Africa's continued reliance on imported medicines, vaccines, and active pharmaceutical ingredients is the direct legacy of colonial extraction, intensified by the structural-adjustment era's dismantling of state-owned drug plants and cemented by intellectual-property regimes that keep critical know-how offshore. The COVID-19 vaccine scramble exposed the full cost of this vulnerability and has triggered a continent-wide push for pharmaceutical sovereignty-an explicit, decolonizing agenda to localize research, regulation, and production. This review distils the latest evidence on the barriers that still block that transition and maps the regulatory, financial, technological, and civic opportunities most likely to accelerate it. A critical narrative literature review was conducted. Six databases (PubMed, Scopus, ProQuest, Google Scholar, BMJ Global Health and the Institute for Economic Justice repository) were searched for English-language records published January 2000-May 2025 using the terms Africa AND (pharmaceutic OR vaccine OR API) AND (sovereign OR manufactur OR decoloni). Grey literature from AU agencies, Africa CDC, WHO and UNIDO was added. Forty-five documents met inclusion criteria and were included in the article. Reflexive thematic analysis identified recurrent barriers and enabling pathways; intercoder reliability was ensured through independent coding and consensus meetings. Four structurally reinforcing barriers dominate the evidence base: (i) TRIPS-based patent exclusivities that restrict technology transfer; (ii) fragmented and immature regulatory capacity (iii) chronic under-investment; and (iv) import-biased procurement. The countervailing opportunities center on (i) AMA-led regulatory harmonization, (ii) pooled-demand instruments (iii) technology-transfer partnerships and (iv) civic-sector mobilization. Africa now possesses the regulatory blueprint, pooled-demand incentives, and emerging technology platforms to localize production of medicines and vaccines. However, its realization is dependent on synchronizing these levers by easing IP constraints, completing AMA-led regulatory convergence, mobilizing concessional finance for API and bulk-drug capacity, and reforming procurement to reward local value. If pursued in concert, these steps can convert pharmaceutical sovereignty from a political slogan into a resilient, continent-wide industrial reality- anchoring Africa's wider agenda to decolonize global health.
Mulumba et al. (Fri,) studied this question.