Africa’s Vaccine Future: Population Growth, Infectious Disease Burden and the Clinical Trial Gap

Timothy Chege Kuria, PhD. Postdoctoral Research Scientist at Columbia University in New York, NY, USA. timothychege@ymail.com // https://orcid.org/0000-0002-2991-6333

Africa’s population is increasing rapidly. By 2026, the continent is estimated to have about 1.6 billion people, almost one-fifth of the world’s population. According to the United Nations’ medium variant forecasts, Africa’s population should reach 2.5 billion by 2050 and 3.8 billion by 2100; at the end of the century the continent may contain nearly four out of every ten people on the globe. Although these are projections and not certainties, their scale is impressive[1].

These figures are usually discussed in demographic terms. Still, for those of us interested in infectious diseases and vaccines, they raise a larger question: will Africa’s scientific, economic, and health infrastructure grow fast enough to meet this population’s needs? The economic picture makes that question particularly important.

In 2024, Africa’s 54 countries produced a nominal economic output of about US$3 trillion. To put this in context, France alone had a GDP of around US$3.16 trillion that year, even though its population was about 69 million, less than 5% of that of Africa[2]. GDP is not equivalent to wealth, public spending capacity, or living standards; moreover, nominal comparisons are affected by exchange rates and do not account for differences in purchasing power or the role of the informal economy. Yet the difference in per-capita economic output is hard to overlook.

According to World Bank data, South Africa, Egypt, Algeria, Nigeria and Morocco together generated approximately US$1.47 trillion in nominal GDP in 2024[2], representing close to half of Africa’s aggregate output. This disparity is particularly concerning given Africa’s rapidly growing population, which places increasing demands on health systems that already operate with relatively limited resources.

A growing population and a heavy infectious disease burden

Africa bears a disproportionate burden of several major infectious diseases. In 2024, the WHO African Region accounted for about 94% of all global malaria cases and 95% of malaria deaths[3]. HIV and tuberculosis also remain major problems on the continent, together with repeated outbreaks of cholera, meningitis, Ebola, mpox and other infections that are either emerging or re-emerging.

This is the context in which Africa’s population is growing. Over the coming decades, hundreds of millions more people will require access to vaccines, diagnostics, medicines, laboratories, hospitals and trained healthcare workers. A growing population can be an enormous economic and social asset, but without corresponding investment in health systems, research and infrastructure, it can also magnify existing vulnerabilities.

Vaccines sit at the center of this challenge. Vaccination is among the most successful public health interventions ever developed. Smallpox has been eradicated, and wild poliovirus transmission has been reduced dramatically, although it remains endemic in Afghanistan and Pakistan, and outbreaks of circulating vaccine-derived poliovirus continue[4]. Many diseases that once routinely killed or disabled children can now be prevented. Yet vaccines are expensive and technically demanding to develop. Researchers may spend years understanding a pathogen, identifying antigens, selecting a vaccine platform, conducting preclinical studies, and establishing manufacturing processes before proceeding to clinical trials involving thousands or tens of thousands of participants.

Here Africa faces a difficult paradox. Some of the populations with the greatest need for new vaccines also have the least purchasing power to drive their commercial development. From a public health perspective, developing a vaccine against a disease affecting millions of people may be an obvious priority. From the perspective of a pharmaceutical company deciding where to invest substantial research and development resources, the calculation can be very different.

The fact that there is a heavy disease burden does not mean that a commercially viable market will result. That is why grants, pooled procurement, tiered pricing, advance market commitments, priority review vouchers, and other market-shaping mechanisms have become important tools in global health; they help bridge the gap between public health need and the financial risk of developing and supplying vaccines.

The clinical trial gap

The same imbalance becomes apparent in clinical trials. Africa accounts for close to a fifth of the global population, yet published estimates suggest that fewer than 3% of all clinical trials worldwide have been conducted on the continent[5]. A separate, vaccine-specific landscape analysis published in 2025 found that only 8% of global vaccine clinical trials assessed for 2007–2024 included a site in Africa[6]. These estimates use different datasets and denominators, so they should not be treated as interchangeable. Both, however, point to limited African participation in global clinical research relative to population size and disease burden.

Vaccine trials conducted in Africa are also unevenly distributed. A 2025 scoping review identified 662 vaccine trials and reported the highest country counts in South Africa (220), Kenya (88), Uganda (52), Mali (44), Tanzania (41), and Burkina Faso (41)[7].

