa’s secret weapon: The Diaspora (https://edition.cnn.com/2013/11/01/opinion/africas-­ secret-­weapon-diaspora/index.html). 5  Frequently asked questions—African Diapora, World Bank (http://siteresources.worldbank.org/ INTDIASPORA/Resources/AFR_Diaspora_FAQ.pdf ); https://www.worldbank.org/en/news/ press-release/2019/04/08/record-high-remittances-sent-globally-in-2018. 6  https://www.worldbank.org/en/news/press-release/2020/10/29/covid-19-remittance-flows-toshrink-14-by-2021. 4

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and I sought the help of my professors and friends in Europe and America for a follow-up training. They generously provided technical support and some funding to ensure the successful implementation of subsequent training programs in biotechnology and molecular biology. I recall Professor Johan Thevelein from the Catholic University of Leuven,  a mentor of mine, and other professors and graduate students accompanying me to Africa for various trainings, and it was fantastic and rewarding for all of us. I also recall another mentor, the late Professor Helmut Holzer from the University of Freiburg, supporting these African training efforts with reagents from his laboratory. Occasionally I run into fellows who benefited from some of those programs and I feel elated when they tell me how our training initiative helped them to become what they are today. Those programs were truly hands-on practical training, and many thanks to everyone who made those possible. Also, as a PhD student, I tried the establishment of a journal focusing on tropical biosciences that could be made freely accessible to institutions in Africa and other developing countries. This was because many African universities did not have the type of library and access to research publications that I saw in European and American universities. I approached several professors and experts on the subject(s) to be on the editorial board and to advice on how to proceed with the project. While I received several encouraging responses from these experts from around the world, the response from one UK tropical disease expert has stuck in my mind till today. In his response, he said in part “UK is not about to become tropical.” In any case, that project never took off and it is pleasing to see the open access revolution that has now made it possible for African scientists and universities to have access to some recent articles at no cost. Later, in my career I met the UK scientist who wrote me because my organization was funding a project that he was a partner in, and we became good friends. On a very personal note, I am very happy that this book has become a reality because I believe that my career path and multifaceted experience makes me the ideal person to write this type of book on research and innovation in my continent. The book may not be perfect, I may not have covered all aspects of R&D and innovation on the continent, but I have shared the lessons based on available data and my practical experience. The goal is to share lessons that will help to make

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progress in African research and innovation. It is hoped that any future edition of this or other books will show improvements in some of the challenges that I have highlighted. Lesson 10: The expectation of African initiatives or institutions from the African Diaspora is high, but several of those institutions have not been structured to better tap into the wealth of expertise of the African Diaspora. Unlike the UNDP TOKTEN program, most African institutions sometimes expect the individual African Diaspora to use their own resources to support programs rather than establishing frameworks that will facilitate the support required. While some African Diaspora are happy to contribute time and money, it is not always possible for most of them to commit personal finances on local projects. The African Diaspora initiatives should at least be prepared to cover travel and per diems for the African Diaspora who want to support local initiatives or projects, and those local projects should be well prepared in advance for project implementation and to receive the African Diaspora. Several years ago, I went to the World Bank in Washington, DC to talk about ANDI and mobilize the African Diaspora support. As I was preparing for the meeting, I reached out to a friend whom I did not realize was involved in the Bank’s Africa Diaspora program. I appreciated his personal input and advice on the program. He was full of praise for the enthusiasm and eagerness of the African Diaspora to help, but he was also clear that the majority of them want something in return from the program. In fact, most of them want to be compensated for the services they provide, and there is nothing wrong with this desire. The misunderstanding is caused by the design of some of the programs that see the Diaspora support only as charity or pro bono support. The African Diaspora have a lot to offer the continent, but strong and clear structures are needed to take their support to scale. Lesson 11: Another important perspective on the African Diaspora contribution is that with a proper enabling environment from governments, individuals or groups of African Diaspora are willing to raise funds and return to Africa to establish and manage technology companies, hospitals, educational institutions and services. This is already happening in many African countries. Some of the progress that we are seeing in the technology space in Africa has been championed by the African

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Diaspora who at one point or the other gained experience overseas and decided to put that experience back into practice in Africa. This approach holds a lot of promise and should be encouraged at all levels of African innovation. A few examples of this approach have been discussed in this book, including the Moringa-Connect, which empowers rural Ghanaian farmers and others. This fact was also highlighted in an article that was referenced earlier on technology hubs: “Most of the founders of successful ‘African Unicorn Companies’ might have some associations with the local hubs but not necessarily supported by one. Most of the time founders of these companies share few traits in common; they have the strong corporate background, they went to good schools, they are coming back home after staying few years abroad, they have a strong network or work with foreign cofounders.”7 Perhaps these types of initiatives and the foreign remittances have been some of the successful parts of the African Diaspora contribution to the continent. Any post COVID-19 development initiatives in Africa should leverage the capacity and expertise of the African Diaspora in a structured way. In other words, the African Diaspora will be a very important stakeholder in the optimization and scaling up of the social innovation enterprise proposed in this book.

 Jumanne R.  Mtambalike (2018) The facts and fictions about innovation and technology hubs in Africa (https://medium.com/@jumannerajabumtambalike/the-facts-and-fictions-about-africainnovation-and-technology-hubs-b46d46c61f75). 7

11 COVID-19 Pandemic, Leadership and Ownership of Innovation in Africa

The COVID-19 pandemic hit the world as this book was nearing completion, and by March 2020, the disease had become a major global challenge. It subsequently became clear that COVID-19 has and will change the world for ever. A pneumonia-like symptom was first reported by the Chinese authorities in Wuhan on 31 December 2019 and was subsequently associated with a novel coronavirus called SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). The disease rapidly spread outside of China, and by 20 January 2020, other countries, including the United States and South Korea, confirmed cases. Wuhan was closed off by the Chinese authorities on 23 January 2020, and the World Health Organization (WHO) declared a “public health emergency of international concern” on 30 January 2020. On 11 February 2020, WHO named the SARS-­ CoV-­2-causing disease as COVID-19 (Corona Virus Disease-2019). On 1 March 2020, WHO declared COVID-19 a pandemic and stressed the imminent danger of sustained global spread.1 Some data that  https://www.who.int/news-room/detail/27-04-2020-who-timeline%2D%2D-covid-19; https://www.nytimes.com/article/coronavirus-timeline.html; https://time.com/5791661/whocoronavirus-pandemic-declaration/. 1

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subsequently emerged from China, Europe and the United States showed that COVID-19-related deaths may have occurred earlier than initially reported, suggesting that the disease was already spreading in November and December 2019.2 China was initially praised for instituting the strictest lockdown in modern history as well as building, equipping and operationalizing major hospitals in Wuhan within weeks to support the management and control of the disease. Chinese scientists and their collaborators led by Dr Zhang Yongzhen sequenced and analyzed the genome of the virus on 5 January 2020 and discovered that it is about 80% related to the SARS and therefore very dangerous.3 On 11 January 2020 Dr Zhang and his collaborator at the University of Sydney, proactively and openly shared the initial sequence data on Virological.org.4 Further investigation also showed that Dr Zhang uploaded the genome to the US National Center for Biotechnology Information (NCBI) on 5 January 2020. This decision to rapidly share the sequence, which subsequently generated controversies in China, made it possible for the world to start developing diagnostics, treatments and vaccines. However, a lot of questions have since been raised about the transparent reporting of the disease in China, such as when the disease was first detected in Wuhan, the precise origin of the virus, the number of cases and deaths. Also certain human rights concerns, including the treatment of resident Africans in Wuhan, during lockdown  as well as cases of discrimination against some Chinese and Asians overseas due to COVID-19. Several unsupported theories about the source of the virus went viral on social media, but many experts believe that the virus is of zoonotic origin.5 Subsequently, the WHO initiated investigation about the origin of the virus as well as the global handling of the pandemic through an Independent Panel for Pandemic Preparedness and Response.6 An ini2  https://www.theguardian.com/world/2020/mar/13/first-covid-19-case-happened-in-november-­ china-­government-records-show-report; https://www.iflscience.com/health-and-medicine/the-firstcovid19-case-was-earlier-than-intially-thought-suggests-new-report/. 3  https://time.com/5882918/zhang-yongzhen-interview-china-coronavirus-genome/. 4  https://virological.org/t/novel-2019-coronavirus-genome/319. 5  Burki T. (2020) The Origins of SARS-COV-2. Lancet Infectious Diseases, 20, 1018–1019 (https:// www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930641-1). 6  https://theindependentpanel.org/about-the-independent-panel/.

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tial press report of the WHO’s investigation team into the origin of the coronavirus in China stated that “the researchers largely discounted the controversial theory that the virus accidentally leaked from a laboratory, and suggested that SARS-CoV-2 probably first passed to people from an animal.”7 While the WHO investigation team suggested that more work is needed to fully address this question, they did not discount two other hypotheses that “the virus, or its most recent ancestor, might have come from an animal outside China, and that once it was circulating in people, it could have spread on frozen wildlife and other cold packaged goods”. Subsequently, WHO indicated that all hypotheses on the origin of the virus remain open.8 A former director of the US Centers for Disease Control and Prevention (CDC) during the pandemic in 2020 (Dr. Redfield) suggested that the likely origin of the virus is a laboratory in china. (https:// edition.cnn.com/videos/health/2021/03/26/sanjay-gupta-exclusive-robert-redfield-coronavirus-opinion-origin-sot-intv-newday-vpx.cnn). A new US intelligence report suggests that three staff of the Wuhan Institute of Virology became ill in November 2019 with COVID-like symptoms to the extent of hospitalization (New Report Points To COVID-19 Lab Origin? Wuhan Scientists Were Hospitalized In November 2019 (ibtimes.com)). While this does not confirm a laboratory origin of the SARS-CoV-2, it strengthens the continued investigation of this and other opinions. China has since refuted the report. Hopefully, this question will be laid to rest in due course. While SARS-CoV-2 was slow in reaching many African countries due to some yet unclear reasons, the initial fear was that with some of the weakest healthcare system in the world, most African countries were ill prepared and that the disease will wreak havoc on the continent. The first confirmed incidence of the disease in Africa was in Egypt on 14 February 2020,9 but in sub-Saharan Africa, Nigeria was the first country to confirm the disease on 27 February 2020.10 The disease quickly spread across many African countries, and in July 2020, the WHO warned that cases  Mallapaty S, Maxmen A. and Callaway E (2021) Mysteries persist after World Health Organization Reports on COVID-Origin Seach (https://www.nature.com/articles/d41586-021-00375-7). 8  https://www.who.int/news/item/30-03-2021-whocalls-for-further-studies-dataon-origin-of-sars-cov-2-virus-reiteratesthat-all-hypotheses-remain-open. 9  https://www.egypttoday.com/Article/1/81641/Egypt-announces-first-Coronavirus-infection. 10  https://dailypost.ng/2020/02/28/coronavirus-in-nigeria-federal-govt-confirms-full-statement/. 7

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Fig. 11.1  Map of the world showing the spread of COVID-19 around the world and in Africa as of 22 March 2021 https://covid19.who.int/

are accelerating in Africa.11 When compared with several European, Asian and American countries, African countries have experienced more attenuated cases and deaths except for South Africa, which recorded the sixth largest number of cases in the world in September 2020 after the United States, Brazil, India, Russia and Peru. However, many African countries subsequently struggled with a more intense second wave of the disease.12 Figure 11.1 shows the map of the world with the pattern of spread as of 11  https://www.dailymail.co.uk/news/article-8542109/Coronavirus-World-Health-Organizationwarns-­acceleration-disease-Africa.html. 12  https://www.afro.who.int/news/new-covid-19-variants-fuelling-africas-second-wave.

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22 March 2021.13 A year after the first cases of the diseases were reported in Africa, it is becoming clear that, while the increasing cases or deaths are worrisome, most African countries have not seen the level of cases and mortality originally predicted. Several theories were presented to rationalize the scenario in Africa, such as the lack of widespread testing, the tropical weather condition of most African countries and the genetic predisposition of the continent’s population.14 Also, it has been highlighted that the younger population of the continent might be a factor as well as the rapid and prompt leadership of African countries in instituting lockdown and control measures. A combination of factors might be responsible, but detailed studies will be required to better understand the disease epidemiology and pathogenesis in Africa. Recent antibody samplings in Africa suggest that many more Africans have been infected with the virus than previously reported, and despite this, mortality appears to have remained relatively low compared to Europe, the United States and several middle-income countries.15 Moreover, the virus appears to be spreading differently and potentially with an attenuated outcome in Africa, despite lack of clear evidence.16 The far less testing in Africa compared to other parts of the world suggests that many more cases are missed. For example, Nigeria, with a population of about 180 million people, tests about one in 50,000 people per day. Perhaps many more people who are not diagnosed may be dying of the disease, but this does not fully explain the relatively documented low death rates. Another proposed explanation could be that regular exposure to other coronaviruses, malaria and other infectious pathogens that are prevalent in Africa could prime the immune system to fight new pathogens, such as SARS-CoV-2. One can also not exclude that genetic factors may have a role in protecting African from severe disease, although the high mortality seen in African Americans in the United States and other parts of the world may raise questions about this theory. Recent evidence  https://covid19.who.int/; see also https://coronavirus.jhu.edu/map.html.  https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Africa. 15  Nordling L (2020) The pandemic appears to have spared Africa so far. Scientists are struggling to explain why (https://www.sciencemag.org/news/2020/08/pandemic-appears-have-spared-africaso-far-scientists-are-struggling-explain-why#). 16  Mbow M, Lell B, et  al. (2020) COVID-19  in Africa: Dampening the storm? Science 369, 624–626. https://doi.org/10.1126/science.abd3902. 13 14

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from Zambia, described as the first systematic surveillance data capturing the impact of COVID-19 in Africa outside of South Africa, have contradicted the prevailing narratives about COVID-19 on the continent.17 The authors show that “COVID-19 deaths were unexpectedly common, explained by the rarity of testing in life. If this typifies resource constrained settings, the impact of COVID-19 in Africa may be significantly underestimated.” They further state that “the absence of data on covid-19 in Africa has fostered a widely held narrative asserting that it has largely skipped Africa and had little impact.” We hope to learn more about this in the coming months and years, but one thing is clear, Africa has recorded fewer cases and deaths compared to Europe, Americas and parts of Asia. However, it has been reported that a likely 3rd wave of the disease has started in some African countries. We are all too familiar with the so-called diseases of poverty such as malaria, TB, HIV, dengue, schistosomiasis, onchocerciasis and leprosy, which disproportionately affect developing countries due to a lack of commercial incentives to drive R&D and innovation in support of their control and elimination. The COVID-19 is different, at least today—it has spread to nearly every country and affects everyone, although some people are asymptomatic to the virus, and we don’t fully understand the disease. Many developed countries are investing billions and trillions of dollars to study, fight, prevent and minimize the damages that this sudden enemy is causing to lives, health systems and the economy. The development and deployment of diagnostic tools, treatments and vaccines to fight the disease have been prioritized. In an era of increasing vaccination misinformation and sceptics, it is important to continue to vigorously pursue the development and deployment of suitable vaccines for COVID-19 for everyone, not just for the rich. Otherwise, the world risks making COVID-19 a future neglected disease that disproportionately affects developing countries just like malaria and HIV. The ongoing discussion about equitable distribution of the vaccines globally is in order, as developed countries invest billions to secure and reserve millions of doses of potential vaccines in development and those approved for their citizens. The WHO has cautioned about the dangers  Mwananyanda L., et al. (2021) Covid-19 deaths in Africa: prospective systematic postmortem surveillance study. BMJ, 372 https://doi.org/10.1136/bmj.n334. 17

