The African Union has the financing, the regulatory groundwork and its first successful pooled tender. What it does not have is anyone responsible for noticing when the 2040 target starts to slip.
The Presidential Declaration adopted in February 2026 on the side of the 39th African Union (AU) Summit reaffirmed the continent’s desire and ambition to operationalize the African Pooled Procurement Mechanism (APPM) and meet at minimum 60% of Africa’s health product needs through local manufacturing by 2040.
The political will is strong, financing is in place and regulatory efforts are underway. But one question stands out: who ensures any of it actually happens? If commitments go unmet, and they often do, who is responsible? Who is tracking implementation between summits, when the cameras disappear and the real work begins?
Who is tracking implementation between summits, when the cameras disappear and the real work begins?
A recent Meridian Letters piece discussed the foundations of Africa’s pharmaceutical manufacturing ambitions and the building blocks needed for success: regional specialization, regulatory harmonization and procurement reforms necessary for signaling demand. What’s missing is who’s responsible for making sure the blocks stack up.
Four questions, one clear answer
Concretely, the question breaks into four parts: Who is accountable: the member states that commit to routing procurement through APPM, or the institutions- Africa CDC, the AU Commission meant to hold them to it? What is actually being monitored: the 60% target itself, or narrower milestones such as how many countries have formally joined the pooled mechanism? What happens when a country does not follow through? And what does any of it mean for the person waiting at the shelf for a medicine that a fragmented, underfunded supply chain hasn’t delivered?
Right now, only the third question has a clear answer and it’s not great: nothing happens.
Structure without participation
Egypt was the first of the AU’s fifty-five member states to formally sign on. Nothing compels the other fifty-four to follow.
It’s not for a lack of structure behind it. A regulatory MOU signed by seven national medicines authorities in February 2025 codifies regulatory harmonization and the African Medicines Agency, is intended to turn that harmonization into a binding continental framework. Financing commitments from Afreximbank and Africa CDC total $2 billion, with another up to $2 billion through the African Vaccine Manufacturing Accelerator. And Africa CDC’s APPM, completed its first tender in May delivering 10 priority reproductive and maternal health products at a reported 30 to 90% below what member states were paying on their own, a true operational milestone and proof the declaration has moved beyond pledges into implementation.
But upon a closer look, the tender worked because 10 states took part in that specific procurement round, but the mechanism the 2040 target depends on is continent-wide participation, which is still theoretical. As of last month, Egypt was the first of the AU’s fifty-five member states to formally sign on to the APPM. Nothing compels the other fifty-four to follow and nothing happens if they don’t.
The Abuja precedent
We have been here before. In 2001, AU member states signed the Abuja Declaration, committing to allocate at least 15% of national budgets to health. Over two decades later, most AU members have not come close to meeting it. Reputational pressure as a tracking mechanism was insufficient, mostly because there was no designated body with standing to flag non-compliance, no escalation pathways and no consequences felt when competing budget priorities arose.
The Pharmaceutical Manufacturing Plan for Africa had a similar voluntary approach and COVAX tells the same story more recently. Research found that COVAX did not employ mutual collective accountability and was not sufficiently transparent. This highlights what can happen when you build a complex multi-stakeholder initiative without proactively designing the accountability mechanisms. My own doctoral research examining voluntary frameworks across sectors found the same patterns: the ones that deliver are those with a credible and recognized authority mandated to track progress and with meaningful tools to apply pressure when delivery falls short.
The missing accountability layer
The current African pharmaceutical manufacturing agenda has the commitments, but it does not yet have the accountability layer. If everyone is in charge, no one is in charge. There is no designated body with the clear mandate to track whether the 2040 target is on course. There is no public scorecard that lets anyone see which countries have joined APPM and which have not. There is no agreed consequence for a country that keeps procuring outside the pooled system. And there’s no one whose job it is to notice, years from now, that the target has slipped, the way Abuja’s did.
What to fix before Nairobi
The architecture becomes much harder to change after deployment.
The Extraordinary Summit on African Health Products Manufacturing, expected in Nairobi later this year, represents a specific window of opportunity. Once member states commit to channeling procurement through APPM and manufacturers invest based on those demand projections, the political incentive to revisit the governance framework drops. The architecture becomes much harder to change after deployment.
Three things would meaningfully strengthen the governance infrastructure without requiring new initiatives. The most important is giving Africa CDC an explicit mandate to publish annual progress assessment, including a country-by-country scorecard. It’s convening role, member state relationships and reputation for credible data make it the legitimate choice. Transparency is what will create pressure.
Have the AU Assembly, AU Commission and Africa CDC agree, in writing, on what happens when commitments slip; no one can impose sanctions, but a structured peer review can still generate the pressure Abuja never had.
And for APPM specifically, there should be a clearly defined commitment, with named signatories and a defined timeline so countries know clearly they have to join or explain why they have not.
Most people who need these medicines have never heard of the 60% target, the APPM or any of the declarations behind them. They will only ever experience whether it all works as intended- through a lower price or a stocked shelf. What decides if it becomes real is whether anyone is put in charge of making sure it does.
Jamila Yakubu is a global health strategist with over a decade of experience in health systems strengthening, access to medicines, and evidence-based program design across Sub-Saharan Africa and the United States. She holds a Doctor of Public Health in Leadership, Management and Policy from Boston University School of Public Health and a Master of Public Health in Health Behavior and Health Education from the University of Michigan School of Public Health. Her doctoral research examined voluntary reporting frameworks, with an institutional focus on an emerging approach to tracking private-sector NCD commitments.
