Every year, the continent falls 3-billion condoms short of what it needs. Could investing in condom factories be the answer — and create jobs to boot?


COMMENT

By the end of today, another 3 300 people in sub-Saharan Africa will become HIV positive. But why are 50% of the condoms the continent needs to prevent this, missing in action?

East and Southern Africa may only be home to 8% of the world’s population but it accounts for nearly half of the world’s HIV infections, UNAIDS 2018 data reveals.

Today, this region sees 30% fewer new HIV infections than it did in 2010. And four out of 10 women are now using contraceptives, according to the United Nations Population Fund’s (UNFPA) 2019 State of World Population report.

But the decline in new infections is less than projected, making it unlikely that any country on the continent will meet a target of reducing new infections by 75% by 2020 compared to 2010.

Condoms, both male and female, are the only contraception that provides triple protection against sexually transmitted infections, including HIV, and unintended pregnancies. These prophylaxes have averted more 45-million new infections worldwide since the start of epidemic according to UNAIDS.

However, each year, only half of the six-billion male condoms needed to prevent HIV and sexually transmitted infections reach the millions living in Africa, a 2016 analysis by UNFPA and UNAIDS shows.

The gap is staggering and likely to get worse.

Watch: We put SA’s new condoms to the test:

Until Africa’s condom conundrum is solved, countries in the region will struggle to meet the targets to distribute 20-billion condoms per year by 2020 or reach the Sustainable Development Goals, including ending Aids and ensure universal access to contraception and sexual and reproductive health care by 2030.

In a 2017 survey of 19 condom manufacturers, almost three-quarters were located in Asia. Although the study — which was conducted on behalf of organisations such as International HIV/AIDS Alliance, had a limited sample size given the large number of condom manufacturers globally, it did include the largest producer in the world and major providers to UNFPA and United States-funded programmes. Only two of the producers surveyed were based in Africa.

Currently, the continent’s five companies that produce less than 10% of the continent’s condom requirement, a 2016 study by the Southern African Development Community found.

And none of these local condom manufacturers are pre-qualified in accordance with international standards set by UNFPA and the World Health Organisation (WHO).

Prequalification is a service provided to test the safety, quality and efficacy of medical products, like medicines or condoms, before they are released to the public. The UNFPA/WHO seal of approval means that countries without the national capacity to regulate medicine and devices can be assured that prequalified products are safe for their public’s use and are globally marketable.  

Because African condom manufacturers are yet to be prequalified, it limits their potential to participate in international tenders.

Meanwhile, the varying requirements of registering products locally in different countries and weak distribution channels, or supply chain management, also prevent African manufacturers from getting their products to market.

There’s money to be made in safer sex

But producing condoms locally and in the region or the world most affected by HIV epidemic could have distinct advantages besides meeting Africa’s gap in preventing commodities and helping us meet the Sustainable Development Goals.

Firstly, local production keeps stocks close at hand, helping avoid stock-outs, the WHO argues in a 2011 report. Second, new producers may benefit from the transfer of technology through, for instance, partnerships with established producers or funding from new investors.

And it may also make economic sense. Local industry generates tax revenues for local governments. Condom manufacturing plants can generate commercial activity in nearby communities, including jobs. These facilities also grow related industries, such as packaging, warehousing and distribution.

Comprehensive condom programming is at the heart of our work at UNFPA. That’s why UNFPA is connecting with investors, manufacturers, governments and development partners to enhance Africa’s condom manufacturing, procurement and distribution capacities, and ensuring manufacturers meet international pre-qualification standards.

Effective condom programming in high HIV burden countries could avert up to 17-million infections between 2015 and 2030, a 2017 study published in the journal PLOS ONE found. It could also prevent 700-million other sexually transmitted infections and 420-million unintended pregnancies.

As far back as 2007 African Heads of State and Governments at the African Union Summit endorsed the Pharmaceutical Manufacturing Plan for Africa to promote the industrial development and production of quality medicines, including condoms.

The efforts, endorsed by the African Union Executive Council in 2015, to establish the Africa Medicines Agency — a single continental agency to oversee the regulation of medical products in Africa — and the agreement on the Africa Continental Free Trade Area (AfCFTA) brokered in 2018 provide unique opportunities to enhance quality and strengthen regulation as well as market size and access across the continent.

The Southern African Development Community (SADC), home to a market for male condoms that the SADC secretariat estimated to be worth US$105-million alone in 2016, is committed to supporting local manufacturing of medicines and condoms.  

But there must be a sense of urgency to identify, plan and develop condom manufacturing plants as viable operations in Africa.

Condom manufacturing has become a critical health and economic imperative for Africa that should no longer be delayed. And it will take everyone — including investors, manufacturers, governments and development partners — to make it happen.

Julitta Onabanjo is the regional director for the United Nations Population Fund in East and Southern Africa. Follow her on Twitter @JulittaOnabanjo