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of COVID-19 vaccine nationalism and inequity,18 referring to the efforts of wealthy countries to sign deals with pharmaceutical companies directly, to secure vaccines for their own populations, thereby limiting the stock available for others.19 As of February 2021, it is estimated that rich countries with just 16% of the world’s population have bought up 60% of the world’s vaccine supply, with the goal to vaccinate 70% of their adult population by the middle of 2021  in pursuit of herd immunity. The Access to COVID-19 Tools (ACT) Accelerator20 has been put in place by WHO and partners to support equitable global access to COVID-19 tools, especially in developing countries. This includes the global COVID-19 Vaccine Access (COVAX) facility.21 COVAX will need about USD 18.1 billion to secure 2 billion doses of vaccines in 2021 for poor countries through certain advance market commitment mechanisms by companies developing the vaccine. While COVAX is making good progress, significant gaps remain, as it struggles to purchase enough doses to cover just 20% of the population of lower-income countries by the end of 2021. The new US administration of President Biden gave a boost to the facility by pledging USD 4 billion in phases to the facility. This complements the ongoing support from the European countries, the United Kingdom, Canada and other development partners and foundations. While low- and middle-income countries are most affected by a lack of access to vaccines, the said vaccine nationalism could have a knock-on effect for the whole world, if most developing countries are left unvaccinated—the slogan “no one is safe until everyone is safe” has become a popular catchphrase. An analysis by the International Chamber of Commerce (ICC) and others shows that the global economy could lose up to $9.2 trillion if poor countries are left behind in the vaccine rollout.22 Indeed, this so-called COVID vaccine nationalism and inequity is another fascinating scenario that is very relevant to the theme of this book and deserves a balanced and critical analysis. The global gravity of the  https://foreignpolicy.com/2021/02/02/vaccine-nationalism-harms-everyone-and-protectsno-one/. 19  https://www.globalcitizen.org/en/content/what-is-vaccine-nationalism/. 20  https://www.who.int/initiatives/act-accelerator. 21  https://www.gavi.org/sites/default/files/2020-06/Gavi-COVAX-AMC-IO.pdf. 22  https://iccwbo.org/media-wall/news-speeches/study-shows-vaccine-nationalism-could-cost-richcountries-us4-5-trillion/. 18

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COVID-19 pandemic aside, is this inequity phenomenon any different from the neglect that many developing countries have endured from the preventable diseases that disproportionately affect them? Are we all not witnessing and promoting the same fragmented approach that does not scratch deep into the challenges of developing countries? The unprecedented and groundbreaking innovations that resulted in the discovery, development and roll-out of COVID-19 vaccines within one year would not have happened without years of strong academic and industry R&D investment and government policies. We now know that small- and medium-sized biotechnology companies like the Germany-based BioNTec, US Moderna and China’s Sinovac have a critical role to play in these efforts. The scale-up of the global manufacture for some of these vaccines, including the Russian Sputnik V, is being initiated and discussed in several countries with the supporting contractual manufacturing infrastructure and capacity, including in India, Brazil and others. These types of robust, flexible and sustainable infrastructure and capacity for vaccines manufacture should be part of the discussion for Africa, as it will help to strengthen Africa’s vaccine manufacturing capacity and create jobs. It is time to start supporting the development of sustainable R&D and innovation systems for the discovery, development, manufacture and delivery of these tools in Africa in a sustainable way. This is a more sustainable way to ensure equity. As the report of the Independent Panel on Pandemic Preparedness and Response highlighted: “Establish stronger regional capacities for manufacturing, regulation, and procurement of needed tools for equitable and effective access to vaccines, therapeutics, diagnostics, and essential supplies, as well as for clinical trials”.23 Africa must take the lead and relevant development support should align with those ideals. It is good to see the positive technology transfer arrangement between Johnson & Johnson and Aspen Pharmacare South Africa on the manufacture of the Johnson & Johnson’s COVID-19 vaccine. It is also refreshing to see that South Africa is the first country to review, approve and roll out the Johnson & Johnson vaccine for emergency use after it discovered that the Oxford/AstraZeneca vaccine is less effective against the dominant  Johnson Sirleaf E. and Clark H. (2021) Report of the Independent Panel for Pandemic Preparedness and Response: making COVID-19 the last pandemic. https://doi.org/10.1016/ S0140-6736(21)01095-3. 23

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B.1.351 coronavirus variant in the country  at the time. It is likely the production of the Johnson & Johnson by Aspen in South Africa facilitated this decision.  South Africa secured an initial nine  million doses of this single-dose vaccine, which is known to be effective in preventing moderate and severe disease from the B.1.351 variant based on trials conducted in South Africa.24 Perhaps there is no other sub-Saharan African country with the regulatory capacity to expeditiously review and provide such authorization—most African countries depend on the WHO pre-­qualification system for the initial review and approval of regulatory dossiers. We hope to see some progress with the proposed production of the Sputnik V vaccine in Algeria as well as discussions to leverage the Institute Pasteur in Senegal for COVID Vaccine production. Furthermore, the proposed Partnership for African Vaccine Manufacturing (PAVM), discussed in Chap. 8, is hoped to boost these efforts and integrate the novel mRNA vaccine technology in the process. Time is of the essence for developing countries to access COVID-19 vaccines to vaccinate their citizens. As COVAX tries to secure more vaccines, it should also consider working with one or two African countries to facilitate the manufacture of vaccines with some of the available resources. It is however important to understand that without strong R&D capacity it will be difficult to sustain a robust manufacturing effort as well as the production of relevant intermediates. The AU is coordinating with countries and partners to ensure access to COVID-19 vaccines. In support of this, both the AfDB and the AFREXIM bank have put in place several billions of dollars in borrowing facilities in the form of bonds to support countries with access to COVID-19 interventions.25 For example, the AFREXIM bank has established a USD 3 billion Pandemic Trade Impact Mitigation Facility (PATIMFA) to support countries, and as part of this, it has established a USD 200 million facility to increase the supply of locally produced tools to fight COVID-19. An African COVID-19 Vaccine Financing Initiative (ACOVFINI) has been established to arrange a financing facility of up to USD 5 billion to enable African procurement of COVID-19 vaccines in a timely and cost-effective  https://edition.cnn.com/2021/02/16/africa/south-africa-astrazeneca-johnson-and-johnsonvaccine-­intl/index.html. 25  https://reliefweb.int/report/world/african-development-bank-launches-record-breaking-3-­ billion-­fight-covid-19-social-bond; https://www.afreximbank.com/afreximbank-announces-3-billionfacility-to-cushion-impact-of-covid-19/. 24

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manner. Also, both AfDB and AFREXIM bank have expressed interest in supporting local vaccine production. Several African partners are also working together to implement the African Medical Supplies Platform (AMSP), which serves as a marketplace to enable access to critical medical supplies on the continent (https://amsp.africa/). The African CDC has done a good job in sharing information about the disease in Africa and in implementing training on diagnosis, safety precautions and virtual conferences. As of 2020, nearly all the diagnostic reagents and tools used for the disease in sub-Saharan came from overseas, and this has continued into 2021, except for the increasing production of personal protective equipments (PPEs) such as  face mask. Furthermore, laboratories that perform available tests in sub-Saharan Africa are limited; for example, the Nigeria Centre for Disease Control and Prevention (NCDC) indicated that the lack of testing labs is one of several bottlenecks to testing in countries, but this has progressively improved over time. The South African government has done far more testing than most African countries. It is known that some companies in Africa have converted to the production of different kinds of face masks and PPEs, for example, the Hela Clothing company in Kenya (http:// www.helaclothing.com/about-­us). However, scale probably remains an issue, and there are a few other companies in Northern Africa, West Africa and Southern Africa that are doing the same. Several African institutes, individuals and leaders touted some unproven herbal and local mixtures as treatment or cure for the disease in the early months of the pandemic.26 As indicated in Chap. 6, it is important that the use and promotion of remedies from TAM are based on scientific evidence and rigor. An article indicated that it will be hypocritical for Africans to cry foul for being used as “guinea pigs” in the clinical testing of Western medicines (drugs and vaccines from developed overseas),27 and yet they promote the unsupported use of local herbal potions. It is encouraging that the African Union (AU) requested supporting data from the  https://news.mongabay.com/2020/04/madagascars-president-promotes-unproven-herbal-curefor-covid-19/; https://en.wikipedia.org/wiki/List_of_unproven_methods_against_COVID-19# Herbs_and_spices; http://www.rfi.fr/en/africa/20200424-two-african-leaders-under-fire-for-touting-unproven-coronavirus-preventatives-madagascar-guinea-covid-organics-artemisia. 27  https://theconversation.com/africa-must-make-sure-its-part-of-the-search-for-a-coronavirusvaccine-136531; https://www.aljazeera.com/indepth/opinion/medical-colonialism-africa-2004 06103819617.html. 26

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government of Madagascar on the said COVID-­organics that were initially promoted as treatment for COVID-19. Subsequently, South Africa, Senegal, Nigeria and other countries tried to evaluate the said herbal cure.28 This would have been a good opportunity for a coordinated evaluation among African countries, institutions and regulatory bodies to ensure that study protocols and processes are aligned, as it will save cost and facilitate structured roll-out of the treatment, if successful. A leading Nigerian institute have since announced that it could not corroborate the claims of Madagascar on the usefulness of COVID-organics either as treatment or as cure for COVID-19,29 and other information has emerged that suggests the same. Unfortunately, the social media helped to amplify major misinformation and conspiracy theories about various unproven COVID-19 treatments and vaccination, even by scientists, medical personnel and religious leaders. A development of significance in Africa includes the evaluation of a low-cost rapid diagnostic test by the Institute Pasteur in Senegal with a British company30 and the fabrication of prototype devices and ventilators in Cameroon, Senegal and Nigeria by young engineers.31 It is hoped that these technologies can be fully evaluated, registered, produced and scaled up to support the need of countries. Most African countries promptly and effectively adopted the classical lockdown and social or physical distancing approach instituted by many countries around the world to mitigate the spread of the diseases and should be congratulated for acting swiftly. However, the lack of suitable palliative and social protection support measures in most countries fueled debate regarding how the lockdown is exacerbating hunger, poverty, ill health from other diseases and economic fragility in Africa. Recent studies and models have analyzed the potential negative impact of COVID-19 on health systems, malaria, HIV, TB and other diseases in low- and  https://au.int/en/pressreleases/20200504/covid19-african-union-discussions-madagascarover-herbal-remedy; https://www.aa.com.tr/en/africa/senegal-approves-madagascar-s-anti-covid19-drug/1833942; https://www.aa.com.tr/en/africa/south-africa-to-examine-madagascar-s-covid19-drug/1831219. 29  https://www.aa.com.tr/en/africa/nigeria-madagascars-herbal-drink-cannot-curecovid-19/1915948. 30  https://hotair.com/headlines/archives/2020/03/ten-minute-test-1-coronavirus-game-changer/. 31  (https://www.premiumtimesng.com/health/health-news/390623-interview-25-year-old-josbased-fabrication-engineer-develops-ventilator.html). 28

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middle-­income countries.32 As the disease continues to spread and vaccination coverage lagging in many African countries, it is crucial to put necessary measures in place to avoid any unintended consequences of easing lockdowns and opening the economies. The measures that have been recommended by experts include ramping-up of vaccination; testing; stronger contact tracing and isolation measures; provision of essential tools for hospitals, including treatments that are known to be helpful; mandatory wearing of face masks in public places and clear guidelines for businesses, schools and others. African countries should intensify efforts to ensure that vaccines are available on the continent. Perhaps the COVID-19 pandemic experience will help most African countries to invest in their health systems, R&D, local manufacturing of quality-assured medicines and boosting local supply chains for essential goods and services. Some of these concepts are already contained in existing strategies and policy frameworks of the continent. It is good to see an announcement by the Nigerian Central Bank: “Turning Covid-19 Tragedy into Opportunity For New Nigeria.”33 The report proposes immediate investment in some of the areas that have been highlighted in this book, for self-reliance in Africa. A BBC story described how COVID-19 is fueling the surge of counterfeit medicines and health tools in Africa.34 Several pharmaceutical companies in India were operating far below normal capacity, and this significantly disrupted the supply chain of medicines in Africa, as Indian companies supply about 20% of medicines used in Africa. The COVID-19 pandemic is already affecting global economies in an unprecedented way, and most African countries remain in recession with uncertain timelines for full recovery (https://www.afdb.org/sites/default/ files/2021/03/09/aeo_2021_-_chap1_-_en.pdf ). The prices of commodities that several African countries rely on fell to all-time lows. Irrespective of what happens, it is important for African countries to prepare for the life ahead—invest in strengthening health and innovation systems and in a strong education system that contribute in addressing societal challenges. In the face of the COVID-19 crisis and future   Hogan B.  A. (2020) Lancet Global Health; 8: e1132–e1141. https://doi.org/10.1016/ S2214-109X(20)30288-6. 33  https://www.cnbcafrica.com/africa-press-office/2020/04/15/turning-covid-19-tragedy-intoopportunity-for-new-nigeria/. 34  https://www.bbc.com/news/health-52201077. 32

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pandemics, a recent editorial has proposed that the G7 and G20 leaders should rapidly establish a Global Institute of Health to manage milestone-based funding and R&D needed to optimally and sustainably scale-up platforms and supply chains of tools against pandemic threats.35 This idea is complementary and synergistic to the proposed African Research, Development and Innovation Institute, with targeted sectors like health (Chap. 5). Such institute could coordinate and address R&D for emergent infections that are prevalent in Africa and, at the same time, coordinate with the global institute. The concept of vaccine diplomacy has been suggested as an important approach to address the current global vaccine inequity. Although it has largely been used in the context of the supply of COVID-19 vaccines, it is broadly relevant to science and research. In his book, Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-science (2021) Dr Peter Hotez called for the promotion of vaccine diplomacy to prevent diseases and to promote peace and cooperation among countries. He suggests that vaccine diplomacy is part of health diplomacy and includes joint development or refinement of vaccines by scientific teams based in two or more countries, even when countries were poles apart in their positions on other matters. China is providing aid in the form of donation of some of its COVID-19 vaccine to countries, and India’s promise of using its enormous vaccine production power to help the world has in the time being been impacted by the intense 3rd wave of COVID-19 in the country. (https:// chinaobservers.eu/how-china-and-india-are-competing-in-vaccine-diplomacy/). Vaccine diplomacy is also promoted in the context of the several developed countries contributing or being encouraged to contribute towards the COVAX facility to support poorer countries. We suggest that a broader science and innovation diplomacy is necessary to strengthen the R&D, manufacturing and supply chain capacity of developing countries. The recent 2021 G7 meeting in the UK have pledged 1 billion doses of vaccines to support global COVID-19 vaccination with the US pledging 500 million doses. However, more doses are needed for poorer countries (https://www.reuters.com/business/healthcare-pharmaceuticals/g7-donate-1billion-covid-19-vaccine-doses-poorer-countries-2021-06-10/).  Zerhouni W., Nabel G. J. and Zerhouni E (2020) Patents, Economics and Pandemics. Science 368, (6495), p1035. https://doi.org/10.1126/science.abc7472. 35

