“Punishment for putting patients at risk ought to reflect the gravity of manufacturing, distributing or selling counterfeit medications.”
—Gene Green
By Omoniyi Salaudeen
The Director General of the National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Mojisola Adeyeye, Wednesday, made a shocking revelation of the quantity of expired and substandard medical products that had illegally entered into the major drug markets across Nigeria.
She disclosed that in a sweep operation involving 1,100 security operatives, 87 truckload of drug in excess of N1 trillion were confiscated, representing the biggest catch so far in the agency’s history.
The operation was said to have been executed in Ariaria and Eziukwu Markets (Aba), Bridge Head Market (Onitsha), and Idumota Drug Market, Lagos.
Traditionally, these are the hubs for illicit trade in counterfeit drugs.
To show the notoriety of the dealers in these markets, the agency was able to discover USAID and UNFPA-donated antiretroviral drugs and male and female condoms, which had already expired, but were repackaged for sale.
The most striking thing is that no one has a clear understanding of how these drugs sneaked into the country.
“Once we complete the operation, we will have a clearer understanding of how these drugs are entering our country,” Adeyeye said.
Though the facilitators of the illicit drugs, their accomplices and other partners in crime are human beings, they carry out their nefarious activities and disappear into the thin air. Everything is shrouded in mystery.
All these revelations show the complexity and intricacy of drug administration and control not only in Nigeria, but also Africa in general. Reports say that African nations have the highest burden of counterfeit medical products, but have the lowest level of enforcement compared to Europe and the US where detection rates are much higher.
The most worrisome part is that there is no clear idea as to the extent of harm done to patients because there is no record for mortality.
Stories suggest that the problem is already out of hand in many countries on the continent because they are no longer in control of the problem.
The only established fact is that these mindless cartels prey on the most vulnerable in their communities.
That has led some key stakeholders in the drug industry to the conclusion that eradication of counterfeit drugs in any society is not just a difficult task; it is without dispute, an impossible objective.
It is even more difficult in countries like Nigeria where people are ready to do anything under the sun to make money.
So, dealing with the cartel behind the illicit trade requires more than occasional market raid.
To get to the root of it, the government must be more proactive in seeking international collaboration with the seriousness it deserves.
The fake medicines industry is a global issue. According to the Institute of Pharmaceutical Security, it continues to evolve and grow.
As much as it is important to sustain the current effort to rid the market of fake drugs, so it is necessary for the government to support the task force leading the sweep operation with adequate security personnel. Otherwise, the agency’s officials will be exposed to the risk of elimination because the Mafias involved are ruthless, mindless, ubiquitous and brutally wicked.
The late former Director General, Prof Dora Akunyili, aptly captured it: “Selling chalk as antibiotics, powder as anti-malaria medication, or unsterilized water as adrenalin, liking it to “selling death for profit.”
History is replete with several assassination attempts made on her life in a bid to intimidate her to give up on her sustained onslaughts, but she remained undaunted. For being so daring, she was nicknamed “Iron Lady”, indicating her unwavering determination to protect the health of Nigerians and safety of patients. Her crusade against counterfeit medical products was not just about regulation; it was also about saving lives.
Yet, despite significant strides she made in restoring trust in Nigeria’s healthcare system, fake medical products in her time accounted for an alarming 60 per cent of the market by some estimates.
This suggests that the fight against counterfeit medications is far from over. With the prolonged lull that followed Akunyili’s exit from NAFDAC and her ultimate demise, the illicit business must have presumably grown to a monstrous size in Nigeria.
Now in her shoes, Prof Adeyeye is seriously facing the heat, while escalating the war. Sharing her experience with journalists, she lamented: “I told you about the attempted murder about six months ago. One of our staff members in Kano had his child kidnapped because he was doing his job. Fortunately, the child escaped.
“For me, I have two policemen living in my house 24/7 in Abuja and Lagos. I can’t go anywhere without police escorts. That’s not my way of living, but I don’t have a choice because we must save our country. Nonetheless, I also use common sense.”
For sustainable effort, she seeks adequate protection for herself and the agency’s officials; she wants legislation that will make the punishment for the culprits more punitive and more deterring, preferably death sentence. It is up to the National Assembly to come up with stringent laws and regulations to prevent the manufacturing and distribution of counterfeit medications. Not only that, the governments and regulatory bodies must have the political-will to enforce the law to prevent substandard counterfeited medications from getting into the hand of patients.
This must be complemented by public campaigns about the dangers of fake medications, how to identify them and how to protect the people from falling victims. The populace needs to be informed about the risks of buying medications from unlicensed sources such as marketplaces and online pharmacies that offer low price.
The introduction of the electronic solutions that allow consumers to verify the authenticity of their medications through text messages as well as the ability to track and trace medications and verify their source should be encouraged. This is no longer optional, but necessary solutions needed to control the scourge of avoidable death arising from fake drug.
Such technologies should be widely adopted and continually improved.
There is also a need to support local research and development to enhance the capacity of local pharmaceutical companies to produce drugs to reduce dependence on imported ones, which are often targets for counterfeiting.
This should go along with support for local scientists and institutions in their efforts to develop safe and effective medications.
As reports indicate, there is international conspiracy in the production and circulation of counterfeit drugs. It has become a global problem like any cross-border challenges. To mitigate the effect on Nigeria’s healthcare system, there must be international cooperation and collaboration. More effort should be focused on sharing of intelligence, resources, and best practices among countries as a necessary part of the solution needed to enhance the effectiveness of the fight against counterfeit medications.
No country can fight the war against the production of substandard and fake drugs alone and win.
It requires collective action because it is an important cause of unnecessary morbidity, mortality, and loss of public confidence in medicines and health structures.
It has been estimated that up to 50 per cent of all sold drugs in Africa and parts of Asia are fake. This estimate suggests annual criminal sales in excess of US$35,000,000,000.
In Nigeria, deaths arising from circulation of fake drugs has become a threatening scourge that can no longer wait for quick and affirmative actions.
This must include serious punitive punishments that is strong enough to discourage offenders or serve as deterrent for others.