Part of the explanation is straightforward: clinical research tends to go where clinical research infrastructure already exists. Sponsors need experienced investigators, research nurses, laboratories, pharmacists, statisticians, data managers, ethics committees, regulators, cold-chain systems, and reliable mechanisms for recruiting and following participants. Countries that possess more of this infrastructure are often better positioned to attract new studies[5].

This process can become self-reinforcing: a center that conducts trials gains experience, trains researchers, and attracts additional investment, which in turn makes it more competitive for the next study. Countries without that initial capacity will end up with fewer trials and therefore fewer opportunities to develop the expertise and infrastructure sponsors require.

Funding is also a significant consideration. A 2025 analysis using G-FINDER data on vaccine R&D funding for diseases disproportionately affecting low- and middle-income countries found that Africa received less than 2% of the funding recorded between 2007 and 2023. The study also found that 95% of the funding was channeled through high-income countries, underscoring the concentration of financial flows and research funding structures outside Africa[6]. Although international partnerships have led to important scientific advances and have helped to set up strong research institutions in Africa, the way in which funding is arranged can also influence the kinds of questions that are supported and the locations where strategic decisions are made.

Therefore, simply increasing the number of clinical trials in Africa is only part of the problem. A trial carried out in Kilifi, Johannesburg, Kampala, or Accra does not mean the vaccine candidate was developed or originated there; African researchers might lead key elements such as recruitment, sampling, and analysis, while decisions on product strategy or intellectual property are made elsewhere. The long-term aim should be greater African involvement not just in carrying out the trials but also in shaping and leading the science that comes before and after them[6].

Why African populations matter to vaccine science

There is also a strong scientific basis for conducting more vaccine research in Africa, since the African population as a whole has greater human genetic diversity than any other part of the world, a result of both its deep evolutionary history and its considerable population structure[8]. Examining vaccine responses within this genetic diversity could show immunological variations that research focusing on a narrower range of populations would fail to detect.

Genetics is only one component of that variation. Previous infections, maternal antibodies, nutritional status, microbiota, environmental exposures, and coexisting illnesses can also influence vaccine responses, while pathogens themselves may differ between regions. The importance of any one factor varies with the vaccine and setting, and the mechanisms underlying geographic differences are not always established. Understanding these interactions can improve vaccine development and how we interpret vaccine performance[9].

A 2024 study of 2,499 infants from Uganda, Burkina Faso and South Africa found associations between variation in the HLA region and antibody responses to five of eight vaccine antigens tested[10]. This demonstrates the value of including populations historically underrepresented in genomic and immunological research, although differences in antibody titers do not necessarily translate directly into differences in clinical protection.

Rotavirus provides a particularly clear example of why context matters. In a randomized trial that enrolled 4,939 infants in Malawi and South Africa, vaccine efficacy against severe rotavirus gastroenteritis was 61.2% overall, but differed between the two countries: 76.9% in South Africa and 49.4% in Malawi[11].

The lower percentage efficacy in Malawi did not translate into lower public health value. Because severe rotavirus disease was more common there, vaccination prevented an estimated 6.7 episodes of severe rotavirus gastroenteritis per 100 vaccinated infants per year in Malawi, compared with 4.2 in South Africa[11]. The example illustrates why relative efficacy must be interpreted alongside the underlying burden of disease; the trial itself did not establish a single cause for the difference between countries.

Oral poliovirus vaccine offers another example. Researchers have recognized reduced immunogenicity in some low-income settings for decades. A systematic review found that concurrent nonpolio enterovirus infection was associated with reduced per-dose seroconversion to poliovirus type 1, while corresponding estimates for types 2 and 3 were less conclusive. Concurrent diarrhea was also associated with lower overall seroconversion[12]. These findings reinforce the importance of evaluating vaccines in the biological and epidemiological settings in which they will be used.

COVID-19 provided a more recent illustration. South Africa participated in several major vaccine trials. When the SARS-CoV-2 Beta variant emerged, a South African trial of the ChAdOx1 nCoV-19 vaccine found no demonstrated protection against mild to moderate disease caused by that variant. The efficacy estimate against Beta-associated illness was 10.4%, with a wide 95% confidence interval from −76.8% to 54.8%; the study could not establish efficacy against severe disease[13]. The result was globally relevant because it provided early evidence that viral evolution could substantially affect measured vaccine performance.

Clinical research conducted in Africa can therefore answer questions of global importance. Broader participation is not simply about increasing diversity within clinical trials. It expands the biological and epidemiological settings in which vaccines are evaluated and can reveal information that might otherwise be missed.

From vaccine access to vaccine development

There are indications that the situation regarding vaccines in Africa is starting to change. The COVID-19 pandemic revealed the weaknesses of a global vaccine system in which production was concentrated outside the continent; when demand increased, many African countries struggled to obtain supplies on time, which in turn sped up initiatives to expand local manufacturing capacity.

