On the beautiful Kenyan coast, roughly halfway between 15th century ruins and the bustling city of Mombasa, sits a small factory helping to achieve one of Africa's greatest healthcare goals: self-reliance.
Revital Healthcare, which has fewer than 700 employees, produces 300 million syringes a year, enough to meet more than half of Africa's routine immunization needs.
At the height of the COVID-19 pandemic, when governments were rushing to vaccinate millions amid severe vaccine shortages, Revital shipped syringes to Sri Lanka, Sweden, the United Arab Emirates and Uzbekistan, and also sent 15 million syringes to India, said Ronique Vora, the company's director of sales and marketing.
“We know that India is a big syringe manufacturing powerhouse, but this is the first time that the African medical industry is exporting syringes to India,” Vora said. “This is a huge milestone for us and has broken a lot of barriers,” he added.
Revital is well funded through grants and contracts from a host of aid groups, including the US Agency for International Development, the Save the Children Foundation and several UN agencies, and its ambitions are lofty.
Many efforts towards medical self-reliance in Africa have been hampered by a lack of funding, a lack of strong regulatory systems and the difficulty of transporting medicines and vaccines. Revital's success offers hope that African companies can manufacture essential products for the continent and also for export to other countries.
The company has 58 products, including rapid diagnostic test kits for various infectious diseases, medical tubing, face masks, and a portable, electricity-free device for providing oxygen to newborns. In May 2022, more than 200 of these devices were delivered to Ukraine.
But the syringes in particular are helping to meet a desperate need in Africa.
Sub-Saharan African countries require 500 million syringes each year just for routine immunization, and these countries experience frequent outbreaks of infectious diseases that require large numbers of vaccines administered in a short period of time. Syringes are often the limiting factor.
“The world invests billions of dollars each year in vaccine development and deployment, but without a simple syringe that costs a few cents, the vaccine and the investment that comes with it would remain in a vial,” said Surabhi Rajaram, program director at the Bill & Melinda Gates Foundation.
More than 80% of the syringes needed for vaccinations are produced in Asia, Rajaram said, and they typically travel by sea, which can delay arrival for months.
During the pandemic, India and China restricted the export of syringes, leading to shortages in many countries, including in Africa, and straining vaccination programs. “We don't want to be in that situation again,” Rajaram said.
Livital's proximity to the port of Mombasa, the international airport and the road network linking landlocked African countries has cut transport times by 80 to 90 percent, she said.
Revital, funded with about $4 million from the Gates Foundation, makes what are called early-activation auto-deactivating syringes, which cannot be reused after the plunger is pushed into the barrel. Other syringes are deactivated only after the plunger is fully pushed into the barrel. That means doctors sometimes stop and refill syringes before they're empty, conserving stock. But this could lead to the spread of HIV, Hepatitis B, Hepatitis C and other diseases.
Revital is the only African company approved by the World Health Organization to manufacture the fast-activating syringe.
Subsidies from international health agencies are mandating that the fast-activating syringes be sold in Africa. Separately, the Africa Centers for Disease Control and Prevention has a goal of producing 60% of the vaccines needed by 2040.
“When you talk about vaccines, you talk about syringes, and we didn't have the capacity to manufacture syringes,” said Dr. Jean Kaseya, the agency's director. “Now, thanks to Revital Healthcare, we're able to meet at least 50% of the demand.”
The company's ambitions go beyond syringes: When the coronavirus arrived in Kenya in March 2020, “we had no surgical masks, no vaccines, no syringes,” Vora recalls. The company quickly ramped up production from 30,000 masks a day to 300,000, making it the largest mask manufacturer in sub-Saharan Africa.
Within six months, the company increased production from 3 million to 30 million syringes per month.
With $2.2 million in funding from the U.S. Agency for International Development, Revital now aims to become Africa's largest manufacturer of rapid diagnostic tests, churning out about 20 million tests a month and hiring 200 employees to keep up with demand. About half of the tests will be for HIV, and the other half for malaria, hepatitis, dengue fever and other diseases. The factory opened in May.
Revital is also a key part of a larger effort launched by Kenyan President William Ruto to make medical kits for epidemics: During a malaria outbreak, for example, while other companies make rapid diagnostic tests, mosquito nets, antimalarial drugs and vaccines, Revital assembles the kits and ships them to affected areas.
The company was founded in 2008 with 60 employees and remains family-owned. Vora is a third-generation Indian-Kenyan. The company's chairman is his uncle, and cousins ​​manage the finances and operations. R&D head Kurpalli Shah is a close family friend. About 80% of the company's employees are women, exceeding the 50% target set by the Gates Foundation.
Located just minutes from Kilifi's gorgeous beaches, the factory operates 24 hours a day, with workers working 12-hour shifts. While most of the work is automated, many workers spend hours in hot rooms with little air because air conditioning and fans can compromise sterility, Shah said. Some of the machines emit harsh screeching noises every few seconds. The workers were offered headphones but declined, according to a floor supervisor.
Vora, whose great-grandmother was deaf and mute, said the company plans to hire more than 200 women to assemble the syringes, though it has hired about 40 so far, fewer than 20 on a hot December day.
Trufosa Atieno, 60, is deaf and decades older than most of her deaf employees. A widow and single mother, she was a primary school teacher but when the pandemic closed her schools, she said she made a “hand-to-mouth living” selling honey, vegetables and sugarcane on the roadside.
In November 2022, she was hit by a minibus and left unconscious for three days, suffering a fractured skull and elbow and bruised ribs and fingers. Still, the mother of four daughters aged 16 to 29, she said she was eager to get back to work.
When Atieno first started working for Revital, she lived in Jombu, about 50 miles from Kilifi, and had to leave home at 4 a.m. to get to work by 7 a.m. Now she shares a room with 13 other women in Kilifi during the week and returns to Jombu on weekends. Her income is “not enough,” she says, so she supplements it by tutoring children on her days off.
Some deaf women quit working in factories because the daily wage is about 600 Kenyan shillings (less than $5) per shift, and the commute from Mombasa costs about half that.
Some couldn't meet daily productivity quotas, while others resented the ban on eating meat and eggs on-site (the Vora family are strict vegetarians).
“Part of the struggle is adapting to the culture here,” said Amina Mahmoud, projects manager for the Mombasa-based nonprofit that sent the women, adding that the company's “expectations are high.”