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By Henry Umahi
On December 31, 2023, Jubilee Syringe Manufacturing (JSM) Limited joined the growing list of international firms exiting Nigeria. Others include Procter & Gamble and GlaxoSmithKline.
• Prof. Mojisola Adeyeye
JSM, which was regarded as one of the largest syringe manufacturing outfits in Africa, announced the suspension of its operations in Awa, Onna Local Government Area of Akwa Ibom State. Owned by a Turkish national, Onur Kumral, the company, which was inaugurated in 2017 by former Vice President Yemi Osinbajo, said it was closing shop due to “unforeseen circumstances affecting our business operations.”
Although the company stopped production some months ago, it officially announced that its operations came to an end on December 31, 2022. The memo to that effect was signed by the company’s managing director, Akin Oyediran.
It said it had to “implement temporary measures to ensure the long-term sustainability of the company.”
The memo to the staff read in part: “We trust this message finds you in good health. With a heavy heart, we write to you today to communicate a challenging decision that Jubilee Syringe Manufacturing Company Limited has had to make due to unforeseen circumstances affecting our business operations.
“After careful consideration and a thorough evaluation of our current business situation, we regret to inform you that we must implement temporary measures to ensure the long-term sustainability of the company.
“Unfortunately, this includes placing all positions, including yours, on temporary redundancy effective January 1, 2024. We want to emphasise that this decision is not a reflection of your individual performance or dedication to the company. The challenging business environment we find ourselves in has compelled us to take these difficult steps. Please, return all company belongings in your custody. Thank you for your understanding and cooperation during these challenging times.”
At a time when the Federal Government is looking for foreign investments, companies in the country are closing down and relocating elsewhere. According to the director-general of the Manufacturers’ Association of Nigeria (MAN), Segun Ajayi-Kadir, “the reason why companies are closing is evident. It is just a matter of resilience. When it gets to the breaking point, you will have to give up because of the employment environment.”
The case of JSM in particular is worrisome considering the concerns associated with imported syringes and needles. Most imported syringes are said to be sub-standard and unsterile. And the consequences are unimaginable because syringes and needles are essential medical products used for the administration of drugs parentally (intravenous, intramuscular, subcutaneous).
Last week, the director-general of the National Agency for Food and Drug Administration Control (NAFDAC), Prof. Mojisola Adeyeye, said: “One of the greatest challenges that we face today in the healthcare sector is the proliferation of substandard and falsified medicines. In our country, this problem is further compounded by the chaotic drug distribution practices by unscrupulous elements of society who have no value for human lives.”
Also, speaking at a sensitisation campaign in north-central Nigeria, Adeyeye, who was represented by Bolaji Abayomi, the agency’s director in the North-Central zone, said: “It is common knowledge that Nigeria has a preponderant share of the global problem of falsified medical products and unwholesome food.
“The advent of COVID-19 pandemic has aggravated the problem with the challenge posed by substandard and falsified personal protective equipment (PPE).”
A lab scientist, Mr. Chimezie Obasi, told Daily Sun: “Yes, we have a lot of fake or sub-standard syringes in the open market. Fake syringes are syringes that don’t have the qualities of good syringes.
“The consequences of using sub-standard or fake syringes are many. It can cause abscess to the patient. It can cause infection after administering the intramuscular injection to the patient.
“During intravenous injection, it may cause tissue of the vein. It may lead to waste of drugs during injection. It usually takes longer time while using fake syringes. Most of the fake syringes can’t be autoclaved.
“The danger of fake syringes is that a patient can visit hospital or clinic with a particular illness and end up going home with another illness. It can cause early death in some cases.”
Similarly, Dr. Uchenna Lawrence Egwu said: “Syringes and needles are essential pieces of medical equipment used in the parenteral (intravenous, intramuscular and subcutaneous) administration of pharmaceuticals to animals and humans. They are among the ‘notified devices’ globally. Therefore, the importance of standard in their production, storage and use cannot be overemphasized. Their production process is expected to follow scrupulous, and stringent quality control measures to ensure safe administering of medications.
“All medical devices are highly regulated by World Health Organisation (WHO) and other relevant national agencies, and syringes and needles are no exception. To ensure safety of these devices, uncompromising quality control measures at every stage of their production, storage and use are critical.”
Egwu said these measures include gross inspections, dimensional validation, functional efficiency tests, sterilization validation, etc.
“By following the above measures, syringe and needles for use are expected to meet the necessary specifications and be free from contaminants; thus, adjudged as being standard products. ‘Substandard/out of specification medical devices are authorized medical products that fail to meet either their quality standards or specifications, or both’.
“The abundance of fake and substandard medical and pharmaceutical products in Nigerian markets is no longer news. Again, there are innumerable alarming reports of unethical practices among professionals, including healthcare providers.