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11.1 L eadership and Ownership of Research and Innovation in Africa A recurrent theme in most African strategic and policy documents on research and innovation is the quest for an “African-led and African-­owned” science, research or innovation. Without going into some theoretical or conceptual arguments regarding the meaning of these terms, it is important to appreciate that what is required is “political leadership” that commits necessary resources (human and financial), creates an enabling environment for research-based private sector development and supports accountable governance and regulatory structures to achieve measurable and sustainable outcomes. Such political leadership provides the policy framework and platform that ensure that official development assistance and aid are properly aligned with the local development agenda and strategies. It provides the framework for African countries and institutions to control and own its R&D agenda. In several countries, the COVID-19 crisis has shown how government leadership, policies, financing and expertinformed decisions incentivize research and innovation, and the private sector to ramp up the production of and access to essential control tools. Leadership and ownership of R&D and outcomes of innovation are often linked to financing,36 intellectual property rights, governance enabling policies, regulation and the impact on society. They are not measured by the number of strategies, declarations, nice words and attendance at meetings alone. The fact is that for a sustainable platform for innovation to succeed in Africa, there is a need to emphasize the creation of sustainable financing sources and building a critical mass of capacity, not just for basic research, but for the entire innovation value chain. Some of these leadership and ownership considerations led to the establishment of a high-level Ministerial Board for ANDI with regional representation as well as representation from ministries of Health, and Higher Education, Science and Technology from the various economic  Nwaka S. Building Scientific and Innovation Capacity to tackle Africa’s health challenges. Africa Policy Review 2017/2018, p 76–80; https://www.intechopen.com/books/key-issues-for-­ management-of-innovative-projects/financing-innovation;  https://dash.harvard.edu/bitstream/ handle/1/30861195/17-043.pdf?sequence=1. 36

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communities. Later on, the ministries of finance were included on the Board. Following a Board reform that was implemented in 2016, an operational Board led by Dr Tshinko Ilunga, as Chairperson, was established, followed by a high-level ministerial advocacy group.37 The service of the Board members and committees to the continent will not be forgotten— at least this book is a testament to that. Despite these efforts, and as with other past African initiatives, over 95% of the funding for the work of ANDI came from overseas. Unfortunatley, several other local organizations are struggling with this type of scenario. A recent campaign for the presidency of the African Academy of Sciences (AAS) further sheds light on the donor-driven influence on African science—an communication from one of the candidates to his peers soliciting votes stated: “I was faced with many internal challenges such as Governance, issues around fiducial responsibilities on financial management which significantly impacted on the effective and efficient functioning of the organization at both the GC and Secretariat levels. On governance, regrettably, we have not involved Fellows enough in the many Academy activities. On finance, AAS is a donor-funded institution …. The way AAS reporting lines on finance and governance was set up … made it almost impossible for the GC to put checks and balances in place to ensure fiduciary observance, financial transparency and compliance to ensure proper approval and implementation processes.” GC refers to the governing council of the Academy. Consistent with this fact, it is known that a major part of the budget of the African Union (AU) comes from external non-African partners according to a proposed new AU reform.38 It is difficult to talk of African ownership or control of its programs under this condition. The reform agenda for the AU has proposed ways to redress this, just like some of the statements in the AU Agenda 2063, but the challenge is with the implementation. A critical measure of progress in the next 5–10 years could be to half this overdependence on external funding syndrome and to show true African ownership and leadership of its programs. This milestone is  Facilitating Health Innovation in Africa—ANDI’s Five Year Strategy (http://andi-africa.org/ ANDI_File/Strategic_Plan/Facilitating_Health_Innovation_in_Africa_ANDI_Strategic_ Plan(2016-2020).pdf ). 38  AU Reforms—Sustaining Financing (https://au.int/en/AUReforms/areas/financing). 37

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achievable—after all Africa loses about USD 148 billion to corruption and over USD 85 billion to illicit financial flows every year.39 Many experts have proposed immediate debt relief for African countries and other developing countries to be able to cope with the immediate impact of COVID-19. While this is a good immediate action, it should not be a substitute to the sustainable developmental decisions that should be made today. There are no shortcuts—building knowledge-based economies require long-term and sustained investment in research and innovation. This requires private sector development, education and integrated human resource development. African leaders know this, they talk about it and they agree with it. At the January 2019 meeting of the World Economic Forum—Paul Kagame, the President of Rwanda, and a past Chairman of the African Union stated:40 “The conditions have never been so favorable for Africa to take the lead in shaping its own global agenda. For too long, we ceded responsibility for Africa’s agenda to others, with some individuals even benefitting …. Challenges relating to migration, security and climate change among others mean there is no longer any actor who sees an advantage in an Africa that is institutionally weak and economically stagnant …. Everyone benefits from a stronger, more united Africa.” Hopefully, the lessons of the COVID-19 pandemic are a stronger wake­up call for the continent. The capability and infrastructure of local pan-African and national organizations with the technical and managerial responsibility to lead research and innovation and their capacity-building efforts should be strengthened. This book has drawn lessons from some of these African organizations, as well as from relevant non-African-based institutions. The mission and activities of some of these African agencies are summarized in Appendix D. It is some of the lessons learned over the years that have led to the proposed establishment of the Innovation Development and Entrepreneurship African (IDEA) University or Academy (described in the next chapter) in helping to fill some of the identified gaps.  https://www.zambianobserver.com/africa-loses-148-billion-to-corruption-and-2-trillion-inmoney-­laundering-a-year-time-to-end-financial-crime/; https://martinplaut.wordpress.com/2018/ 04/12/a-quarter-of-africas-economy-148bn-is-lost-to-corruption-every-year/. 40  https://www.newtimes.co.rw/news/wef19-kagame-makes-case-institutionally-strong-africa. 39

12 Integrating Innovation and Entrepreneurship into the African Educational System: Concept of IDEA University

It is important to recall the link between innovation and entrepreneurship. While innovation is the “creation of new value from an original idea,”1 entrepreneurship is the “pursuit of opportunity beyond resources controlled.”2 It is about converting a good idea or innovation into a business opportunity.

12.1 O  verview and Rationale for IDEA Academy or University The rationale for this proposed specialized institution focusing on innovation and entrepreneurship training responds to the empirical evidence presented in the various parts of this book, the lessons learned and the gaps identified.

 Adapted from a series of definitions reviewed by Jeff Dance at https://www.freshconsulting.com/ what-is-innovation (accessed January 7, 2018). 2  Stevenson, H. H. (1983). A perspective on entrepreneurship. Harvard Business School Working Paper 9-384-131. 1

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There is a rapid rise in business and entrepreneurship in general across the continent, but the level of home-grown technological or social innovations and associated businesses remains low. Many entrepreneurial developments, for example, in the ICT space, are very noteworthy in themselves, but are based largely on technologies developed from overseas, or adaptations thereof, and not on substantive local technical innovation. We have also determined that the informal sector is an important source of innovations in Africa, but the entrepreneurs in this sector have limited avenues to train, improve and scale up their businesses. The current low level of innovation, as opposed to informal entrepreneurial business development, within Africa is probably best illustrated by the comparatively small numbers of scientific publications originating from Africa, as well as the small number of patents being applied for from within Africa, as already discussed. Even where such publications and patents occur, they often originate from a developed country partner in the Americas or Europe, which has paid for the research, and not from an African source. In the development of parts of Asia, we see a similar situation in post-­ war Japan and in China at the end of the twentieth and the early twenty-­ first century, where business development initially focused on low-tech and me-too innovations and entrepreneurship. However, these were transformed in later years into high-technology innovations with strong vocational training for artisans and service providers. These countries, and others in Asia, such as South Korea, India and Singapore achieved this because at the same time as they were developing low-tech manufacturing and service businesses, they were also investing in science and technology to pave the way for globally competitive home-grown high-­ tech innovation and associated entrepreneurship. This latter aspect of investment in science- and technology-driven innovation and entrepreneurship is missing in much of Africa. In the so-called massification process of higher education under way in Africa, many countries continue to increase both the number of universities and the number of graduates emanating from them. What is lacking in most cases, however, are robust career development training opportunities, postgraduate funded research and development (R&D) programs, and the appropriate interface and expertise to bridge academic R&D

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with marketable innovation and associated entrepreneurship. In addition, post-primary and post-secondary vocational training programs are not well developed, and where they exist, they are not properly resourced. This gap is implicitly acknowledged in the Sustainable Development Goals (SDGs), the AU Agenda 2063, and other national and regional strategies. We believe that one avenue to fill these gaps is by scaling up targeted practical education, mentorship and training on innovation, entrepreneurship and digitalization for scientists, innovators, entrepreneurs and businesses as proposed for the IDEA University. Such training should prepare students to be strategic, analytical and creative thinkers, communicators and potential producers of goods and services. At the same time, it should instill confidence and leadership skills that will nurture innovation and an entrepreneurial mindset that supports private sector development and community service.

12.2 Vision and Operational Framework The vision of such university or academy is to sustainably generate knowledge and develop human capital that addresses societal problems and creates jobs. In meeting this vision, it will respond to the critical national, pan-African and global developmental objectives. It will also support African universities and institutions, researchers and innovators in progressing their discoveries from the laboratory to market, and in developing digital learning platforms. The training programs will cover the innovation value and supply chains, business development, intellectual property (IP) and technology transfer management, implementation of contracts and financing, as well as regulatory and ethical processes associated with specific innovations and businesses. IDEA University could be established as a public-private partnered and self-sustaining entity that operates a mixture of virtual online education (open distance and e-learning) and face-to-face training by renowned faculty with diverse backgrounds from different parts of the world. The program can start with continuous professional development certificate programs, vocational certificate training and support services for African

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institutions on innovation, entrepreneurship and digitalization—targeting individuals, leaders, officials and executives from the private and public sectors as well as from informal sector businesses. Once these programs are established and demonstrate success, the overall program can gradually extend to undergraduate and postgraduate programs. IDEA University should emphasize and implement close partnerships with other universities, industry, relevant government and non-governmental entities, and international organizations in the delivery of its programs. Suitable financing modalities, including grants, venture, endowment and impact investments, should be sought and aligned with the institution to support the development and scaling-up of innovations and entrepreneurship programs. The university should provide technical support on technology development, IP, technology transfer, licensing, regulatory and commercialization issues. This office should be equipped with appropriate infrastructure and experts, who can provide consultancy services at subsidized and/or commercial rates as appropriate to individuals, companies, government agencies and other universities across Africa. Any profit generated from the work of the university, including fees, consultancy services, technology transfer and licenses, could be used to offset any loans secured to support its development and be re-channeled into the further development of the university. This will include the establishment of a venture or endowment fund or impact investing vehicles to support the incubation and development of SMEs.

12.3 Additional Supporting Information A discussion paper,3 published by the late Calestus Juma, Professor of Practice of International Development at Harvard Kennedy School, stated: “Africa must create ‘innovation universities’ if it is to achieve economic transformation, sustainable development and inclusive growth” consistent with AU’s agenda 2063. Such universities would need innovative new curricula that address local needs and would serve as innovation hubs.  Calestous Juma (2016) Harvard Kennedy Belfer Center Discussion Paper 2016-01 https://www. belfercenter.org/sites/default/files/files/publication/JumaDP-Education-Africa2.pdf (accessed January 6, 2017).

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The concept of entrepreneurial university was first described in the 1980s by Henry Etzkowitz of State University of New York’s Purchase College.4,5 He noted how entrepreneurial universities can transform traditional teaching and research universities by encouraging interaction among university, industry and government as key to improving the conditions for innovation in a knowledge-based society. Since then there has been a growing global phenomenon whereby universities are gravitating toward innovation and entrepreneurship, with the goal of going beyond their traditional role to incorporate research into innovation, to commercialize knowledge and to promote entrepreneurship.6 There is no continent where this need is greater than in Africa, and presently no such dedicated university or academy exists on the continent. Stanford University in 2015 opened two centers in Africa (in Ghana and Kenya) to offer internship programs to young entrepreneurs as part of its business school. At Harvard University, economic and social entrepreneurship in Africa is one of the fastest-growing areas of interest. In the 2014–2015 academic year, the Center for African Studies consolidated multiple initiatives along with some new ones into its African Entrepreneurship Program. Laudable and important as these initiatives are, they are different from a dedicated African-led University, but they can certainly be helpful in kickstarting the IDEA University concept in Africa. In addition, opportunities exist for collaboration with other universities with practical experience in launching innovation programs and ventures that impact society such as Oxford University and others (https://innovation.ox.ac.uk/wp-content/uploads/2021/06/ OUI_Innovation-Insights-_Issue_Final.pdf ). Combining the study of innovation and entrepreneurship in a higher education setting within Africa as in the proposed IDEA University is novel. It would transform the way potential innovators and entrepreneurs are trained to confront the challenges of Africa in the twenty-first century. The COVID-19 pandemic has reinforced how important this type of education can be, including its strength, in supporting virtual and digital education.  Etzkowitz, H. (1983) Entrepreneurial scientists and entrepreneurial universities in American academic science. Minerva, 21, 198–233. 5  Etzkowitz, H., et  al. (2008) Pathways to the entrepreneurial university: towards a global convergence. Science and Public Policy, 35, 681–695. 6  Musau Z. (2017) Entrepreneurial universities: marrying scholarly research with business acumen http://www.un.org/africarenewal/magazine/special-edition-youth-2017/entrepreneurial-­ universities-­marrying-scholarly-research (accessed January 6, 2017). 4

Appendix A: Examples of Email Exchanges with African Scientists and Institutions That Resulted in Establishment of ANDI

On Thu, Feb 14, 2008 at 11:29 PM, Nwaka, Solomon wrote: Subject: “African Network for Drug Discovery and Innovation”? Dear Colleagues, It has become clear that several drug discovery activities are ongoing in Africa but more efforts are needed to bring groups working in this area together to share lessons, identify challenges and explore a more coordinated approach to product R&D and innovation in Africa. WHO/TDR is working with a number of institutions in Africa as part of our Innovative Drug Discovery efforts for Infectious Tropical Diseases. This effort is based on networks of partners from academia and industry in developed and developing countries and based on the success stories from several participating centers in Africa, it has become important to explore a broader participation of African investigators and institutions in this initiative. This of course includes natural products and traditional medicines-­ based R&D. The TDR drug discovery team is considering a meeting in Africa to discuss ongoing activities supported by TDR and how these can be

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leveraged to establish an “African Network for Drug Discovery and Product Innovation”. I am proposing that the meeting be held in the week of October 6, 2008. I will be visiting the National Institute for Pharmaceutical Research and Development Partnership (NIPRD) at Abuja next week and will discuss the possibility of holding the meeting in Abuja with the Director General of NIPRD. I welcome any suggestions you may have and hope that you would like to participate. We might be able to involve some African leaving abroad and other international organizations if the level of interest for this meeting is high. Best regards, Solomon. Solomon Nwaka. Head, Drug Discovery for Infectious Tropical Diseases, TDR, World Health Organization, Geneva, Switzerland. From: NYASSE BARTHELEMY [mailto:[email protected]] Sent: 18 February 2008 12:03 Subject: “African Network for Drug Discovery and Innovation”? Dear Kelly, Dear Solomon, Solomon’s idea to bring African scientists together in a network for drug discovery and innovation is a wonderful proposition. It is difficult to go against this when considering the level of Africa contribution into drug discovery and development. Our contribution is rather marginal to say the least. Despite the rich biodiversity of Africa, we have failed to produce even simple nutraceuticals of significant commercial advantages, we have also failed to address our people expectations as far as Malaria, TB, AIDS and others diseases are concerned, we have succeeded in putting nice publications in peer reviewed journals and make ourselves known in international scientific meetings. Some of us have gathered nice and wonderful chemicals either through the study of medicinal plants or specially designed chemical syntheses. Some of these compounds are “New Chemical Entities” which will never compete with NCEs known in Drug Discovery.

