China’s ‘health silk road’ in Africa gets a boost with insulin and other pharma projects
Move to manufacture insulin locally is set against forecast of nearly 55 million Type 2 diabetes cases in sub-Saharan Africa by 2045
China is advancing its “health silk road” in Africa by initiating major offshore projects to manufacture essential medicines, such as insulin and antiretrovirals.
Nigeria is set to produce Chinese-made insulin, while in the Ivory Coast further west, Chinese giant Shanghai Fosun Pharmaceutical is on track to complete the first part of its three-phase €50 million (US$58 million) facility by the end of the year. The facility near Abidjan, the country’s biggest city, will manufacture antimalarial and antibacterial drugs.
Chinese firms are stepping in to fill Africa’s medicine manufacturing gaps, driven by high demand for generic medications and chronic illness treatments.
Africa, home to about 18 per cent of the global population, bears a quarter of the world’s disease burden and imports nearly all its vaccines and 70 per cent of its essential medicines, according to global health agencies.
Beijing’s ambassador to Nigeria, Yu Dunhai, announced late last month that Chinese companies planned to build an insulin production plant in the country.
The facility would expand access to life-saving diabetes medication and lower treatment costs as rates of the disease surge across the continent, “potentially ending Nigeria’s reliance on imported insulin and positioning Nigeria as a hub for African medical biotechnology”, Yu said.
His comments followed the signing of the related deal between Nigeria’s National Biotechnology Research and Development Agency and the Shanghai Haiqi Industrial Company.
Lauren Johnston, a China-Africa specialist and senior research fellow at the AustChina Institute, a Melbourne-based think tank, said there appeared to be a race to produce insulin in Africa. This included efforts agreed to or under way in Egypt with a US-based partner, in South Africa with a European partner, and now Nigeria with a Chinese partner.
“This is amazing news – unless this also relates to forecasts in diabetes onset prevalence,” Johnston said.
Nigeria, as a starting point on medical manufacturing for China, offered the continent’s largest domestic consumer market, as well as a presumably underserved West African market, Johnston said.
Egypt’s EVA Pharma began producing insulin last year in partnership with US firm Eli Lilly. The initiative is similar to one involving South Africa’s Aspen Pharmacare and Denmark’s Novo Nordisk for the local “filling and finishing” or final, critical manufacturing stage of insulin, to improve regional access.
Kai Xue, a Beijing-based lawyer who advises on foreign direct investment and cross-border financing, said the diplomatic framework for China’s health engagement was provided under the Forum on China-Africa Cooperation (FOCAC), which includes mechanisms such as the health silk road cooperation conference and the China-Africa ministerial forum on health cooperation.
But sustained momentum required commercially viable projects, Xue noted. For instance, if insulin production in Nigeria proved profitable, it could encourage related investments, such as the manufacture of blood glucose monitors.
He said Chinese firm Sinocare was already selling blood glucose monitors in Nigeria. “Commercial success will invite expansion and competing investments not only from other Chinese companies but also firms from elsewhere, creating a biotech hub in Nigeria,” Xue added.
Diabetes cases have been sharply rising across Africa. A recent Lancet study estimated that Type 2 cases in sub-Saharan Africa alone would rise to nearly 55 million by 2045, driven by changes in diet and reduced physical activity.
Johnston said while the situation implicitly represented competition for existing exporters of related medicines to Africa, it might “ultimately be difficult to compete with the prospect of producing such essential medicines locally”.
This could represent both a major contribution to the globalisation of China’s health-related industries and an incremental advance for Africa’s health and pharmaceuticals sector, she said.
The health silk road is a nickname for health sector investments under the Belt and Road Initiative, Beijing’s global trade and infrastructure strategy.
Chinese President Xi Jinping promised during the FOCAC summit in September last year that Beijing would promote pharmaceutical production and the medical equipment industry in Africa, including access to active pharmaceutical ingredients (API), through co-investment by Chinese and African private sector players.
Zhou Taidong, vice-president of the China Centre for International Knowledge on Development, said it was a state-driven push factor that accelerated commercial opportunity, framing health cooperation not as charity but as a “win-win” partnership.
According to Zhou, this would build goodwill by helping African countries develop their own pharmaceutical capacity, as was evident during Covid-19 when China supported local production while Western nations were accused of “vaccine hoarding”.
“China’s [expansion] in the sector can undercut price, ensure supply security and leverage Chinese API advantage,” Zhou said.
By focusing on African production, Chinese companies were “more willing to engage in technology transfer and joint ventures with local partners”, he added.
Besides insulin, Nigeria is also angling to make antiretroviral drugs. Nigerian drug maker Fidson Healthcare signed a deal last year with Chinese firms to build a US$100 million pharmaceutical plant in the city of Lagos.
The agreement with Jiangsu Aidea Pharma, PharmaBlock Sciences Nanjing Inc and the China-Africa Development Fund supports construction of the facility in the Lekki Free Trade Zone to boost Africa’s self-reliance in healthcare delivery, particularly in tackling HIV.
The facility is expected to be completed by early 2027. Crucially, it will help fill the gap left by the exit of major Western pharmaceutical giants GSK and Sanofi from the Nigerian market in 2023.
Meanwhile, Fosun Pharma’s plant in Ivory Coast is expected to produce antimalarial drugs and antibiotics, with a full capacity of 5 billion tablets annually once all three phases are complete. Fosun’s business in Africa will cover 17 French-speaking countries, including Senegal, Cameroon and Mali.
Chinese pharmaceutical firms are also boosting local production in other African countries, especially in Ethiopia, Zambia and Kenya.
Other recent moves include Chinese firm Africa Bio Chem’s partnership with the government in Zanzibar, Tanzania, for a drug and vaccine facility, and Jijia International Medical Technology’s deal last year to build a cholera vaccine plant in Zambia.
Analysis from the Beijing-based consultancy Development Reimagined indicated that African markets offer Chinese pharmaceutical companies high-margin opportunities they cannot access at home.
This high growth capacity is quantified by Africa’s low health expenditure. At just under US$35 per capita in 2019, it is far below the global benchmark of US$160.