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By Enyeribe Ejiogu
Nigeria’s health sector has been careening from one personnel crisis to other, and has been contending with serious infrastructural deficiencies. Policy distortions have particularly affected the development of the indigenous pharmaceutical industry. In this interview, National Secretary of the Pharmaceutical Society of Nigeria, Pharm. Gbenga Falabi, bares his mind on these and other related issues.
Looking at the pharmaceutical industry today, what would you say is the biggest issue of concern for pharmacy practitioners in Nigeria?
It is the same issue of security, security, security, which everybody is worried about. When you are talking about security from the angle of the PSN, you are talking about drug security. Right now India is facing serious health challenges relating to the COVID-19 pandemic which has led to restriction of exports. This first happened in the thick of the pandemic last year. Now they are having a terrible second wave that necessitated restricting exports. This is a big challenge for the Nigerian pharmaceutical industry. The reason is that we depend on Asia for active pharmaceutical ingredients (APIs) as well as formulations (finished drugs that are in ready-to-use state). Principally we import these from India and China, so if anything hits them, it affects us. This, once again, throws up the need to build capacity locally. We have been paying lip service to this for too long. The Federal Government wants us to produce 70 per cent of our pharmaceutical needs locally, which we are currently importing. But where is the encouragement? Where are the clusters for the production of active pharmaceutical ingredients (APIs)?
When you say security, how exactly do you mean?
I say security in the sense of having a national strategic goal towards self-sufficiency in the area of health. Nigeria is old enough and has the human resource to be able to this. In the race to make the Pfizer-BioNtech COVID-19 vaccine, it was Dr. Onyema Ogbuagu, an associate professor, who was involved in the research effort to produce the vaccine in the United States. If the conditions are right, in terms of social security and other incentives, then we will do wonders. This was what India did. It created the right environment and guaranteed social security that attracted her professionals who were overseas, to return home and develop the pharmaceutical industry which has put India where it is today. The question for us is this: how do we woo our professionals in the Diaspora to come back home? Many of them want to return, but the question is: what are they coming home to do? They want to impact the society. They will be more proud to say, ‘This is made in Nigeria. But where is the support? The factory to support their enthusiasm is not available. The finance to support their research is lacking. We have a vaccine laboratory, Biovaccines Nigeria Limited, which was once functional, but it was abandoned. Then a contract was signed between the Federal Government of Nigeria and May & Baker Nigeria Plc for the revamping of the facility about three years ago, as if we knew that COVID-19 was coming. Since that signature ceremony was held, what has come of it?
I was shocked when I got to the Federal Manufacturing Laboratory and learnt that the idea was conceived in the late 1960s. Equipment and machinery are there and lying in waste. In fact, a director who took us round the facility said that a bulldozer can ride through the building up to the last floor. The structure is that strong that it can support the weight of a bulldozer – that tells you the quality of work that went into the construction of the facility. Some element of manufacturing is going on, but should we be talking about that in 2021? Nigeria needs to wake up. If COVID-19 has not been able to wake up the giant in us, I don’t know what else can do it. As a nation, we need to take drug security very seriously. We need to pay premuim attention to social security. Also, we need to police the country; that is very important. The reason is that if there is insecurity in the society, who will go to the factory to work, who will go to the laboratory to do research for drugs? That is why I said that all the major concerns revolve around the issue of security.
Now talking about APIs that I mentioned earlier, the Eleme Petrochemical Plant in River State, which is supposed to produce the materials needed by pharmaceutical manufacturers is not functioning. But there is hope. We got into an engagement with the Dangote Group more than 10 years ago. We invited the President of the Group, Aliko Dangote, to the annual conference of the National Association of Industrial Pharmacists (NAIP), when we heard that he was planning to build a new refinery in the country. We appealed to him to consider including a petrochemical plant in his plans. The fact is that the APIs used in making drugs come from derivatives of petrochemical products. Without a functional petrochemical plant, we cannot synthesise our APIs locally.
So, what was his response?
He sent a representative to the conference though he had wanted to attend in person. What happened was that the Presidency called and asked him to accompany the then President Goodluck Jonathan, who was going on an investment tour to Rwanda. It was that tour that led Dangote to start producing cement in Rwanda. At the conference, NAIP discussed with his representative. It is for us at PSN, PMGMAN (Pharmaceutical Manufacturing Group of Manufacturers Association of Nigeria) or NAIP to follow up now that the refinery is expected to come on stream towards the end of next year, and to see how the petrochemical plant part of the project is progressing, so that people can get ready to key into it.
Assuming we didn’t have the present security challenges, were the things that should have been done during the 10-year period while waiting for the take-off of the petrochemical plant?
Let me put this in perspective: when you look at a particular drug product, there are two major components: the active pharmaceutical ingredient and the excipients. An excipient is a substance formulated alongside the active ingredient of a medication, included for the purpose of long-term stabilization, bulking up solid formulations that contain potent active ingredients in small amounts (thus often referred to as “bulking agents”, “fillers”, or “diluents”), or to confer a therapeutic enhancement on the active ingredient in the final dosage form, such as facilitating drug absorption, reducing viscosity, or enhancing solubility. Excipients can also be useful in the manufacturing process, to aid in the handling of the active substance concerns such as by facilitating powder flowability or non-stick properties, in addition to aiding in vitro stability such as prevention of denaturation or aggregation over the expected shelf life. The selection of appropriate excipients also depends upon the route of administration and the dosage form, as well as the active ingredient and other factors.