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Why is it so? What can we do to reverse the situation? Maybe Solomon is opening new vistas where meaningful answers could be found to these realistic questions. Maybe the new network will become the right forum for addressing health problems by providing expected drugs. In order for the new network to let that happen, some points raised by Kelly must be taken into consideration in a business-like manner. We must not overlook examples such AiBST that Collen is struggling hard to put in place and look into some centers of excellence that have received support from TDR over the years, etc. This was just a pretext to acknowledge the receipt of you messages and say how enthusiastic I am about the idea of a network for drug design and innovation in Africa. Bye for now and good take off to ANDI (African Network for Drug Discovery and Innovation) Barthelemy Nyasse From: collen masimirembwa [mailto:[email protected]] Sent: 23 February 2008 10:05 Subject: RE: “African Network for Drug Discovery and Innovation”? Dear Solomon and Colleagues, I am really happy that this proposal is gaining widespread support. There has already been some important inputs from some of you and I think its time to start working on an “innovative” concept of such a meeting in October. Here I was thinking of us organizing the meeting on a “mock” drug discovery program where invitations to this meeting are well targeted to specific aspects of the drug discovery process—from idea, target, hit, lead, clinical trials through to market issues. This will ensure that our deliberations are not short-sighted by over-emphasis on one or a few aspects of this complex process. As alluded to by other colleagues, lets focus the meeting to people who know what they are talking about in these respective areas and are committed to contributing to a team effort that will address drug discovery and innovation issues with its center of gravity in Africa. I was therefore thinking that we can already start thinking of the following: (a) how long the meeting could be: 2, 3 or 5 days? (b) can we start identifying and approaching leading scientists in Africa who fit in the

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various aspects of drug discovery described above? (c) can we start identifying and approaching African scientist in the diasporas as per (b), (d) can we start identifying and approaching other international scientist in academia and industry as per (b)? With such a focused approach we are probably looking at not more than 30–50 delegates. The meeting could then start by outlining the vision and context of this networking, defining specific issues which need to be addressed to ensure success of individual processes and the whole drug discovery plan. This can be followed by break away groups of 5–10 individuals to work on and provide clear thoughts and guidelines on what needs to be done on each process. The groups could then convene and each have someone present their group’s results. After all presentations, discussion on the way forward could collectively be done leading to say the nomination of a Drug Discovery and Innovation Team tasked with the implementation of whatever issues will have been raised or proposed e.g. working on a website at which discourse can continue, information & resources accessed, linking of current drug discovery, & develop projects in Africa together and/or with other international efforts, sourcing and focusing of research funds etc. I am saying this because for us to think things through carefully, we need to start early. This way, the sooner we get delegates for the various aspects of drug discovery and innovation the better. They may be requested to prepare 1–2 page summary papers on the aspects their expertise is specifically being requested for. These could be circulated before the meeting so that by the time we meet, we are warmed up and ready to play the “game” of drug discovery and development. Regards, collen “Nwaka, Solomon” wrote: Thanks Collen for these thoughtful suggestions. I plan to circulate a short document in the coming days that outlines the concept and rationale for this initiative, and initial plan for the meeting in October for input by everyone. The idea of breakout groups at the meeting is great. Here are answers to the specific questions you raised:

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(a) I believe that a 3-day meeting will be fine plus perhaps an extra day for a small group to finalize meeting report and outline of a possible publication (technical and advocacy) that may result from the meeting. (b) Yes, we should start identifying key African experts in the various parts of the process. Kelly also mentioned something along those lines. I envisage that a small organizing committee will be put in place shortly to help with this, but may I request you to take the lead in assembling a list of key African players before a formal organizing committee is put in place. (c) Some of us have already started talking to Africans in Diaspora about this but we want this to be well coordinated. I will talk to Carmelle Norice at Columbia University and colleagues here to figure out how best to coordinate this. (d) Points c and d are linked. I have started talking to a few international organizations about this idea and the October meeting. Will keep you all posted. Regarding the number of participants: about 50 participants sound right, although this will be finalized by the organizing committee. I know that some of you will be here end of March for EDAC meeting—we can use that opportunity to review where we are with planning etc. and to discuss budget. Another point: I had a very good meeting with Dr. Inyang (Director General of the National Institute for Pharmaceutical Research and Development (NIPRD), Abuja Nigeria) last week. He was very happy about the idea of an African Network for Drug Discovery and Innovation and expressed the desire to have NIPRD as a co-sponsor for the meeting in Abuja. Best regards, Solomon. From collen masimirembwa 02/25/08 8:20 PM >>> Dear Colleagues, Following up on Solomon’s response, I am here proposing a simple excel sheet into which we could enter the names of the respective Experts

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in Africa in drug discovery and development. A similar Excel sheet could be made for African scientists in the Diaspora. This will already help use see our strengths and weakness in this ambitious endeavour to discover drugs in Africa, thus guide’s us in our strategy for success at the meeting. I guess we are already working on the networking because I realize that I do not know so many contacts in the different areas and that only our collective input can make us have a reasonable compilation!! So can you please suggest modifications to this way of identifying the experts AND also add the names of the experts whom you know including their e-mails. If we work on this table during this week, we can then have a mailing list that Solomon and the Organizing Committee can use to approach prospective delegates with the proposal/invitation to participate in this meeting. Kind regards collen Dear Kelly, I do agree with your suggestions regarding either target to lead or lead to target while keeping in mind synthetic analogues and naturally occurring compounds. The cross disease expertise could be extended to any medicinal chemist. Here again, I share Kelly’s views. Best regards, Barthelemy Dear All, As promised, please find attached additional background information regarding the proposed African Network for Drug Discovery and Innovation, and the objectives of the proposed meeting in October for your review and input. Please send me any suggestions/correction in track changes by Wednesday this week so that we can finalize the document for internal and broader circulation. We have proposed an organizing committee with an interim Chair in the document. We welcome suggestions as to other possible members of the committee. It will be up to the Organizing Committee to now appoint a Chair. This committee will help to develop a technical program for the meeting in close collaboration with TDR, help with commissioning and delivery of background

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papers on the current landscape of product R&D in Africa. The committee might also recommend participants. We will likely have a local organizing committee in Abuja to help with the logistics of the meeting including accommodation, hotel, transport, meeting rooms and logistics. We will follow up with NIPRD and WHO regional office in Abuja to see how to structure this. Suggestions are welcomed. Please start filling the spreadsheet from Collen. I will talk to Carmelle to see how best to proceed with African Diaspora. Best regards, Solomon. Note that we also reached out to some African Scientists in the Diaspora and received overwhelming positive feedback.



Appendix B: Report of the External Review of ANDI in October 2012 and Response of the ANDI Board

The Executive summary of the report of the external review commissioned by the ANDI Board to review the work of ANDI from inception till the end 2012 is presented with the response of the ANDI Board. The Board authorized the public release of the document including through the ANDI website.

Executive Summary Background The African Network for Drugs and Diagnostics Innovation (ANDI) was established to promote & sustain African-led health research and development (R&D) and innovation by building capacity, developing infrastructure, promoting collaborative efforts and delivering affordable new tools including natural products and traditional medicines. ANDI has the overarching goal of linking health innovation to development by sustaining local R&D and market access to diagnostics, drugs, vaccines and other health products in Africa. Launched in late 2008 and incubated in the World Health Organization’s (WHO) special programme for Research © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021 S. Nwaka, Social and Technological Innovation in Africa, https://doi.org/10.1007/978-981-16-0155-2

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and Training in Tropical Diseases (TDR), ANDI is now hosted by the United Nations Economic Commission for Africa (ECA) in Addis Ababa, Ethiopia. Under the terms of the EU Contribution Agreement “PP_ AP/2009/220-143 Support to regional Networks for Health Product R&D Innovation in Africa Asia and Latin America”, a committee of four experts was commissioned to carry out an external review of ANDI.

The Terms of Reference and the Review Process The Review Team was given the task of assessing the structure and function of ANDI, reviewing how ANDI is moving forward towards the achievement of its mission, vision, goals, and highlighting its effectiveness and achievements to date in the context of its transition to Africa. The Team studied ANDI outputs and related documents; and interviewed ANDI staff, some members of the Board, the Scientific and Technical Advisory Committee (STAC), pan-African Centres of Excellence (CoE), current and potential funding partners and other key stakeholders in the health sector in Africa and beyond. The Review was carried out between July and October 2012.

Key Findings The ANDI mission and vision received enthusiastic approval and commendation from stakeholders interviewed. For example, Fig. B.1 shows level of satisfaction with process of selection of CoE among the respondents who included researchers, policy makers, donors and health professionals, who commended the relevance and timeliness of ANDI for harnessing the competencies of the continent towards priority-driven health agenda-setting, product R&D and innovation. The ANDI Strategic Business Plan, drawn up in 2009 by the ANDI Task Force was seen as having been well planned and innovative, though acknowledged as being ambitious when seen in the context of today’s financial climate.

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Fig. B.1  Level of agreement with selection of CoE

The genuine interest, enthusiasm and commitment of the African scientific and political community are yet to translate into the level of financial support anticipated in the original business plan. However, despite being seriously under-resourced and understaffed, significant progress has been achieved in the organisation and implementation of the ANDI framework. Most of the key performance indicators for both the EU and strategic business plan have been completed or are in progress. ANDI now has its basic infrastructure in place: a core Secretariat hosted by an African-based organization, 38 CoE, operating procedures for its Board and STAC and is in the process of setting up Regional Hubs, with the West African Hub agreement with Nigeria now finalized. Two projects addressing specific African health needs have been selected for funding with funding already disbursed for one, while final contractual discussions were taking place for the other during the time of this Review. The Review Committee found the products of these two projects would be the kind of “low-­ hanging fruits” that ANDI should focus on in the short term. In addition, we were informed by the Secretariat that targeted project-driven training and fellowship programmes were being finalised with CoE.

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The Review Committee learned that some African investigators and institutions have already leveraged new funding and partnerships due to the ANDI Centre of Excellence label. The fora provided by the ANDI stakeholders meetings were given as examples of the positive impact on scientific collaborations across Africa by some informants. These meetings also served as fora to recognise excellence through the presentation of Innovation Awards to deserving African scientists. In future, these stakeholder meetings could be restructured to include detailed discussions of results from ANDI-funded projects and workshops on cross-­ cutting issues. The funding from the EU grant has been critical in enabling establishment of the framework and basic infrastructure for ANDI. The Review Committee hopes that the EU will continue its support in order to allow ANDI to expedite implementing its mission and leverage other funding opportunities.

Key Recommendations Based on the Review findings, a SWOT analysis and in line with the ToR, the Review Committee makes the following recommendations:

The Mission, Vision and Unique Features of ANDI The ANDI vision, operating model and its niche within the health research and innovation arena are key unique features and selling points. The Business Plan clearly sets out the intention to have synergies and complementarities with other African initiatives working on improving access to health products. We recommend the following: • The ANDI Secretariat should leverage the organization’s unique features to ensure effective advocacy and resource mobilization. • Mechanisms for operationalisation of strategic partnerships need to be explored directly by the ANDI Secretariat and Regional Hubs, which would be implemented by its CoE.

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• Collaborations should be aimed at achieving synergy and efficiency, especially given the backdrop of resource constraints. • ANDI should maintain and build on its relationship with the WHO, in particular TDR and PHI as well as the AFRO and EMRO regional offices as there are synergies and complementarities to be gained. • The ANDI mission is widely commended but given that it is four years since the initiative started, and taking cognisance of the funding challenges, it is recommended that options for strategic prioritization should be explored.

Governance High-level advice and policy oversight is provided to ANDI by the Board which comprises representation from each of the 5 sub-regions of Africa, leading health experts, a representative from the African Diaspora, and key institutional partners—ECA, WHO and the African Development Bank (AfDB). • We recommend that ANDI consider broadening the profile of Board membership and other organs such as the Executive Committee and the Resource Mobilisation Committee by co-opting individuals with expertise in business, entrepreneurship, strategy, finance and communication. • We recommend in addition that a more effective executive steering group or task force work closely with the ANDI Secretariat to provide support and guidance. • We consider that the Board would be more effective with a single chair and that the high-level patronage of ANDI by government ministers be translated into a form of ambassadorial representation which is distinct and separate from the role of the Board. Such an Ambassadorial Board could meet during the annual or bi-annual ANDI stakeholder’s meetings. • The STAC was found to be fulfilling its purpose through diligently providing scientific and technical guidance in the selection and operationalisation of CoEs, Regional Hubs and projects. ANDI should be

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mindful of striking a more balanced gender representation and also consider broadening the STAC to include members with a wider range of expertise in order to ensure continued high-quality scientific oversight and strategic technical direction as projects are rolled out.

Secretariat and Transition to ECA The MOU between WHO and ECA was signed in October 2010 and ANDI Secretariat staff moved to Addis early in 2011. However, the transition was made difficult due to the TDR financial situation, and some administrative challenges at ECA. We recommend the following: • That the appointments of an ANDI Director and Secretariat staff with the required skills profile and diversity need to be finalized urgently as these are key to the future progress of ANDI. • ANDI should also explore avenues for secondment of staff from its partner organizations in and outside of Africa, for example programmes such as the GSK Pulse, Pfizer fellows, Roche employee programme and others which allow their employees to be seconded to provide their expertise to non-profit/development organisations. • Procedures for managing and institutionalising relationships with the various partners also need to be put in place as the initiative grows, in order to ensure continuity and relevance.