African contributions to vaccine innovation are not new. South African-born scientist Max Theiler developed the yellow fever 17D vaccine in 1937 while working in the United States, earning the 1951 Nobel Prize in Physiology or Medicine[14]. More recently, South Africa’s Biovac has advanced local vaccine manufacturing through technology transfer from the International Vaccine Institute, with its investigational oral cholera vaccine entering clinical trials in 2025[15]. Another notable example is Kenyan vaccinologist Professor George Warimwe, who led the development of ChAdOx1 RVF, a vaccine candidate against Rift Valley fever designed to protect humans and livestock. After successful preclinical studies and a Phase I human trial, the vaccine entered Phase II clinical evaluation in Kenya in 2025[16], [17]. Together, these examples demonstrate Africa’s scientific contributions and growing vaccine development capabilities, while highlighting the need for sustained investment in African-led vaccine discovery, clinical research, tsechnology ownership and manufacturing.

The African Union and the Africa CDC aim to meet at least 60% of the continent’s routine immunization vaccine needs through local production by 2040[18]. The African Vaccine Manufacturing Accelerator, which was launched in June 2024 and backed by Gavi, is expected to make US$1.2 billion available over a ten-year period to help establish commercially sustainable vaccine manufacturing in Africa[19]. Another way of developing technological capability is through the mRNA Technology Transfer Program supported by the WHO. This program’s hub in South Africa involves Afrigen, Biovac and the South African Medical Research Council, and it offers technology transfer and training for manufacturing partners in Africa and in other regions[20].

Although these initiatives are important, manufacturing capacity represents only one element of the vaccine development process. A vaccine can be filled and finished in Africa even though its antigen, the platform technology, the intellectual property, and the development strategy come from elsewhere. This helps to improve supply security, but on its own it does not establish a full vaccine research and development ecosystem. Just as the Africa CDC’s assessment of manufacturing capacity has pointed out the difference between the continent’s increasing ability to carry out fill-and-finish operations and its more limited capacity for local antigen production[21].

Building such an ecosystem requires connections between pathogen surveillance, basic science, antigen discovery, immunology, preclinical development, clinical trials, regulatory science, manufacturing, and pharmacovigilance. It also requires markets that can sustain the products that emerge from these activities.

What would progress actually look like?

The real measure of progress will therefore not be the number of new trial sites or vaccine factories alone. It will be whether African institutions can increasingly move vaccine candidates through the full development pathway, from identifying a pathogen and designing a candidate to preclinical evaluation, clinical trials, regulatory review, manufacturing and deployment. Different pieces of this pathway already exist across the continent, but analyses of vaccine R&D, trial activity, regulation, and manufacturing show that capabilities remain unevenly distributed[6].

It doesn’t mean that each country has to go through the whole process of developing a vaccine. A more practical approach is to build a linked continental ecosystem in which countries develop different areas of strength. For example, one country might have outstanding capacity in early-phase trials, another might have a large number of people involved in Phase III trials, a third could have advanced genomic surveillance or regulatory expertise, and others might have the ability to manufacture. The key issue then is whether these different strengths can function as part of a connected system.

It is the responsibility of African governments to make this a reality. Universities, laboratories and research institutes need continuous investment, and scientists must have secure long-term careers. Moreover, clinical research centers also require support which goes beyond that provided by individual grants. Better coordination of procurement, regulatory procedures, and purchasing commitments could create a more predictable market for vaccines manufactured on the continent.

The international financing mechanisms needed to support this transition are not new. Global health funders already use grants, pooled procurement, advance market commitments, and other approaches to reduce the financial risks associated with products that have high public health value but uncertain commercial returns. The more important question is whether these mechanisms can increasingly build durable capacity, stronger African research institutions, functioning clinical trial networks, manufacturing expertise, and greater ownership of vaccine technologies.

International partnerships will remain important, but their nature matters. Progress should increasingly involve African investigators leading multi-country studies, African laboratories conducting advanced analyses, African regulators evaluating complex products, and African companies participating in the ownership and development of vaccine technologies. African institutions should be involved when researchers formulate research questions, not only when they need to recruit participants.

The ultimate test is whether a vaccine can originate in an African laboratory, move through African clinical trial networks, undergo rigorous regulatory review, be manufactured at scale on the continent, and reach the populations that need it. When that pathway becomes routine rather than exceptional, Africa will no longer be defined mainly by its participation in vaccine research. It will help shape the global vaccine landscape.

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