Inside the factory that supplies half of Africa's syringes

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

With fewer than 700 employees, Revital Healthcare produces 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 found themselves having to vaccinate millions of people under 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 in the lifetime of Africa that a medical industry is exporting syringes to India, when we know that India is a powerhouse in syringe manufacturing,” Vora said. “This was a big deal for us – it broke a lot of barriers,” she added.

Revital is richly funded through grants and contracts from many donor organizations, including the US Agency for International Development, the Save the Children Foundation and several branches of the United Nations, and the company has big ambitions.

Many of Africa's attempts to achieve medical self-sufficiency have been hampered by limited funding, a lack of a robust regulatory system and difficulties transporting medicines and vaccines. In this context, Revital's success offers 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 portable, electricity-free 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 meet a desperate need in Africa.

Sub-Saharan African countries need 500 million syringes every year just for routine vaccinations. And these nations are often hit by epidemics that require mass vaccinations in short order. Syringes are often the limiting factor.

“The world invests billions every year in developing and distributing vaccines, but without a simple syringe, which costs pennies, vaccines and associated investments will remain in the vial,” said Surabhi Rajaram, program manager at the Bill & Melinda Gates. .

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

During the pandemic, India and China have restricted the export of syringes, creating shortages 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 connecting landlocked African countries, has reduced transportation times by 80 to 90 percent, he said.

With about $4 million in funding from the Gates Foundation, Revital makes so-called early-activation self-disabling syringes, which cannot be used again once the plunger has been pushed into the barrel. Other syringes are deactivated only after the plunger has been pushed all the way through the barrel; this sometimes encourages doctors to stop before emptying a syringe and refilling it, in order to conserve supplies. But this 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 for the production of early activation syringes.

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

“When we talk about vaccines, we talk about syringes, and we didn't have the capacity to produce 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 far 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,” Vora recalled. The company quickly increased production of face masks from 30,000 to 300,000 per day, becoming the largest mask manufacturer in sub-Saharan Africa.

Within six months, it increased syringe production from 3 million per month to 30 million.

With $2.2 million from the US Agency for International Development, Revital now aims to become Africa's largest maker of rapid diagnostic test kits, churning out around 20 million a month, and the company is hiring 200 workers to meet this question. About half of the test kits would be for HIV and the other half for malaria, hepatitis, dengue and other diseases. The factory was inaugurated in May.

Revital is also the centerpiece of a larger effort launched by Kenya's president, William Ruto, to produce health kits for epidemics. In a malaria epidemic, for example, other companies might produce rapid diagnostic tests, mosquito nets, malaria drugs and vaccines; Revital would assemble the kits and ship them to areas affected by the epidemic.

The company was founded in 2008 with just 60 employees and remains family-owned. Mr. Vora is a third generation Kenyan of Indian origin. His uncle is the president of the company. His cousins ​​handle finance and operations. And Krupali Shah, who leads research and development, is a close family friend. Women make up approximately 80% of the workforce, exceeding the 50% goal set by the Gates Foundation.

Just minutes from Kilifi's spectacular beaches, the factory is open all day, every day, with 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 could compromise sterility, Ms. Shah said. Some machines emit high-pitched screams every few seconds. According to a floor supervisor, workers were offered headphones and refused them.

Mr. Vora's great-grandmother was mute and deaf, and she said the company was planning to hire more than 200 women to assemble the syringes. So far the company has hired about 40. On one hot December day there were fewer than 20.

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

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

When she 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 get 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 earns is “not enough,” she said, so she supplements her income by tutoring the children on her days off.

Some other hearing-impaired women leave 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 couldn't meet daily productivity quotas, or didn't like the ban on eating meat and eggs on site. (The Vora are strict vegetarians.)

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

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