Scientific and Technical Components Expectations on, and from, the CoE are very high and the challenge now is for ANDI to ensure CoE are fully operationalised. Framework documents on CoE and how they will operate, and other information on the CoE should be shared with stakeholders and disseminated as part of operationalising the institutional model and bridging information gaps. Regional Hubs are well articulated in the Business Plan. All respondents and the Review Committee agree that Regional Hubs once

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established, should further enhance implementation of ANDI activities, communication and outputs and thus have added value. The agreement for the establishment of the West African hub in Nigeria is timely and motivational for ANDI. Lessons from the process of securing this Hub should be documented and used in progressing efforts in the other regions.

The Business and Finance Model Financial sustainability requires a business model that is not solely dependent on continuous donor support. We underscore that while the international donor community expressed enthusiasm for the ANDI mission and vision, they emphasized the need for more focus and prioritization of activities. We make the following suggestions: • In the short term, a creative and strategic approach to traditional bilateral donors, non-traditional donors (such as Korea, China, Kuwait Fund, Abu Dhabi Fund,), foundations and the private sector in both Africa and beyond needs to be developed and implemented. This is where packaging of specific issues in the Strategic Business Plan will be helpful. • Short-term funding should be used to achieve a balance between ensuring stability of the Secretariat and demonstrating capability of the initiative through early successes with projects such as the two projects currently being implemented with support from ANDI. • The medium and long term should focus on raising funds to build on early successes, to support more and longer-term projects and enhancing capacities of the CoE and Regional Hubs. Delivery through the CoE-Hubs-Projects approach should be at the core of ANDI’s work so that it maintains its uniqueness. • Also, in the medium to long term, feasibility of other innovative financing models needs to be investigated. These models may include: membership subscription (by countries and also the pharmaceutical industry for use of the ANDI framework and business development

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service); innovative funding from the private sector (e.g. a few cents from each call from mobile phone operators; or health levies for the extractive industries); income from profit-driven/marketable products of ANDI activities. • In the long term, ANDI needs predictable, sustainable funding. Over the long-term, sustainable funding particularly for the CoE and Regional Hubs can be envisaged through the inclusion of a committed budget line for ANDI by African Governments. The ECA can play a supportive role in policy setting through the joint meetings of the AU Ministers of Finance and Health.

Support for ANDI in Africa There is high-level political support for the ANDI vision in Africa, which raises optimism that this support will translate into funding in the future. We note that ANDI addresses a continental objective and occupies a niche that appears to be unoccupied by other initiatives in Africa yet, thus providing an enormous advantage when it comes to seeking resources. ANDI must exploit this competitive advantage. The recent commitment from Nigeria to ANDI through the hosting of the West African Regional Hub of ANDI confirms this support, and should be leveraged to seek support for other Regional Hubs and the broader mission.

Communication On communication, we make the following observations and recommendations for follow up by ANDI. • Although the ANDI brand is loyally supported by its stakeholders, it is largely unknown beyond this group. A communication strategy that clearly articulates what ANDI is needs to be developed and implemented.

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• Attention needs to be given to improving information exchange in order to manage expectations of stakeholders, particularly CoE.  We advise the Secretariat to work more closely and communicate more with the Board to ensure more effective support and guidance from the Board. • A strategy for managing external relations with potential donors, new stakeholders and partners should be developed. Building relationships and exploring mutual interests e.g. through one-to-one meetings with the donor community will be important.

Conclusions The Review Committee notes that while ANDI is still in its infancy, and is currently under-resourced and understaffed, considerable progress has been achieved in development of the ANDI framework and the implementation of the Strategic Business Plan, and the objectives of the EU contribution agreement. A functional ANDI organisational structure is now in place consisting of the Board and a number of its sub-­committees, the STAC, an interim ANDI Secretariat, 38 CoE, one Regional Hub (West Africa) and two funded projects.

Response of the Board to the Report of the 2012 External Review of ANDI: 3rd ANDI Board Meeting, Addis Ababa, Ethiopia The Board acknowledges receipt of the report submitted by the External Review Panel and appreciates the report. The Board further commends the team for a job well done. Pursuant to the recommendation of the Executive Committee of the Board (ECB) and follow up discussions of the Board, the Board approves the report subject to the following: 1. That the Executive Summary of the report be posted on the ANDI Website along with this document, which summarizes the Board’s response to the recommendations of the review panel. This is important because, while the Board agrees with most of the r­ ecommendations,

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it seeks to clarify a few of the points raised in the recommendations of the panel by issuing the following responses thereto:









(a) On the recommendation requesting the revision and updating of the strategic business plan of ANDI, the Board feels that the strategic business plan of ANDI and indeed any business plan should be seen as a living document. The strategic business plan of ANDI which was developed in 2009 provided the rationale for the work of ANDI to date. The Board has agreed that rather than revising the plan in an ad hoc manner, an updated strategic business plan be prepared in 2014 for the next five years (2015–2020) to reflect the second phase of the work of ANDI, and recommendation of the panel. (b) On the question of hosting of ANDI at UNECA, the Board agrees that the recommendations on the hosting of ANDI at UNECA have been taken care of with the new hosting arrangement being finalized for ANDI. (c) On the recommendations regarding the ANDI Board and governance of ANDI, the Board is working with the ANDI Secretariat to develop options for the optimal functioning of the Board and the governance structure of ANDI. This document will consider lessons learned to date and the recommendation of the review panel with the goal of addressing the issue of the optimal composition of the Board, co-Chairs of the Board as well as a revision of the Board Operating Procedures. (d) On the recommendation to expand STAC, the preference of the Board is to carefully analyze the skills set required for the optimal operation of STAC, as a guide to the expansion of its membership. The Board has therefore requested the ANDI Secretariat, to work with STAC to implement this analysis and make recommendations to the Board on the enhancement of the current membership of STAC. (e) On the recommendation requesting ANDI to reach out to programmes such as GSK Pulse, Pfizer fellows, Roche employees programme and other similar programmes for possible staff to be seconded and to support the work of ANDI: The Board agrees

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that it is better for ANDI to reach out to as many constituencies as possible for support as needed, rather than just the ones mentioned in the recommendation. To ensure transparency, ANDI could place an announcement on its website to solicit organisations willing to help in specific areas. 2. Finally, the Board further requests the ANDI Secretariat to work expeditiously, where appropriate, with STAC, in developing a framework and initiate the implementation of the External Review recommendations that have been approved by the Board.



Appendix C: External Initiatives Coordinating R&D and Innovation

We present non-African headquartered product development partnerships and initiatives that address products for diseases that are predominant in developing countries and COVID-19 as well as those that support capacity building with a focus on health and science, technology and innovation. These organizations are largely not-for-profits, most of them operate virtually. They depend on the laboratories and infrastucture of their partners, and they use public, private or philanthropic funds to incentivize companies and public institutions to address R&D, innovation and access to products. Some of them address capacity building in developing countries but most do not. They are stakeholders-driven and the type of contracts that they enter into with partners highlights the delivery of resultant product(s) at cost or at minimal profits. Some of the resultant products are delivered through procurement processes. Though they support the discovery, development and delivery of high-tech products, their mode of operation is consistent with social innovation. We summarize some of the organizations below.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021 S. Nwaka, Social and Technological Innovation in Africa, https://doi.org/10.1007/978-981-16-0155-2

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Medicines for Malaria Venture (MMV) MMV is a product development partnership focusing on antimalarial drug discovery, development and delivery (https://www.mmv.org/). It was established in 1999 as a Swiss foundation. Like other product development partnerships, it is a “virtual R&D” organization. Its vision is a world in which these innovative medicines will cure and protect the vulnerable and under-served populations at risk of malaria and help to ultimately eradicate this terrible disease. Stakeholders and donors include project partners from academia, public and private R&D institutions, malaria endemic countries and the organization’s donors, that is, government agencies, private foundations, international organizations and corporations. Initiatives and projects include a portfolio of over 30 projects spread across various stages of research, preclinical and clinical development, and regulatory review. The organization has registered about ten antimalarial drugs largely based on re-formulation of existing products or combination of existing products with its partners. MMV is also promoting COVID-19 drug screening by providing as part of its pathogen box a COVID box of select compounds with known or predicted activity against coronavirus.

1.1 D  rugs for Neglected Diseases Initiative (DNDi), and the Global Antibiotics Research and Development Partnership (GARDP) DNDi is a virtual R&D organization focusing on neglected diseases, founded in 2003 (https://www.dndi.org/). Its mission is to develop new drugs or new formulations of existing drugs for people living with neglected diseases. Its vision is to improve the quality of life and the health of people suffering from neglected diseases

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by using an alternative model to develop drugs for these diseases and by ensuring equitable access to new and field-relevant health tools. Stakeholders and donors include its seven founding partners, disease-­ endemic countries, project partners and donors. Initiatives and projects include a portfolio of over 30 projects spread across various stages of research, preclinical and clinical development, and regulatory review. It has registered 11 drugs for neglected diseases largely based on re-formulation of existing products or combination of existing products with its partners. It has also established a viral initiative and support for clinical trials for COVID-19. DNDi has incubated and helped to develop GARDP—the Global Antibiotics Research and Development Partnership, which is now an independent Swiss Foundation (https://gardp.org/). GARDP was started in 2016 as a joint initiative by the World Health Organization (WHO) and DNDi, and supported by various donors. Its mission is to develop new antibiotic treatments addressing antimicrobial resistance and to promote their responsible use for optimal conservation, while ensuring equitable access for all in need.

 DCTP—European Developing Countries E Clinical Trial Partnership EDCTP is a public-public partnership between countries in sub-Saharan Africa and the European Union (http://www.edctp.org/). It is headquartered in The Hague, with an African office in Cape Town. Stakeholders and donors include African and European countries and institutions. It is largely funded by the European Union. It aims to support collaborative research that accelerates the clinical development of new or improved interventions to prevent or treat HIV/ AIDS, tuberculosis, malaria and neglected infectious diseases in sub-­ Saharan Africa. Initiatives and projects include many clinical trials, capacity-building and networking projects as well as fellowships, scholarships, ethics, regulatory and networks of excellence, and other projects in Africa. It has provided some emergency research support for COVID-19.

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F oundation for Innovative New Diagnostics (FIND) FIND enables the development and delivery of much-needed diagnostic tests for poverty-related diseases. It was founded in 2003 and is registered as a Swiss foundation (https://www.finddx.org/). Its mission is “turning complex diagnostic challenges into simple solutions to overcome diseases of poverty and transform lives.” Its vision is “a world where diagnosis guides the way to health for all people.” Stakeholders and donors include project partners, disease-endemic countries and the organization’s donors, that is, government agencies, foundations and private contribution. Initiatives and projects include the delivery of about 21 diagnostic tools. FIND creates an enabling environment for others through the provision of specimen banks, reagent development and better market visibility. It supports the appropriate use of diagnostics in countries through training, quality assurance and laboratory-strengthening work. FIND is an important partner of the global Access to COVID-19 Tools (ACT) Accelerator (discussed further below), advancing research, development and access to new diagnostics.

 ATH (formerly known as Program P for Appropriate Technology in Health) PATH was launched in 1977 as a non-profit that would deliver the expertise, resources and innovations of the private industry to improve health for all (www.path.org). Today it has about 1600 employees in more than 70+ offices around the world. It specializes in developing, introducing and scaling up solutions to the world’s most pressing health challenges. It is headquartered in Seattle. Stakeholders and donors include project partners, the countries where PATH works and donors, that is, governments, foundations, private sector and so on.

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Initiatives and projects cover vaccines, drugs, devices and diagnostics, digital health, advocacy and policy. It is supporting some COVID-19 initiative.

 NICEF/UNDP/World Bank/WHO Special U Programme for Research and Training in Tropical Diseases (TDR) TDR is a global program of scientific collaboration that helps facilitate, support and influence efforts to combat diseases of poverty (https://www. who.int/tdr/about/en/). It is hosted at the World Health Organization (WHO) and co-sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and WHO. Its legacy began with the agreement at the World Health Assembly in May 1974 to set up the program. Since then, TDR has provided the most vulnerable communities in the world with new prevention strategies, treatments and approaches. It has also significantly strengthened research capacity in those countries. Over the years, TDR has provided research evidence for five major elimination campaigns for neglected diseases and has been part of the development of 12 new drugs. It helped to establish the effectiveness of insecticide-treated bednets and artemisinin combination therapy. It has trained thousands of researchers in low- and middle-income countries. It helped to create product development partnerships like MMV and DNDi, and regional innovation networks and ANDI. Its mission is to “support effective and innovative global health research, through strengthening the research capacity of disease-affected countries, and promoting the translation of evidence into interventions that reduce the burden of infectious diseases and build resilience in the most vulnerable populations.” Its vision is “the health and well-being of people burdened by infectious diseases of poverty is improved through research and innovation.” Stakeholders and donors include project partners, disease-endemic countries and donors, that is, governments and foundations.

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Grand Challenges Initiatives Grand Challenges are a family of initiatives fostering innovation to solve key global health and development problems (https://grandchallenges.org). Launched in 2003 by the Bill & Melinda Gates Foundation as Grand Challenges in Global Health, this initiative initially focused on 14 major scientific challenges that, if solved, could lead to key advances in preventing, treating and curing diseases of the developing world. It was re-­ launched in 2014 as Grand Challenges, its new name reflecting its expanded scope encompassing challenges in global development. A number of other Grand Challenges in operation around the world include: Grand Challenges Canada, which was launched in 2010; Grand Challenges for Development, which was launched in 2011 by the US Agency for International Development (USAID); and Grand Challenges South Africa, which was launched in 2011. Grand Challenges Africa, which was launched in 2015 with the support of the Wellcome Trust, the Bill & Melinda Gates Foundation and the UK’s Department for International Development (DFID). Some other countries are also engaged in the Grand Challenges.

CEPI—Coalition for Epidemics Preparedness Innovation CEPI is an innovative global partnership between public, private, philanthropic and civil society organisations launched in Davos in 2017 to develop vaccines to stop future epidemics (https://cepi.net/about/ whyweexist/). Its mission is to accelerate the development of vaccines against emerging infectious diseases and enable equitable access to these vaccines for people during outbreaks. CEPI has been at the forefront of vaccine development for COVID-19 and initiated major partnerships to that effect. It is a major partner of WHO and GAVI in the COVAX Facility (see Chap. 11 and next section

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of this Appendix). CEPI recently signed an agreement with the African CDC to support research and manufacturing of COVID-19 vaccines. CEPI’s other priority diseases included Ebola virus, Lassa virus, Middle East Respiratory Syndrome coronavirus, Nipah virus, Rift Valley Fever and Chikungunya virus. It also invests in platform technologies that can be used for rapid vaccine and immunoprophylactic development against unknown pathogens.

