Inside the factory supplying half of Africa’s syringes

On the beautiful Kenyan coast, halfway between 15th-century ruins and the bustling city of Mombasa, a small factory is helping to achieve one of Africa’s greatest health goals: self-sufficiency.

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

In the midst of the coronavirus pandemic, when governments needed to vaccinate millions amid severe shortages, Revital shipped syringes to Sri Lanka, Sweden, the United Arab Emirates and Uzbekistan – and even sent 15 million syringes in India, said Roneek Vora, the company’s director of sales and marketing.

“This is the first time in Africa’s history that a medical industry has exported syringes to India, even though we know that India is a syringe manufacturing powerhouse,” Vora said. “It was a very big deal for us – it broke down a lot of barriers,” he added.

Revital is largely funded by grants and contracts from numerous donor organizations, including the U.S. Agency for International Development, the Save the Children Foundation, and several branches 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 absence of a robust regulatory system and difficulties in transporting medicines and vaccines. In this context, the success of Revital gives hope that an African company can produce essential products, not only 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 tubes, face masks and a power-free wearable device that delivers oxygen to newborns. More than 200 of these devices were delivered to Ukraine in May 2022.

But syringes, in particular, are helping to meet an urgent need in Africa.

Sub-Saharan African countries need 500 million syringes each year just for routine vaccinations. And these countries are frequently affected by epidemics which require massive vaccinations within a short time frame. Syringes are often the limiting factor.

“The world invests billions each year in vaccine development and deployment, but without a simple syringe, which costs pennies, the vaccines and associated investment will remain in the vial,” said Surabhi Rajaram, program manager 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 several months.

During the pandemic, India and China restricted the export of syringes, creating deficits and straining vaccination programs in many countries, including some in Africa. “It’s a place we never want to be again,” Ms. Rajaram said.

Revital’s proximity to Mombasa’s seaport and international airport, as well as a road network connecting landlocked African countries, has reduced transport times by 80 to 90 percent, she said. .

With about $4 million in funding from the Gates Foundation, Revital is making so-called early-activation and auto-deactivation syringes, which cannot be reused once the plunger is pressed into the barrel. Other syringes are only deactivated once the plunger has been pushed to the end of the barrel; this sometimes encourages clinicians to stop before emptying a syringe and refilling it, in order to conserve supply. But it can contribute to the spread of HIV, hepatitis B and C, and other diseases.

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

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

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

The company’s ambitions go well beyond syringes. In March 2020, when Covid arrived in Kenya, “we didn’t have surgical masks, we didn’t have vaccines, we didn’t have syringes,” recalls Mr. Vora. The company quickly increased its production of face masks from 30,000 to 300,000 per day, becoming the largest mask manufacturer in sub-Saharan Africa.

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

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

Revital is also the cornerstone of a larger effort launched by Kenya’s President William Ruto to produce health care kits in case of outbreaks. In the event of a malaria outbreak, for example, other companies could make rapid diagnostic tests, bed nets, and anti-malaria drugs and vaccines; Revital would assemble the kits and ship them to outbreak areas.

The company was founded in 2008 with just 60 employees and remains a family business. Mr Vora is a third generation Kenyan of Indian origin. His uncle is the president of the company. His cousins ​​manage the finances and operations. And Krupali Shah, who heads research and development, is a close family friend. Women make up about 80 percent of the workforce, surpassing the 50 percent goal set by the Gates Foundation.

Just minutes from the spectacular beaches of Kilifi, the factory operates all day, every day, with workers working 12-hour shifts. Much of the work is automated, but many workers spend hours in hot, poorly ventilated rooms because air-conditioning units or fans could compromise sterility, Shah said. Some machines release piercing screams every few seconds. Workers were offered headphones and refused, according to a floor supervisor.

Mr. Vora’s great-grandmother was hard of hearing and mute, and he said the company planned to hire more than 200 women to assemble the syringes. The company has hired around forty so far. On a hot December day, there were fewer than 20 of them.

Truphosa Atieno, 60, is hard of hearing and several decades older than most other hard of hearing employees. A widow and single mother, Ms Atieno was a primary school teacher, but when the pandemic closed the school, she “lived hand to mouth” selling honey, vegetables and sugar cane on the side of the road , she said.

In November 2022, she was hit by a minibus and remained unconscious for three days. She suffered a fractured skull and elbow, and 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 got a job with Revital, Ms Atieno lived in Jomvu, about 80 kilometers from Kilifi, and had to leave home at 4am to go to work at 7am. She now shares a room in Kilifi with 13 other women during this time. during the week and returns to Jomvu at the weekend. What she earns “isn’t enough,” she says, so she supplements her income by tutoring her children on her days off.

Other hearing-impaired women have left the factory because their daily wage is about 600 Kenyan shillings per shift (less than $5) and their journey from Mombasa costs about half that amount.

Others couldn’t meet daily productivity quotas or didn’t like the ban on eating meat and eggs on site. (The Voras are strict vegetarians.)

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