Excipients include starch, bulking agents, lubricants that ensure that when you punch the product you are trying to make into tablets, it won’t stick to the mould. I know that members of PMG-MAN (Pharmaceutical Manufacturers Group – Manufacturers Association of Nigeria) have tried to do some backward integration to have a pharmaceutical grade starch factory. But how do you sustain a starch factory that will run on a giant generator 24/7?
What are the materials required to produce pharmaceutical grade starch?
The basic raw material for making pharmaceutical grade starch is corn which is also known as maize. The universities have produced actionable research results on this, instead of relying on the other type of starch. They have done research on how cassava can be processed to be an alternative to corn starch. But by the time you compare the cost of local production to that of importing the finished, ready-to-use starch, the difference is huge for you to be able to compete in terms of price with the finished goods. Even the government does not guarantee patronage of what you produce locally.
Is it that the people in government don’t understand the implication for the economy?
First, there is a policy that says you ‘Buy Made In Nigeria’ goods first before you can buy what you can’t source from here. But who implements those policies? We have been talking about 70/30 for a long time. The government structure for implementation does not exist. It is disjointed. You have a situation where you produce with funds borrowed from banks at 27% interest, and the government would buy through tender but would not pay you three years after you have supplied the goods. If government takes drug security serious in Nigeria, we would put pharmaceutical production in the second place after petroleum products in the scale of priority for foreign exchange disbursement. The pharmaceutical products rank abysmally low on the forex disbursement scale. What we need in terms of foreign exchange is very low compared to other sectors. It is all because people have the wrong attitude towards our health generally, and this has been brought into local drug production.
Why has it been difficult for operators in the pharmaceutical industry to come together, pull resources to establish a factory that would produce pharmaceutical grade starch, by exploiting the benefits of cooperative competition of instead of going about it alone as it is now?
This was what PMGMAN and NAIP were established to do. We are not letting down our guard. We are still engaging with the government and will continue until the goal is achieved. Right now, NAIP is leading the creation of manufacturing clusters. We just got an approval and the foundation laying ceremony has already been done in Abakaliki, Ebonyi State.
The governor has allocated over 100 hectares of land for this purpose. We are also in discussion with Seplat, a private oil and gas company in Imo State, to see where we can create pharmaceutical production cluster.
Power is a major consideration and hindrance. What plans do you have over this issue?
Everyone has over 1000 KVA diesel or gas-powered generator that is causing air and noise pollution. Meanwhile, one independent power project (IPP) can generate more than enough power for everybody in the cluster and drastically reduce the cost of power for everybody and ultimately the cost of producing drugs. If it is possible, where we have clusters, we will engage with the government to grant a waiver to the pharmaceutical industry establish an IPP project.
What needs to be done to end ‘prescribing pharmacists and dispensing doctors’ syndrome? What should be the role of the public to aid the process?
In the first place, the public needs to understand the role of a pharmacist. A pharmacist knows everything about all drugs and a little about diseases, sufficient enough to utilise the drug. A good doctor on the hand knows everything about the disease and has sufficient knowledge about the drugs. What I am saying is that if Nigerians would get this clear, then they will get quality healthcare service in Nigeria. These two people, doctor and pharmacist, must work harmoniously together with respect. The medical doctor respects the pharmacist for his knowledge of drugs and the pharmacist respects the doctor for his knowledge of diseases. When the two work together, then the patient is in for the best healthcare delivery. When people travel abroad, the people they end up meeting there are clinical pharmacists who simply review their drug therapy, make amendments and suggestions; the same dugs, some removed, the dosage adjusted and the man suddenly gets better because he has met someone who has the full knowledge about drugs. So, once the patient realises this that would mark the beginning of the change. Gone are the days when Nigerian public hospitals were led by hospital administrators. That was before Prof Olikoye Ransome-Kuti, the then minister of Health, changed the status quo and brought medical doctors to head the hospitals. How do you bring a surgeon who all through his career has been cutting human beings to be an administrator? He was not prepared for it, and you have seasoned administrators in the system. I will not conduct a surgery, so why should a surgeon now want to play the role of the pharmacist. Nigeria is the only country in the world that is still wasting health professionals as hospital administrators. We don’t have enough doctors or pharmacists in the country, so it is an aberration taking these professionals who should be attending to patients and having them sit down to deal with files and other administrative issues.
Is it possible to revert to the era when our hospitals were properly structured and functioned well?
It would be nice if we revive that era.
What do you think it will take to bring back that era?
The simple answer is that the people who we are serving must push and campaign for it.
And who can lead that kind of campaign?
Those who have travelled overseas for health issues and have benefited from the experience, I believe that common sense should make them eager to push for this, to revitalise and transform our healthcare system. When they go to hospitals overseas, they should seek to know who leads the hospital facility, who is the administrator there? I was surprised when I visited a hospital in Canada and saw that the person who was doing the posting of pharmacists was a nurse. They have more nurses than pharmacists. And Canada can never have enough pharmacists. Do you know what it takes to become one and the requisite knowledge that the pharmacist carries? They don’t want to waste it. But here there is no social security and people are looking at where their bread is buttered the most. You see clinicians and other healthcare professionals going for developmental courses and programme that enable them offer better services to the patients. But here we leave the health of the masses in the hands of stark illiterates.