COVID-19 Therapeutics Initiatives There are a number of new and emerging initiatives or projects that seek to address the needs for COVID-19 therapeutics. We summarize some of them below: CTA—COVID-19 Therapeutics Accelerator is a new collaborative effort to research, develop and bring effective treatments to market quickly and accessibly (https://www.therapeuticsaccelerator.org/). It is a philanthropic initiative designed to coordinate R&D efforts, remove barriers to drug development and scale up treatments to address the pandemic. It serves as: (i) a global coordinated effort—working with the World Health Organization, the research community, governments, private sector organizations and global regulators to accelerate drug development, (ii) end-to-end approach—addressing drug pipeline development through manufacturing and scale-up; (iii) fast and flexible funding—provides funding at all stages of the process; (iv) equitable access—it puts equity at the core of its approach. CARE—Corona Accelerated R&D in Europe consortium, supported by Europe’s Innovative Medicines Initiative (IMI). It focuse on understanding the disease, development of therapies for it and future coronavirus threats. It also addresses immediate efforts to repurpose existing therapies for the disease. CARE is funded by grants from the European Union (EU) as well as from cash and in-kind contributions from 11 European Federation of Pharmaceutical Industries and Associations (EFPIA) companies and three IMI-associated partners. It is a five-year project bringing together

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37 partners from Belgium, China, Denmark, France, Germany, the Netherlands, Poland, Spain, Switzerland, the United Kingdom and the United States, and is led by the French National Institute of Health and Medical Research (Paris), Janssen Pharmaceuticals in Belgium (subsidiary of Johnson & Johnson) and Takeda Pharmaceuticals International AG (Zurich, Switzerland).

 nited Nations-Linked Science U and Innovation Initiatives A number of new initiatives that are linked to the SDGs have already been mentioned in the book. They include the Technology Bank for least developed countries (LDCs), located in Gebze, Turkey (http://unohrlls. org/technologybank/), and the global Technology Facilitation Mechanism (https://sustainabledevelopment.un.org/tfm). The 2030 Agenda for Sustainable Development launched a “Technology Facilitation Mechanism” (TFM) to support the implementation of the Sustainable Development Goals (SDGs). It facilitates multi-stakeholder collaboration and partnerships through the sharing of information, experiences, best practices and policy advice among member states, the civil society, the private sector, the scientific community, United Nations entities and other stakeholders. In 2019, the World Health Organization established a Science Division with the mandate to harness the power of science and innovation to improve global health and deliver impact at country level (https://www. who.int/departments/science-­division). The division produces cutting-­ edge research for health, conducts quality assurance for norms and standards, and leverages digital technologies to improve health outcomes. It oversees some of the hosted research partnerships such as the Special Programme for Research and Training in Tropical Diseases (TDR) and the Alliance for Health Policy and Systems Research. It also hosts an innovation hub incubator. As part of the response to COVID-19, WHO and partners launched the Access to COVID Tools (ACT) Accelerator (https://www.who.int/

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initiatives/act-­accelerator) to facilitate access to COVID-19 interventions equitably. Launched at the end of April 2020, the ACT Accelerator brings together governments, scientists, businesses, the civil society, philanthropists and global health organizations (the Bill & Melinda Gates Foundation, CEPI, FIND, GAVI, The Global Fund, UNITAID, Wellcome Trust, the WHO, World Bank and Global Financing Facility) to speed up an end to the pandemic by supporting the development and equitable distribution of the tests, treatments and vaccines the world needs to control the disease and bring normalcy to the world.



Appendix D: African Initiatives Coordinating R&D and Innovation

The ANDI’s portfolio of projects and initiatives have been discussed elsewhere in the book, so those will not be repeated here. ANDI’s mission is to promote and sustain African-led health innovation to address the continent’s health needs through the assembly of collaborative networks and the building of capacity to support public health and economic development. Its vision is to create a sustainable platform for health innovation in Africa to address the health challenges of the continent and populations in need. An unforeseen “mistake” that was made in the early days of developing ANDI was to believe that viable product-based R&D projects supported under the platform in Africa could get enough resources that they need to meet their translational research and infrastructural needs. ANDI proposed up to USD 1 million per project (annually or bi-annually) depending on the project, its stage and needs. While those projections outlined in the 2009 business plan remain valid and reflect the needs, they did not reflect the financing realities on the ground in Africa, especially if significant funding is expected to come from within the continent. ANDI probably underestimated the challenges associated with financing panAfrican product innovation through African national governments and © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021 S. Nwaka, Social and Technological Innovation in Africa, https://doi.org/10.1007/978-981-16-0155-2

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grants as well as the appetite of external partners to invest in this area of work on the continent at the time.

 UDA-NEPAD: AU Development Agency-­New A Partnership for African Development The AUDA-NEPAD, previously called NEPAD (http://www.nepad. org/), is a socio-economic development flagship program of the African Union (AU), adopted by African leaders at the 37th Summit of the Organization of African Unity (OAU) held in Lusaka, Zambia, in July 2001. As part of a global reform to improve AU’s impact and operational efficiency, the 31st Ordinary Session of the Assembly of the Heads of State and Government held in Nouakchott, Mauritania, in June 2018 transformed the NEPAD Planning and Coordination Agency into the African Union Development Agency—NEPAD (AUDA-NEPAD). The Agency focuses on six broad areas of work, with the mandate to: (a) coordinate and execute priority regional and continental projects to promote regional integration toward the accelerated realization of Agenda 2063; and (b) strengthen capacity of AU member states and regional bodies, advance knowledge-based advisory support, undertake the full range of resource mobilization and service as the continent’s technical interface with all of Africa’s development stakeholders and development partners. Over the years, AUDA-NEPAD’s Industrialization, Health, and Science, Technology and Innovation programs have done a lot to support the continent through various initiatives, partnerships and policy briefs. Key stakeholders and donors include the African Union and governments, development partners, foundations and others. The organization’s mission is to address the critical challenges of poverty, development and Africa’s marginalization internationally. Initiatives and projects related to STI and health include: (i) African Biosafety Network for Expertise (ABNE); (ii) African Institute for Mathematical Science (AIMS—Next Einstein Initiative); (iii) African Medicines Regulatory Harmonization (AMRH), which is supporting the

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creation of the African Medicines Agency (AMA); (iv) African Science Technology and Innovation Indicators (ASTII); (v) Alliance for Accelerating Excellence in Science in Africa (AESA); (vi) Biosciences Eastern and Central Africa at the International Livestock Research Institute; (vii) African Health Research Strategy and so on. Also, through other NEPAD departments, work is ongoing in the following areas: Comprehensive Africa Agriculture Development Programme (CAADP), Africa Power Vision, Infrastructure Skills for Africa, Agriculture Technical Vocational Education and Training (ATVET) and others.

 frican Academy of Sciences (AAS) A and Its Initiatives The AAS is a not-for-profit pan-African organization. Its tripartite mandate is recognizing excellence through the AAS fellowship and award schemes; providing advisory and think-tank functions for shaping Africa’s Science, Technology and Innovation (STI) strategies and policies; and implementing key STI programs addressing Africa’s developmental challenges (https://aasciences.ac.ke). Its vision is to see transformed lives on the African continent through science. Stakeholders and donors include the fellows of the Academy, African scientists and those in the Diaspora, and non-African scientists—supported through contributions of fellows and development partners. Later, a substantial contribution from Nigeria through former President of Nigeria—Olusegun Obasanjo—helped the AAS establish an endowment fund and acquire a property, where it is located in Kenya. This is an example of the power of substantial flexible funding to an African organization. Prior to this funding, AAS struggled with funding. Recent donors for the research and fellowship programs include Foreign, Commonwealth & Development Office (FCDO), Gates Foundation (through the Grand Challenges Africa and NEPAD as partners), Wellcome Trust (through DELTAS and H3Africa projects) and others.

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Initiatives and projects include the recognition of African fellows and honorary fellows who are proven STI leaders, policy advisors and thinkers, most of whom live and work within and outside of the continent. In addition to the AAS fellows, there are many recognized AAS affiliates, who are early-career researchers with the promise to become world-class researchers. The AAS has three platforms that support STI agenda-setting and funding, publishing, and research and innovation: 1. The Alliance for Accelerating Excellence in Science in Africa (AESA) is an initiative of AAS and AUDA-NEPAD in partnership with the Wellcome Trust and Bill & Melinda Gates Foundation who provide funding. AESA’s mission is to catalyze investments, strategies and programs that promote the brightest minds in Africa, foster scientific excellence, inspire research leadership and accelerate innovation in ways that will improve lives and shift the center of gravity for research in Africa to Africa. 2. The AAS Open Research is an innovative publishing platform powered by F1000, offering immediate publication and open peer review for researchers supported by the AAS and programs supported through the agenda-setting and funding platform AESA. 3. The Coalition for African Research and Innovation (CARI) is a platform, to place research and innovation at the forefront of Africa’s drive to achieve the SDGs by accelerating a wide range of scientific breakthroughs in Africa that will help more Africans lead better lives sooner. CARI is promoted by AAS through funding from the Gates Foundation and Wellcome Trust and support from the US NIH. A study commissioned by the Wellcome Trust and US NIH addressed AESA and CARI.1 It was recently reported that AAS is undergoing some administrative and governance challenges, and the hope is that these challenges will be overcome. (https://www.researchprofessionalnews.com/ rr-news-africa-pan-african-2021-5-major-rift-at-aas-as-auditorsprobe-finances/).  Simpkin V, Namubiru-Mwaura E, Clarke L, et al. (2019) Investing in health R&D: where we are, what limits us, and how to make progress in Africa. BMJ Global Health, 4: e001047. https://doi. org/10.1136/bmjgh-2018-001047. 1

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F APMA—Federation of African Pharmaceutical Manufacturers Association FAPMA is a federation of regional pharmaceutical associations committed to the development of Africa-based pharmaceutical manufacturers (https://www.fapma.org/). FAPMA was officially inaugurated and launched in 2013 in Addis Ababa. Its mission is to facilitate collaboration between regional pharmaceutical manufacturing associations to address the common challenges faced by the industry and enhance opportunities toward self-sufficiency. Its vision is the development of a vibrant and self-sustaining pharmaceutical manufacturing industry in Africa by providing quality and affordable medicines so as to contribute to the reduction of disease burden and promote economic development of the continent. Stakeholders and donors include the African pharmaceutical industry. Initiatives and projects include: (i) proactively advocating for an enabling environment for the growth of the local production in Africa through policy changes and time-limited incentives, (ii) promotion of higher good manufacturing practices and efficiencies in production, (iii) contributing to and facilitating knowledge and skills development and technology transfer, (iv) contributing toward the realization of the regulatory harmonization vision in Africa, (v) supporting the development of partnerships or business linkage platforms for access to markets, funding and technology, and (vi) supporting and strengthening regional manufacturing associations.

Other Initiatives Within the African Union (AU) Finally, it is important to mention that there are several other relevant initiatives within the various departments of the AU such as the Human Resources, Science and Technology, and the Social Affairs departments. The AU and AUDA-NEPAD house the Pharmaceutical Plan for Africa initiative PMPA initiative, which have been discussed in different parts of this book. The Africa Centre for Disease Control and Prevention

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(Africa CDC), which has been at the forefront of the COVID-19 pandemic, has been mentioned in Chaps. 8 and 11. Africa CDC is a specialized technical institution of the African Union established to support public health initiatives of Member States and strengthen the capacity of their public health institutions to detect, prevent, control and respond quickly and effectively to disease threats. It has mobilized research expertise for SARS-CoV-2 genome sequencing as well as the recent high-level vaccine conference on COVID-19 manufacturing in Africa (Chap. 8). The Human Resources, Science and Technology department have a number of excellent initiatives such as the STISA strategy, which we have already discussed. They have also implemented the Pan-­African University within existing universities in different countries and regions of Africa.2 This university is a step in the right direction, as it drives home the concept of African integration. AU is also launching a pan-Africa Virtual University to support open distance and e-learning education.3 It also implements the Kwame Nkrumah Award for scientific excellence4 and other fellowships. It is understood that this Award is still implemented with funding from the European Commission. Perhaps an African country, example, Ghana should complement the funding for the Award. A final note, as someone who has worked in different developed countries and in Africa, it is one thing to support or direct research and innovation in Africa from Geneva, New York or London, but it is a different thing to do it from within the continent. Everyone involved in supporting research and innovation in developing countries should endeavor to understand the circumstances on the ground before making decisions that may not be aligned with facts on the ground. Therefore, bravo to all the African institutions and scientists doing great work despite the immense challenges and misunderstandings.

 https://edu-au.org/agencies/pau.  https://thepienews.com/news/pan-african-university-to-have-an-odel-wing/. 4  https://au.int/en/announcements/20180611/african-union-kwame-nkrumah-awards-scientificexcellence-auknase-continental. 2 3

Index1

A

Academy, ix, 151, 155, 157 Access to COVID-19 Tools Accelerator (ACT Accelerator), 143, 182, 186, 187 Active pharmaceutical ingredient (API), 113, 115–117 Adaption, ix, 124 Adoption, ix, 124 Advance market commitment (AMC), 143 Advocacy, 151, 163, 170, 183 Africa, vii–ix, 1, 3–9, 11–24, 27–34, 37, 41, 42, 44–50, 52–56, 59–63, 65–73, 75–79, 81, 85, 87–97, 101–107, 109–119, 122–127, 129–135, 137–152, 154, 156, 157, 167, 168, 170–174, 181, 189–194

Africa CDC, 119, 193–194 African Academy of Science (AAS), 42, 62, 75, 151, 191–192 African Continental Free Trade Area (AfCFTA), 34, 57, 110 African COVID-19 Vaccine Financing Initiative (ACOVFINI), 145 African Development Bank (AfDB), 39, 40, 42, 46, 47, 52, 54, 74, 77, 78, 84, 85, 145, 171 African Diaspora, vii, ix, xiv, 42, 129–135, 165, 171 African Export and Import Bank (AFREXIM bank), 77, 78, 145 African-led, 1–24, 28, 29, 50, 150, 157, 167, 189 African Medical Supplies Platform (AMSP), 146

 Note: Page numbers followed by ‘n’ refer to notes.

