Wednesday, June 19, 2024

Inside the Factory Supplying Half of Africa’s Syringes

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On the stunning Kenyan coast, about halfway between 15th-century ruins and the vibrant city of Mombasa, a small factory is helping to achieve one of Africa’s biggest health care goals: self-reliance.

With fewer than 700 employees, Revital Healthcare makes 300 million syringes a year, enough to meet more than half of Africa’s routine immunization needs.

In the throes of the coronavirus pandemic, when governments were faced with vaccinating millions of people amid severe shortages, Revital shipped syringes to Sri Lanka, Sweden, the United Arab Emirates and Uzbekistan — and even sent 15 million syringes to India, said Roneek Vora, the company’s director of sales and marketing.

“This is the first time ever in the life of Africa that a medical industry is exporting syringes to India, when we know India is a powerhouse of syringe manufacturing,” Mr. Vora said. “This was a very big deal for us — it broke a lot of barriers,” he added.

Revital is richly funded through grants and contracts from many donor organizations, including the U.S. Agency for International Development, the Save the Children Foundation and multiple arms of the United Nations, and the company has lofty ambitions.

Many of Africa’s attempts at medical self-reliance have been hampered by limited funds, the lack of a robust regulatory system and the challenges in transporting drugs and vaccines. Against that backdrop, Revital’s success offers hope that an African company can manufacture essential products — not just for the continent, but also for export to other countries.

The company has a portfolio of 58 products, including rapid diagnostic test kits for several infectious diseases, medical tubing, face masks and a portable, electricity-free device that delivers oxygen to newborns. More than 200 of those devices were delivered to Ukraine in May 2022.

But the syringes, in particular, are helping to fill a dire need in Africa.

Countries in sub-Saharan Africa require 500 million syringes each year just for routine immunizations. And these nations are frequently hit by outbreaks that require mass vaccinations in short order. Syringes are often the limiting factor.

“The world invests billions each year in developing and deploying vaccines, but without a simple syringe, which costs pennies, vaccines and the associated investment will remain sitting in the vial,” said Surabhi Rajaram, a program officer at the Bill & Melinda Gates Foundation.

More than 80 percent of the syringes needed for vaccination are produced in Asia, Ms. Rajaram said. They are usually delivered by sea, which can delay their arrival by months.

During the pandemic, India and China restricted export of syringes, creating shortfalls and straining immunization programs in many countries, including some in Africa. “That was a place we never want to be again,” Ms. Rajaram said.

Revital’s proximity to Mombasa’s seaport and international airport, and to a road network that connects to landlocked countries in Africa, has reduced transport times by 80 to 90 percent, she said.

With about $4 million in funding from the Gates Foundation, Revital makes so-called early-activation auto-disable syringes, which cannot be reused once the plunger has been pushed into the barrel. Other syringes are disabled only after the plunger is pushed all the way through the barrel; this sometimes encourages clinicians to stop before emptying a syringe and refill it, in order to conserve supply. But this can contribute to the spread of H.I.V., hepatitis B and C and other diseases.

Revital is the only African company approved by the World Health Organization to make early-activation syringes.

Its grants from global health organizations mandate that the early-activation syringes be sold within Africa. Separately, the Africa Centers for Disease Control and Prevention has set a goal to manufacture 60 percent of the vaccines it needs by 2040.

“When we talk about vaccines, we talk about syringes, and we didn’t have capacity to manufacture syringes,” said Dr. Jean Kaseya, director general of the agency. “Now with Revital Healthcare, we can at least cover 50 percent of our needs.”

The company’s ambitions go well beyond syringes. In March 2020, when Covid arrived in Kenya, “we didn’t have surgical face masks, we didn’t have vaccines, we didn’t have syringes,” Mr. Vora recalled. The company rapidly ramped up production of face masks to 300,000 from 30,000 daily, becoming the largest manufacturer of the masks in sub-Saharan Africa.

Within six months, it increased its production of syringes to 30 million from 3 million per month.

With $2.2 million from U.S. Agency for International Development, Revital now aims to become Africa’s largest manufacturer of rapid diagnostic test kits, churning out about 20 million per month, and the company is hiring 200 employees to meet that demand. About half the test kits would be for H.I.V., and the other half for malaria, hepatitis, dengue and other diseases. The factory opened in May.

Revital is also the linchpin of a larger effort initiated by Kenya’s president, William Ruto, to produce health care kits for outbreaks. In a malaria outbreak, for example, other companies might make rapid diagnostic tests, mosquito nets, and antimalarial drugs and vaccines; Revital would assemble the kits and ship them to outbreak zones.

The company was founded in 2008 with just 60 employees, and it remains family-run. Mr. Vora is a third-generation Kenyan of Indian descent. His uncle is the chairman of the company. His cousins manage finance and operations. And Krupali Shah, who leads research and development, is a close friend of the family. Women make up about 80 percent of the work force, exceeding the 50 percent goal set by the Gates Foundation.

Just minutes away from the spectacular beaches of Kilifi, the factory runs all day, every day, with workers taking 12-hour shifts. Much of the work is automated, but many workers spend hours in hot rooms with little air — because air-conditioning units or fans might compromise sterility, Ms. Shah said. Some machines set off piercing shrieks every few seconds. The workers were offered headphones and refused, according to a floor supervisor.

Mr. Vora’s great-grandmother was hearing-impaired and mute, and he said the company was planning to hire more than 200 such women to assemble the syringes. The company has so far hired about 40. One hot day in December, there were fewer than 20.

At 60, Truphosa Atieno, who is hearing-impaired, is decades older than most of the other hearing-impaired employees. A widow and single mother, Ms. Atieno was an elementary-school teacher, but when the pandemic shuttered the school she “lived hand-to-mouth” selling honey, vegetables and sugar cane on the road side, she said.

In November 2022, she was hit by a minibus and was unconscious for three days. She fractured her skull and elbow, and sustained bruises to her ribs and fingers. Still, with four daughters ranging in age from 16 to 29, she was eager to work again, she said.

When she first got the job at Revital, Ms. Atieno lived in Jomvu, about 50 miles from Kilifi, and had to leave home at 4 a.m. to make it to work by 7 a.m. She now shares a room in Kilifi with 13 other women during the week, and returns to Jomvu on weekends. What she makes “is not enough,” she said, so she supplements her income by tutoring children on her days off.

Some other hearing-impaired women quit the factory because the daily wage is about 600 Kenyan shillings per shift (less than $5) and their commute from Mombasa costs about half that.

Others could not cope with the daily quotas for productivity, or they disliked the ban on eating meat and eggs on site. (The Voras are strict vegetarians.)

“One of the struggles is adapting to the culture here,” said Amina Mahmud, a project officer at a Mombasa-based nonprofit that placed the women, adding that the company’s “expectations are high.”



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