Nigeria’s New Year resolutions- # 1: Combatting Fake Medicines

During the month of January, I will be discussing Nigeria’s health care challenges as New year resolutions so that we may advocate and play our part in helping our country’s health system. A few days ago, an elderly relative reached out to me to find a drug for her. She was previously managed for diabetes […]

During the month of January, I will be discussing Nigeria’s health care challenges as New year resolutions so that we may advocate and play our part in helping our country’s health system.

A few days ago, an elderly relative reached out to me to find a drug for her. She was previously managed for diabetes in the UK and some of the medicines she returned with were depleted. So far, her blood sugar had been controlled and so she wanted to continue the medication, but she had been unable to find the medicines at her local pharmacy. Could I help? Or did she have to return to London?

Recognising the drug, I immediately called a big pharmacy outlet in Sabon Gari and asked if it was available. 

‘Which one Dr? The one with number or the one without number?’

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You cannot be in healthcare and not understand what he was insinuating, but for the purpose of clarity- I asked him to explain what he meant.

‘The one without NAFDAC number will cost you about N27,000 while the one with NAFDAC number costs about N35,000. Which one you want?’

Welcome to our new reality.

Since the exit of Pharmaceutical giants- GSK and Sanofi-there has been and flood of their products in the market, albeit through the back door. Nigerians, always in a bid to find quick cash, found a gap in the market and keyed into it with all their energy. Business people found a way to smuggle the scarce medicines of these companies from nearby countries into Nigeria and then distribute them to large pharmaceutical plugs, bypassing NAFDAC.

Hence, the question- the one with number or the one without number?

The one with NAFDAC number, are the remaining stock in the country and are therefore scarce, hence the higher price. The one without the number was smuggled in from countries like Cairo, Turkey, South Africa (where GSK companies still operate) and sold directly to wholesale outlet sidestepping Nigerian authorities.

Technically, they are the same thing. Both medicines are produced by the same company and therefore function the same way. It is means of acquiring the drugs that is illegal.

And yet, however illegal this whole business deal is, it is not as catastrophic as the production and sale of Substandard and Counterfeit medicines (SCMs). In Nigeria, the manufacture and distribution of substandard and counterfeit medicines in the drug market is booming, despite the efforts of law enforcement agencies to crack down on criminal syndicates. Although adulteration, falsification, and illicit manufacture of drugs is not a new threat, recent advances in industrialization and commerce have exacerbated the complexity of the problem.

It is true that Nigeria has made tremendous progress in reducing the circulation of SCMs from 40% in 2001 to 17% in 2005, thanks majorly to Prof Akunyili (may God rest her soul), however, this issue continues to be a major challenge, particularly with regard to medicines of great public health importance, such as antimalarial drugs. In 2011, 64% of antimalarials circulating in Nigeria were reported to be substandard. 

64%!!! Let that figure sink in. That translates to millions of Nigerians managing malaria and not getting better or worse yet, getting sicker and eventually leading to complications and death, especially among children.

Whenever, the subject of SCMs is discussed, the famous scenario illustrated by Chambliss et al in is often quoted:

“Imagine that a patient is prescribed chemotherapy to treat a life-threatening tumor. A pharmacist dispenses the prescribed medication and counsels the patient without realizing that the tablets did not contain an active ingredient. In this scenario, not only is the patient not receiving the prescribed medication, but the physician and pharmacist are evaluating treatment outcomes based on the patient’s response to a placebo.”

The patient eventually succumbs to the disease and the death is placed solely on the shoulders of health care workers. We should have done better. Short of opening a drug manufacturing unit in my backyard, how else can I do better?

Unscrupulous businessmen and women involved in the illegal production, importation, and circulation of SCMs target medicines with a large volume of use for the treatment of common diseases. It therefore makes sense that the drugs commonly produced are antibiotics, anti-malarials, anti-diabetic agents, antihypertensives and analgesics. 

Of course, consumption of these SCMs can result in serious health implications including development of resistance (in the case of antibiotics), poisoning, and death. Furthermore, the public health implications like increased out-of-pocket expenditure, increased burden on the already-overburdened health system and loss of confidence in the country’s health system are consequences that worsen healthcare indices.

Can readers remember the catastrophic event that happened in 2008 where several children developed acute kidney injury and later died as a result of consuming a supposed teething solution called “My Pikin”? The medicine was proven to be contaminated by the ‘accidental’ (read: intentional) addition of diethylene glycol (DEG) as a solvent instead of propylene glycol. Similar events occurred when the same DEG was used instead of propylene glycol in South Africa in 1969 and Nigeria in 1990, resulting in 7 and 47 deaths respectively. 

No be today wahala start.

The continued presence of highly unregulated open drug markets in Nigeria’s major cities has been a major contributor to the prevalence of counterfeit drugs. This is a country where medicines are hawked and sold freely on street corners, bus stops, kiosks, and stalls. Notable open, unregulated, drug markets in Nigeria include those located in Kano (Sabon-Gari market), Lagos (Idumota market), Onitsha (Head-bridge market), Abia (Ariaria Market, Aba) and Rivers (Mile 1 and Mile 3 markets). In fact, the Idumota market in Lagos has been described as one of the world’s largest markets. Manufacturers sell directly to merchants at the market, who then export to other parts of West Africa and Central Africa. 

Somebody once said to me: ‘there is big money in medicines.’ 

I concur.

Combatting SCMs, even in developed countries is a very daunting task. Preventing counterfeit medicines from entering Nigeria is very difficult partly because more than 70% of drugs in Nigeria are imported from India and China, who are two of the world’s biggest sources of counterfeit medicines. 

Additionally, in Nigeria, detecting these counterfeit medicines is equally difficult, because many of them pass through the unregulated open drug markets mentioned above thereby creating opportunities for counterfeits and substandard medicines to enter the legitimate supply chain.  Therefore, as long as the open drug markets remain operational, combatting substandard and counterfeit medicines will continue to be a herculean task. 

#NewYearresoution1: Do not buy medicine without NAFDAC numbers. Try and buy medication from reputable outlets with PSN registration.