1

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021 S. Nwaka, Social and Technological Innovation in Africa, https://doi.org/10.1007/978-981-16-0155-2

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196 Index

African Ministerial Conference on Science and Technology (AMCOST), 41 African Network for Drugs and Diagnostics Innovation (ANDI), vii, 9, 13, 14, 24, 28, 35–57, 60, 62, 63, 71, 72, 74, 76, 79, 84–86, 102–104, 117, 118, 122, 125–127, 134, 150, 151, 167–177, 183, 189 African Union (AU), x, 2–4, 7, 42, 43, 73, 75, 96, 130–132, 145, 146, 151, 152, 174, 190–191, 193–194 African Union Development Agency (AUDA-NEPAD), 2, 3, 42, 49, 75, 91, 190–192 Agenda 2063, x, 4–6, 61, 151, 155, 156, 190 Agriculture, xiv, 2, 70, 78, 81, 85, 90, 123 Agritech, 89 Alibaba, 88 Artificial intelligence (AI), 96 Aspen Pharmacare South Africa, 69, 144 AstraZeneca, 144 AU Agenda 2063, x, 5, 61, 151, 155, 156 Author, vii, ix, 15, 22, 28, 35, 37, 40, 72, 77, 95, 132, 142 B

Basic research, 25, 33, 60, 150 Bilateral, 2, 131, 173 Bill and Melinda Gates Foundation, 79

Biodiversity, 1, 83, 83n2, 84n8, 85, 85n9, 124, 125, 160 Bioinformatics, 17, 20, 90 BioNtec, 144 Biotechnology, vii, 24, 80, 89–91, 94, 96, 103–105, 132, 133, 144 Board, xx, 41, 42, 50, 54, 55, 133, 151, 167–169, 171, 175–177 Brain drain, 129–135 BRICS, 113 Bubble continuous positive airway pressure (bCPAP), 102 Business, viii, 12, 23–26, 29, 31, 39, 40, 45, 46, 48, 54, 67, 74, 76, 80, 84, 86, 89, 90, 107, 112, 122–124, 126, 127, 148, 153–157, 161, 169, 171, 173, 176, 187, 189, 193 Business plan, 39, 40, 48, 54, 74, 76, 113, 169, 176, 189 C

Cameroon, 14, 16, 42, 51, 147 Canada, xix, 95, 143, 184 Capacity building, xi, 35–37, 46, 49, 50, 52, 53, 61, 63, 65, 67, 73, 85, 152, 179, 181 Capacity utilization, 63, 71, 73 Cases, 3, 9, 22, 23, 27, 31, 33, 62, 100, 103, 115, 137–142, 154 Cassava, 91 Catholic University of Leuven, 133 Central Africa, 16, 191 Centres of Excellence(COEs), 14, 41, 43, 48, 49, 51, 62, 63, 70–72, 89, 95, 104, 117, 168

 Index 

CGIAR, 91 Challenges, viii, ix, 2, 3, 5, 7, 9, 13, 22, 23, 27, 30, 43, 46–48, 52, 54–57, 60–62, 69, 70, 72, 77, 83, 89, 93–97, 101, 102, 105, 107, 110, 111, 118, 122, 125, 130, 132, 134, 137, 144, 148, 151, 152, 157, 171, 172, 182, 184, 189–191, 193, 194 Chemical technology, 88–95 China, 56, 64, 68, 69, 85, 112, 114, 115, 118, 122, 129, 137–139, 144, 149, 154, 173, 186 CHI Pharmaceuticals, 116 Chocolates, 91, 124 Chronic diseases, 16, 17, 20, 66 Civil unrest, 2 Clinical trials, 15, 16, 55, 61, 73, 181 Coalition for Epidemic Preparedness Innovation (CEPI), 184–185, 187 Cocoa, 91, 124 Colonial, 22, 68 COMESA, 34 Communicable diseases, 2, 9, 63 Communication, 7, 37, 65, 97, 151, 171, 173–175 Companies, ix, 8, 12, 15, 27–29, 33, 40, 52, 54, 61, 63, 67, 74, 77–80, 86, 94, 95, 101, 103–105, 107, 109–112, 114–118, 124, 125, 131, 134, 135, 143, 144, 146, 148, 156, 179, 185 Compound annual growth rate (CAGR), 118

197

Corona Virus Disease-2019 (COVID-19), viii, 6, 34, 45, 47, 54, 56, 69, 77, 87, 90, 97, 107, 112, 118, 123, 132, 135, 137–152, 157, 180, 181, 184–187, 194 Corporations, 32, 33, 180 Corruption, 93, 152 COVAX facility, 143 Create market, vii, ix, 8, 26, 29, 30, 32, 125 Create value, ix, xiii, 33, 34, 116, 125, 153 Critical mass, 23, 60, 71, 104, 110, 118, 150 D

Dangote Foundation, 79 Data, vii, 5, 8, 9, 13, 14, 17, 22, 56, 70, 72, 74, 87, 90, 104, 115, 133, 137, 138, 142, 146 Database, 86 Definition, 8, 26, 30, 64, 105 Democratic Republic of Congo (DRC), 16, 69, 88, 93 Developed countries, viii, 1, 13, 63–65, 74, 101, 130, 131, 142, 149, 154, 186, 194 Developing countries, 3, 9, 22, 31, 36, 42, 53, 63–65, 68, 70n31, 72, 76, 77, 84, 109, 111, 122, 123, 127, 133, 142–144, 149, 152, 159, 179, 194

198 Index

Development, vii–x, 1–9, 12, 14, 15, 22, 23, 25, 26, 29–37, 40, 41, 43–46, 49, 51, 53–55, 57, 60–81, 83–85, 87–93, 96, 101–106, 109, 111, 112, 115, 118, 119, 122, 123, 125–127, 130–132, 135, 142–144, 147, 150, 152, 154–156, 167, 172, 173, 175, 179–185, 187, 189–191, 193 Development partners, 4, 31, 32, 35, 55, 61, 63, 66, 75, 111, 132, 143, 190, 191 Devices, 25, 91, 103, 110, 117, 118, 147, 183 Diagnostics, 45, 47, 51–53, 69, 79, 102, 110, 117–119, 125, 138, 142, 146, 147, 167, 182, 183 Diarrheal diseases, 16 Digital health, 183 Digital technology, 5, 27, 29, 46, 55, 90, 91, 123, 186 Disability adjusted life years (DALYs), 2 Disease, 2, 7, 9, 13, 14, 16, 17, 20, 23, 31, 33, 36, 47, 52, 53, 55, 63, 66, 69, 70, 76, 83n1, 84, 85, 87, 90, 103, 111, 118, 126, 133, 137–142, 144–148, 179–185, 187, 193 Donors, viii–x, 8, 22, 23, 28, 32, 43, 47, 48, 54, 61, 66, 70, 72, 75, 81, 97, 103, 168, 173, 175, 180–183, 190, 191, 193 Drugs, 6, 28, 29, 31, 35–37, 45, 60, 63, 66, 85, 87, 106, 107, 110, 114, 115, 117, 146, 167, 180, 181, 183, 185

Drugs for Neglected Diseases Initiative (DNDi), 63, 180–181, 183 E

East Africa, 88 Ebola, 44, 45, 69, 185 Economic Communities for West African States (ECOWAS), 38 Economy, 3, 4, 7, 8, 66–68, 76, 89, 90, 94, 96, 97, 101, 105, 109, 112, 115, 118, 131, 142, 143, 148, 152 Ecosystem, vii, 5, 31, 32, 38, 73, 88, 90, 123 Education, viii, 2, 3, 6, 8, 12, 16, 26, 56, 64, 68, 71, 74, 79, 90, 97, 111, 123, 125, 131, 148, 150, 152, 154, 155, 157, 194 Egypt, 13, 14, 40, 42, 45, 50, 51, 59, 88, 110, 116, 117, 139 Egyptian Academy of Scientific Research and Technology (ASRT), 42, 45, 50–52, 60 Egyptian International Pharmaceutical Industries Co. (EIPIC), 116 Emergent infections, 45, 66, 149 Emerging technologies, 29, 31, 95–97 Emory, 46 Empirical evidence, 5, 153 Employment, 130 Enabling environment, 27, 134, 150, 182, 193 Entrepreneurs, viii, x, 24, 31, 33, 45, 48, 52, 77, 79, 88, 89, 104, 105, 112, 154, 155, 157

 Index 

Entrepreneurship, vii–ix, 46, 52, 55, 56, 71, 77, 79, 88, 95, 152–165, 171 Environmental biotechnology, 94 Epidemiology, 17, 19, 53, 141 Equity, 30, 33, 76, 89, 185 Ethics, 181 Ethiopia, 42, 88, 118, 168, 175 European Commission (EC), 30n16, 42, 43, 55, 119, 194 European Developing Countries Clinical Trial Partnership (EDCTP), 49, 55, 181 European Union (EU), 48, 67, 181, 185 Evans Medical Plc, 116 Expenditure, 11, 73 Export, 2, 31, 34, 93, 109, 115 External review, 37, 43, 48, 50, 54, 167–177 F

Facebook, 88 Fellowship, 63, 131, 169, 181, 191, 194 Financing, viii, ix, 4, 5, 8, 12, 15, 22, 24, 30, 31, 45, 47, 55, 57, 60, 61, 70–81, 87–89, 94, 101–104, 113, 118, 121, 145, 150, 155, 156, 173, 189 Fintech, 80, 89, 90 Foreign, 15, 34, 72, 97, 105, 111, 118, 122, 132, 135 Foundation for Innovative New Diagnostics (FIND), 182, 187 Fragmentation, vii, 4, 81, 87 Frugal innovation, 102, 121, 122, 124

199

Fund, 23, 43, 46, 47, 51, 53, 55, 62, 63, 65–67, 69–81, 88, 89, 110, 125, 134, 156, 173, 179, 191 Funding, viii, ix, 4, 9, 12–14, 22, 23, 27–29, 31, 33, 46–48, 50–53, 55, 56, 60, 61, 65–67, 69–73, 75–77, 87, 90, 97, 104, 105, 117, 125, 133, 149, 151, 168–171, 173, 174, 185, 189, 191–194 Fundraising, 47, 105 G

GARDP, 180–181 Genome sequencing, 95, 138, 194 Genomics, 35, 53 Global Alliance for Vaccine Initiative (GAVI), 66, 75, 187 Global Fund to Fight Aids, TB and malaria (GFATM), 66 Global health, 22, 22n19, 35n1, 63, 119, 183, 184, 186, 187 Global Innovation Index (GII), 12 Good Manufacturing Practice (GMP), 52, 116, 193 Google, 88 Governance, vii, 1, 2, 5, 41, 50, 51, 57, 62, 71, 96, 150, 151, 171–172, 176 Government, viii, 5, 7, 8, 12, 13, 27, 28, 38, 40, 45, 57, 60, 61, 65, 67, 69, 75, 77, 78, 80, 88–90, 97, 99–102, 105, 110, 134, 144, 146, 147, 150, 156, 157, 171, 180, 182, 183, 185, 187, 189, 190

200 Index

Grand Challenges, 184 Grants, ix, 29, 31, 70, 76, 79, 88–90, 102, 110, 125, 156, 170, 185, 190 Gross domestic product (GDP), 8, 11, 12, 74 G7, 149 G20, 119, 149 H

Harmonization, 34, 193 Harvard University, xx, 7, 157 Health, vii, xiv, 2, 4–6, 9, 12, 22, 29, 31, 34–57, 60, 61, 63–66, 69–74, 70n30, 76, 78–81, 83–85, 90, 91, 97, 103, 104n8, 104n9, 105, 110–113, 115, 118, 119, 123, 127, 137, 142, 147–150, 167–171, 174, 179–184, 186, 187, 189, 190 Healthcare delivery, 45, 126 HIV, 16–18, 53, 66, 84, 142, 147, 181 Hope, 6, 29, 55–57, 90, 104, 124, 142, 170 Hub, 5, 31, 46, 47, 50–51, 60, 63, 88–90, 93, 104, 115, 135, 156, 173, 186 Hunger, 123, 147 I

ICT, 3, 88, 89, 154 IDEA University, 152–157 Illicit financial flow, 152 Imo State, 56

Impact, ix, 23, 29, 30, 59, 72, 79–81, 89, 90, 94, 96, 97, 105, 106, 114, 132, 142, 145, 147, 150, 152, 156, 157, 170, 186, 190 Impact Investing, ix, 79, 80, 156 Implementation, 3–6, 26, 40, 41, 46, 48, 50, 52–57, 62, 70, 80, 94, 97, 104, 106, 113, 133, 134, 151, 155, 169, 173, 175, 177, 186 Import, 91, 115, 119 Incubators, 88, 101 India, 13, 53, 56, 68, 69, 112, 114, 115, 118, 122, 140, 144, 148, 149, 154 Industrialization, 96, 110–112, 190 Industrial revolution, 95, 96 Infection, 45, 66, 149 Infectious diseases, 181, 183, 184 Informal sector, ix, 154, 156 Information technology, 80, 96, 123 Infrastructure, viii, 2, 8, 12, 16, 65, 67, 69–71, 73, 74, 80, 104, 110, 112, 114, 118, 119, 123, 125, 130, 144, 152, 156, 167, 169, 170 Innovation, vii, xiii, 1–9, 11–57, 59, 62, 63, 65, 66, 68–81, 89, 89n19, 91–97, 99–107, 116, 121–127, 129–135, 137–157, 167, 168, 170, 179–187, 189–194 Innovation Award, 43, 44, 170 Innovation Development and Entrepreneurship Africa (IDEA), ix, 152

 Index 

Innovation ecosystem, vii, xiii, 5, 31, 38, 73, 123 Innovation gap, 101 Innovators, viii, xiii, 15, 33, 45, 76, 84, 92, 104, 155, 157 Integration, vii, 3, 7, 16, 34, 53, 57, 97, 116, 190, 194 Intellectual property (IP), viii, ix, 15, 24, 30, 36, 45–47, 76, 101, 102, 121, 126, 127, 150, 155, 156 Intellectual property (IP) rights, ix, 30, 150 International development, 4, 72, 105, 132, 156 Internet of Things (IoT), 96 Intra-African collaboration, xiv, 17, 23, 57, 63, 69, 87 Invention, 25–34, 92, 124, 125 Investment, viii, 6, 8, 11–13, 22, 28, 31, 34, 56, 59, 61, 69, 71, 73, 79–81, 84, 90, 96, 104, 105, 111–113, 118, 125, 129, 144, 148, 152, 154, 156, 192 J

Jobs, ix, 6–8, 6n17, 28, 55, 56, 101, 102, 110, 112, 115, 116, 122, 129, 130, 132, 146, 155, 175 Johnson and Johnson, 63, 69 K

Kagame, Paul, 152 Kenya, 12, 14, 27, 41, 43, 50, 51, 54, 80, 88, 89, 111, 115–118, 146, 157, 191

201

Kenyan Medical Research Institute (KEMRI), 50, 51 Knowledge, viii, 8, 9, 13, 22, 25, 26, 62, 65, 67, 70, 85, 87, 93, 96, 101, 125, 130, 132, 155, 157, 193 Kwame Nkrumah, 7 L

Laboratory, viii, 6, 15, 29, 30, 37, 45, 53, 55, 61, 62, 87, 99, 101, 116, 133, 139, 146, 155, 179, 182 Landscape, vii, viii, xiii, 9, 11–24, 37, 45, 46, 48, 54, 71, 73, 85, 113, 118 Leapfrogging, 85, 118, 121–127 Legal, viii, 2, 32, 42, 46, 47, 67, 131 Lesson, vii, ix, x, 5, 9, 23, 37, 47, 56, 62, 67, 68, 71, 73, 76, 89, 91, 112, 113, 115, 126, 133, 134, 152, 153, 159, 173, 176 Lessons learned, vii, 5, 23, 47, 112, 152, 153, 176 Local, vii–ix, 2, 6, 8, 9, 22, 23, 28, 29, 32–34, 36, 37, 44–48, 52, 54, 55, 60–63, 66, 67, 69, 73, 77, 87, 89, 93, 101–104, 107, 110, 112–119, 124–126, 130, 132, 134, 135, 145, 146, 148, 150–152, 154, 156, 165, 167, 193 Local technologies, 44, 55, 62, 107 Lockdown, 90, 138, 141, 147, 148 Long term, 3, 4, 6, 28, 29, 32, 67, 106, 112, 131, 152, 173, 174