“The use of substandard syringes and needles are extremely hazardous. Both needle and syringe must be discarded once used. It is not safe to change the needle and reuse the syringe. Such practice can transmit pathogens from one patient to another. Reusing a needle or syringe can put patients in danger of contracting hepatitis B virus (HBV), hepatitis C virus (HCV), HIV, etc.
“Substandard syringes, needles, and all the notified devices have grave health and economic implications, and must be individually and collectively resisted for a healthy and prosperous Nigeria.”
Dr Kayode O. Valentine, a consultant paediatrician and neonatologist, also offered insights on the issue. He said: “What defines substandard is any product that does not meet quality in terms of the acceptable quality or standard generally. When you say substandard syringes, that means the syringe do not meet the recommended standard for hospitals to use.
“I must qualify that as hospital used syringes. Though there are other things that are not used in the hospitals but they are called syringes. Hospitals that use needles and syringes that do not meet required standards are said to be substandard.
“The consequences are grave because these needles and syringes are used together, especially in emergency situations and also non emergency situations. But you will appreciate the value when you have emergency situations when you are supposed to draw a particular injection and as quick as possible.
“Myself and members of my team, we have seen occasions where we try to pull a drug from the vire and it is not been pulled because the covering is blocked or the syringe pressure effect is not felt and you end up wasting time. You can waste important time and at the moment the patient can die because you cannot use you hand to scoop the injection and put in the patient’s veins. You need to get a syringe to bring it out before you can give the drugs. It is a medium of giving the drugs; sometimes in an emergency if a needle or syringe is substandard, it can have grave consequences. It is a grave error to have substandard syringe and needles, some of them even get broken when you are trying to withdraw the syringe from the body. If the syringe does not meet quality, sometimes, it can give an unacceptable result.
“In emergency situations, it is a problem and in non-emergency situations, you may actually be on night duty and a patient is due for a drug but low and behold the syringe and needles are substandard, you will not be able to administer the drug. These are actually important consumables that should always meet the required standard.”
Kayode urged the Standards Organisation of Nigeria (SON) and NAFDAC to keep ensuring that products meet the right specifications or quality products.
“It is very important that these needles and syringes are not substandard i.e they don’t get broken when they are supposed not to be broken because you are supposed to use it on time so that the patients’ life will be saved. Also, for people can get vire injections and dosage at the right time.
“Re-using needles or syringes is dangerous because of infection control. You could spread a germ from one patient to another in the short term and that can give a lot of resistance and the patient can die.
“For example, in the short term, if Patient A has pneumonia while Patient B has malaria, if you exchang syringes and needles, you can transfer germs. The pneumonia causing germs can be transferred to the patient with malaria. So, it is not acceptable to re-use syringes and needles.
“On the long term, you can transfer something as serious as HIV/AIDS or blood borne diseases such as HIV, Hepatisis B, C and they can be transferred from one person to another. HIV/AIDS has drugs and people can manage it but if an individual gets something that he has not had before because he has used a re-used syringe, it is a grievous offence, unethical and it is criminal to re-use needles and syringes.
“If anybody is caught, they should be severely punished because you are endangering the lives of people. In some climes, it is caused by poverty but at the same time, government has to do well in terms of providing resources in rural areas where there are insufficient doctors.
A standard hospital will not re-use syringes and needles but quackery is one thing that encourages reuse of needles and syringes. Policies have to be on ground, strong enough and in rural areas, there is need to look at them and help them because they don’t have doctors and nurses in some of their health care centres, which are not functioning. These are the things that encourage substandard or unethical practices and quackery.
“If these things are looked into, the danger of re-using needles and syringes will be a thing of the past. It is unacceptable, unethical, unprofessional and criminal to re-use needles and syringes for patients,” Kayode stated.
According to the World Health Organizations (WHO), ”blood-borne diseases such as hepatitis B, hepatitis C and HIV/AIDS can be transmitted through unsafe injection practices, including overuse and more dangerously reuse of injection equipment.
“These viruses can remain dormant in the body for a long time before the first symptoms start to appear. Thus unsafe injections can lead to a silent epidemic that occurs many years after the original unsafe injections which caused the infections.”
In trying to deal with the situation, the Senate, in 2021, initiated probes into the state of manufacturing, importation and policy guideline for syringe and needles. It also summoned then ministers of health and trade as well as the director general of NAFDAC, among others.
The Senate raised the alarm that imported substandard, unsterile, used and rewashed syringes and needles from the Asian continent had flooded the country. It said it would investigate the unwholesome unwholesome practices endangering the lives, health and safety of Nigerians.