202 Index

Low and middle income countries (LMIC), 22, 23, 31, 68, 121, 125, 126, 143, 147–148, 183 M

Malaria, 15–18, 53, 66, 83n1, 84, 111, 111n7, 123, 141, 142, 147, 180, 181 Management, 15, 24, 28, 33, 45–47, 53, 54, 87, 91, 96, 105, 106, 118, 125, 138, 151, 155 Mandela, Nelson, 54 Manufacture, 33, 73, 109, 110, 112, 113, 117, 119, 123, 144 Manufacturing value added (MVA), 109 Mapping, 71 Market, vii–ix, xiii, 6, 7, 15, 24, 29–34, 37, 45, 55, 57, 62, 66, 67, 89, 102–107, 112, 115, 116, 117n24, 118, 124–127, 143, 155, 161, 167, 182, 185, 193 Massachusetts Institute of Technology (MIT), 86, 89 Maternal and child health, 51 May & Baker Nigeria Plc, 116 Medicines, 8, 9, 17, 21, 27, 31, 33, 34, 54, 60, 83n1, 84, 85, 87, 91, 111–114, 111n7, 116, 117, 123, 125, 146, 148, 167, 180, 193 Medicines for Malaria Venture (MMV), 28, 29, 63, 180, 183 Medium term, 32, 102 M/eHealth, 89

Methods/methodology, 17, 26, 91, 95, 124 Micro-Small- and Medium- Sized Enterprise (MSME), xiv Millennium Development Goals (MDGs), 3, 4 Minerals, 84, 93, 124 Misinformation, 90, 123, 142, 147 Mission, 4, 40, 117, 152, 168, 170, 171, 173, 174, 180–184, 189, 190, 192–194 Mobile phone, 3, 29, 122, 123, 174 Morbidity, 84 Morocco, 12, 88, 110 Mortality, 3, 55, 84, 141 M-pesa, 27 Multilateral, 2, 68, 131 Multinationals, 63, 74, 79, 94, 111, 112, 130, 131 N

Nana Akufo-Addo, 94 NASA, 86, 99 National Aeronautics and Space Administration (NASA, USA), 86, 99 National Institute for Pharmaceutical Research and Development of Nigeria (NIPRD), 50, 51, 60, 103 Natural products, 87, 107, 159, 167 Natural resources, vii, 93, 105, 109, 124, 125 Neglected diseases, 31n17, 31n18, 33, 53, 55, 66, 67, 111n7, 142, 180, 181, 183

 Index 

Networks, 15, 30, 31, 35–37, 48, 49, 61, 76, 79, 88, 97, 132, 135, 159–162, 164, 181, 183, 189 NGO, 38, 80, 131 Nigeria, 13, 14, 47, 50–54, 56, 59, 69, 78–80, 88, 89, 92–95, 103, 110, 111, 115–118, 122–125, 129, 132, 139, 141, 147, 169, 173, 174, 191 Nigeria Centre for Disease Control and Prevention (NCDC), 146 Nigeria Federal Institute for Industrial Research Oshodi (FIIRO), 92 Niprisan, 51, 103 Non communicable diseases (NCDs), 2, 9, 63 North Africa, 12, 115 Not-for profit, 179, 191 Nutrition, 2, 79, 81, 84, 85, 90 Nwaka’s African Innovation Development Theory (AfID Theory), ix, 32 O

Official Development Assistance (ODA), 64–81, 150 Oil and gas, 95, 124 Open innovation, 53, 121–127 Operating procedure, 97, 169 Operational framework, 155–156 Opportunities, vii–ix, 6, 7, 9, 31, 46, 48, 52, 55, 67, 77, 79, 87, 90, 95, 96, 104, 110, 122, 124, 129–132, 147, 153, 154, 170, 193

203

Overdependence on aid, 94 Overdependence on development partners and aid, 4 Ownership (of research and innovation), 94, 150–152 Oxford University, 119, 157 P

Pandemic, viii, xiii, 3, 6, 47, 56, 69, 77, 87, 90, 112, 113, 118, 119, 123, 132, 137–152, 157, 185, 187, 194 Pandemic Trade Impact Mitigation Facility (PATIMFA), 145 Parachute research, 22 Partnership for African Vaccine Manufacturing (PAVM), 114, 145 Partnerships, xiv, 9, 15, 22, 28, 29, 35, 42, 44–46, 48, 49, 51, 54, 59–81, 85, 89, 97, 102, 106, 111, 118, 126, 127, 156, 170, 179–181, 183, 184, 186, 190, 192, 193 Pasteur Institute Senegal, 145 Patents, 15, 84, 103, 114, 154 Petroleum, 93, 124 Pfizer, 172, 176 Pharmaceutical manufacturing, 110, 113, 193 Pharmacology, 17 Phase, 24, 28, 30, 43, 106, 143, 176 Philanthropy, 66 Platform, 45, 54, 66, 81, 85, 86, 90, 118, 123, 125, 126, 149, 150, 155, 185, 189, 192, 193 Pneumonia, 137

204 Index

Policy, viii–x, xiii, xiv, 3, 4, 25, 26, 30, 32, 38, 48, 69, 73, 92, 97, 100, 104, 112, 123, 148, 150, 168, 171, 174, 183, 186, 190–193 Political will, 71 Polymerase chain reaction (PCR), 107 Population, 1, 12, 36, 84, 94, 114, 122, 124, 125, 141, 143, 180, 183, 189 Post colonial, 111 Poverty, 3, 6–8, 30, 56, 74, 142, 147, 182, 183, 190 Poverty alleviation, 30, 74 Primary secondary and tertiary levels of manufacturing, 113 Products, viii, 1, 11, 23–26, 29–31, 33–35, 41, 55, 57, 62–64, 66, 67, 71, 73–77, 79, 80, 85–87, 90–94, 96, 102–104, 106, 107, 110–114, 116, 118, 119, 121, 126, 127, 159, 160, 165, 167–170, 174, 179–181, 183, 189 Program for Appropriate Technologies in Health (PATH), 182–183 Proof of concept, 55, 99, 101–103, 106 Proteomics, 53 Public and private sector, xiv, 29, 60 Publications, 5, 9, 12–14, 17, 21, 22, 51, 133, 154, 160, 163, 192 Public health, 36, 76, 112, 137, 189, 194 Pumani, 51, 102, 103

Q

Quality assurance, 116, 182, 186 Quality control, 116 Quantum computing, 96 R

R&D, 5, 11–16, 22–26, 29, 31, 32, 47, 59, 60, 65–67, 70–74, 76, 77, 79, 81, 83, 89, 91, 92, 97, 99, 101, 104–107, 110–112, 116, 119, 125, 126, 129, 133, 142, 144, 145, 148–150, 154, 159, 165, 167, 168, 179–194 Regional hubs, 47, 50–51, 60, 169–175 Regional manufacturing, 115, 193 Regulation, 31, 103, 118, 150 Regulatory harmonization, 34, 57, 190, 193 Remittances, 131, 132, 135 Resolutions, 41, 3, 50, 52 Risk, 96, 97, 104, 142, 180 Robotics, 27, 90, 96 Russia, 140 S

Safety, 56, 87, 116, 146 SARS-CoV-2, 45, 107, 127, 137, 139, 141, 194 Scale up, ix, 51, 57, 76, 91, 93, 101–103, 106, 107, 113, 115, 144, 154, 185 Science diplomacy, 149 Science, Technology and Innovation (STI), vii, 2, 3, 8, 26, 60, 61, 65, 76, 77, 97, 190–192

 Index 

Science, Technology and Innovation Strategy for Africa (STISA), 4, 75, 194 Science, Technology, Engineering and Mathematics (STEM), 3, 6, 130 Scientific and Technical Advisory Committee (STAC), 41, 42, 168, 169, 171, 172, 175–177 Scientists, viii, 8, 9, 14, 22, 23, 25, 28, 30, 36–57, 60, 73, 85, 87, 92, 95, 104, 129–131, 133, 138, 147, 155, 170, 187, 194 Senegal, 13, 114, 117, 145, 147 Sequence, 127, 138 Short term, 4, 6, 67, 70, 110, 131, 169, 173 Silicon Valley, 27, 89 Small and medium scale enterprises (SMEs), xiv, 62, 76–79, 84, 85, 93, 104, 110, 126, 156 Social, ix, xiii, 7, 9, 24–34, 68, 69, 73, 79, 80, 87, 89, 90, 102, 103, 105, 110, 116, 121, 122, 126, 127, 135, 147, 154, 157, 179 Social distancing, 90 Social innovation, ix, 9, 24, 29–34, 57, 68, 69, 73, 79, 87, 103, 105, 116, 119, 121, 126, 127, 135, 154, 179 Societal problems, viii, 101, 155 Society, 29, 30, 150, 157, 184, 186, 187 Socio-economic, 2, 8, 31, 32, 36, 68, 90, 96, 101, 112, 190 Songhai Centre, 92

205

South Africa, 12–14, 40, 50, 51, 53, 59, 60, 65, 69, 72, 80, 88, 104, 110, 111, 114–117, 129, 140, 142, 144, 145, 147, 184 South African Medical Research Council (MRC), 40, 50, 51, 60 South African National Research Foundation (NRF), 60, 72 Southern Africa, 34, 146 South Korea, 68, 122, 137, 154 South-South and North-South collaboration, 53, 54 Special Programme for Research and Training in Tropical Diseases (TDR), 28, 35, 37, 39, 55, 76, 111, 168, 171, 172, 183, 186 Stagnation, 55, 104 Stakeholders, ix, 27, 29, 31–34, 37–43, 45, 48–50, 57, 67, 73, 75, 88, 102, 103, 106, 116, 121, 126, 135, 168, 170–172, 174, 175, 180–183, 186, 190, 191, 193 Stakeholders meeting, 37–43, 45, 48–50, 170 Stanford, 89 Strategies, x, 3, 4, 6, 32, 36, 38, 41, 50, 61, 63, 65, 67, 69, 72, 74–76, 94, 97, 104, 148, 150, 155, 171, 174, 175, 183, 191, 192, 194 Strengthen, ix, 57, 65, 79, 119, 144, 149, 190, 194 Sub-Saharan Africa, 2, 11, 13, 28, 56, 61, 110, 113, 115, 123, 129, 132, 139, 146, 181

206 Index

Sustainability, viii, ix, 32, 63, 67, 74, 75, 89, 106, 118, 173 Sustainable Development Goals (SDGs), 3, 4, 9, 55, 61, 64, 65, 76, 80, 155, 186, 192 Swiss Pharma Nigeria Limited, 116 SWOT analysis, 170 T

Task force, 39–41, 171 TB, 17, 19, 142, 147, 160 Technological Innovation, ix, 24, 29–34, 102 Technology, vii–ix, 3, 5–7, 12, 14, 15, 17, 24, 27–33, 37, 41, 43, 45, 46, 49, 51–55, 63–65, 69, 78, 80, 83–97, 99–107, 112, 113, 115, 118, 121–126, 134, 135, 147, 154–156, 179, 185, 186, 193 Technology Readiness Levels (RTLs), 99–107 Technology Transfer, Leadership (of research), 94, 150–152 Tertiary Education Trust Fund (TET Fund, Nigeria), 60 Theory(ies), 90, 138, 139, 141, 147 Tomatoes, 91 Tony Elumelu Foundation, 79 Tools, 23, 31, 44, 45, 51, 90, 97, 111–113, 118, 119, 142–146, 148–150, 167, 181, 182 Trade Related Aspects of Intellectual Property Rights (TRIPS), 114 Traditional African Medicines (TAM), 17, 83–87, 146

Traditional knowledge, vii, 66, 83–97 Training, ix, xiv, 29, 45, 46, 50, 61–63, 66, 79, 92, 95, 97, 125, 130, 131, 133, 146, 153–155, 169, 182 Transition, 4, 26, 29–31, 42, 101, 106, 168, 172 Tunisia, 12, 14, 40, 42, 118 21st century, 96, 154, 157 U

UK Foreign Commonwealth & Development Office (UKFCDO), 101 UNAIDS, 113 UNDP, 68, 132, 134, 183 UNESCO, 11, 68, 70 UNICEF, 42, 44, 47, 117, 183 UNITAID, 66, 75, 187 United Nations (UN), 2, 3, 68, 80, 116, 186–187 United Nations Economic Commission of Africa (UNECA), 42, 43, 75, 115, 168, 176 United Nations Industrial Development Organization (UNIDO), 109, 113 United Nations Office for Project Services (UNOPS), 42, 43, 46, 47, 54 Universal Corporation Limited Kenya, 116 University, ix, 7, 40, 45, 46, 51, 59, 60, 103, 133, 138, 152–158, 163

 Index 

University of Cape Town (UCT), 28, 29, 37, 60 University of Freiburg, 133 University ranking, 59, 60 US Centers for Disease Control and Prevention (CDC), 139 US National Biotechnology Institute (NCBI), 138 US National Institute of Health (US-NIH), 62, 186, 192 V

Vaccine diplomacy, 149 Vaccine nationalism, 143 Vaccines, 9, 27, 45, 47, 66, 110, 117, 118, 138, 142–146, 148, 167, 183–185, 187 Valley of death, 30, 55, 99–107 Value and supply chains, 32, 124, 155 Venture, ix, xiv, 12, 76, 77, 79, 88, 89, 93, 101, 106, 107, 110, 122, 126, 156 Venture capital (VC), 80, 81, 106, 107 Virological.org, 138 Vision, 12, 29, 44, 64, 92, 148, 155–156, 162, 168, 170, 173, 174, 180, 182, 183, 186, 189, 191, 193 Vocational training, ix, 154, 155

207

W

Water and sanitation, 2, 81 Wealth creation, 29, 30, 32, 74, 116 Wellcome Trust, 62, 75, 184, 187, 191, 192 West Africa, 44, 47, 50, 52, 60, 69, 124, 146, 175 WHO/AFRO, 42, 70 WHO prequalification, 116 World Bank, 44, 62, 64, 77, 88, 132, 134, 183, 187 World Health Assembly (WHA), 36, 41, 52–57, 76, 183 World Health Organization (WHO), 28, 35, 37, 39, 43, 46, 52, 53, 55, 70, 76, 84, 113, 115, 116, 137–139, 142, 143, 145, 167, 171, 172, 181, 183, 185–187 World Intellectual Property Organization (WIPO), 12 World Trade Organization (WTO), 114 Y

Young population, 141 Youth, vii, 1, 6, 6n17, 42, 94 Z

Zipline, 27, 28 Zoonosis, 138