According to the Senate, an over one billion units of syringes and needles are being imported into the country annually, leading to huge loss of foreign exchange. It explained that the estimated requirement of syringe and needle in the country is 1.5-2 billion units per annum.
The position of Senate was sequel to a motion titled, ‘The need to regulate the manufacturing, importation, and use of syringes and needles to protect the lives and safety of Nigerians as well as the economy of the country.’ It was sponsored by Senator Ibrahim Oloriegbe, representing Kwara Central and co-sponsored by Senator Suleiman Umar, from Kwara North.
In his presentation, Sen. Oloriegbe said that the Upper Legislative chamber was “aware that syringes and needles are essential medical products used for the administration of drugs parentally (Intravenous, Intramuscular, Subcutaneous) to safe human lives. It is also used for the collection of blood samples for purpose of laboratory tests and in some surgical procedures;
“Aware also that if not sterilized “and of the right quality, the use of syringes and needles could cause disease and even death to the patient. Hence, instead of being a life-saving instrument, it becomes a danger to the patient.
“Further aware that syringe and needle manufacturing is a very strategic Industry for National development particularly in the Health sector and is also of great importance in attaining the Sustainable Development Goals (SDG) on Good Health (SDG 3) and good Job/Economic Growth (SDG 8). The syringe manufacturing industry is a developing sector in Nigeria and has seven (7) existing manufacturing factories, cut across the nation.”
Remarking that the estimated requirement of syringe and needle in the country was 1.5-2 billion units per annum, he said that the Senate “notes that certified and approved local manufactures of syringe and needles in Nigeria by NAFDAC have the capacity to produce 1.6 billion units per annum with a potential to produce 2.4 billion units per annum if provided with favorable business environment;
“Worried that despite this capacity, an estimated over one billion units per annum of syringes and needles are being imported into the country making the country to lose huge foreign exchange.
“Further worried that majority of the imported syringes and needles are substandard, unsterile (used and rewashed syringes from Asian continent) hence endangering the lives, health, and safety of Nigerians;
“Concerned that despite the introduction of 75% import duties on imported syringes and needles, the Customs department is not enforcing this, enabling mass importation of cheap substandard and unsterile syringe and needles.
This action is killing the local manufacturers making them lay off staff and preventing them from contributing effectively to the economy;
“Concerned further that the plan to establish and implement a Backward Integration Policy (BIP) to feel the gap between need and local production by the Ministry of Trade and Investment has not been given the desired necessary action. This has contributed to the indiscriminate importation and killing of the Local manufacturing efforts; and
“More concerned that the Federal Ministry of Health does not have an effective policy on the procurement and utilization of syringe and needles by the federally owned hospitals and agencies. This has led to federally owned hospitals to sometimes procure and use substandard syringe and needles in their centers.”
He remarked that investment in the sub-sector was about N64 billion with a potential market value of about N100 billion that could be created locally, engaging about 3000 Nigerians directly and saving the country about $150 million in foreign exchange requirement per annum.
It was learnt that the menace assumed a life of its own when NAFDAC was removed from the Port between 2011 and 2018. As Adeyeye put it, “during that time, cabals were formed. And you know you cannot remove cabals overnight. Removing such cabal from the port is not easy. And you think things will work well with them there? Certainly no; not immediately.”
It was also learnt that substandard syringes and needles are imported by companies who outsmart NAFDAC. Such dubious companies present good samples to NAFDAC to get approval but will bring in something different. Again, there is the issue of some people preferring foreign made goods irrespective of the quality.
Available data from the National Bureau of Statistics (NBS) showed that in 2023, Nigeria imported medications worth N81.81billion between July and September, 2023. This is an increase of 68 per cent from the N48.74billion worth of drugs imported in the same quarter of 2022. With fewer manufacturers and distributors due to the exit of major pharmaceutical companies, there is a decrease in competition and astronomical rise in the prices of essential and generic drugs in the country.
The MAN also disclosed that based on its “survey since 2013, cumulative new manufacturing employment was estimated at 1,686,725 at the end of 2022. However, in the second half of 2022, manufacturing employment dipped to 6,741, down from 8,508 and 9,559 recorded in the corresponding half of 2021 and the first half of 2022, respectively.
“The decline in the number of jobs created in the sector during the period corroborates the poor operating business environment that was perverse with high energy cost, exorbitant cost of borrowing, high inflation, low sales due to limited cash and many more.”
Stakeholders are demanding that stifling government policies should be adjusted to encourage local production of goods. They argue that if the economy does not improve, the people will continue to bear the burnt.
A businessman, Mazi Uche Kalu, said: “Government should create a stimulus programme to save the economy. They should find a solution to high energy cost, free-fall of the naira, lack of access to cheap credit, poor roads network, multi-dimensional poverty and hunger in the land.
