Nigeria’s Drug Industry
Why Nigeria Drug Industry is Increasing Mortality Rate
By Kate Umukoro-Edege
Ufuoma Akpofure, 77 is a grand mother based in Warri. She bought a recommended drug at a pharmaceutical shop at Airport road but unknown to her the drug given to her was of a higher specification. By the time she took it after her dinner she began to feel dizzy. She quickly picked up the sachet of the drug to read it. That was when she discovered that what was sold to her was a higher version of the recommended drug.
If she was lucky, it was not so with Henry Okafor, 44. In his case, Okafor, a carpenter based in Asaba, the Delta state capital, could hardly afford food and household needs, let alone a medical consultation fee or diagnosis, yet he was terribly ill. In June this year he sent a relation to visited a “chemist”-an informal name for drug merchants with or without medical background who own a drug store at a popular medicine market in Onitsha who sold a cheap drug for Okafor’s ailment. After taking the drug for about ten days, his health began to deteriorate and he was rushed to the hospital where it was diagnosed that the drug he has been taking was sub-standard. Unfortunately, he died two days later.
In Nigeria, health experts are worried about the widespread reported cases of counterfeit and substandard drugs across the country from both local and foreign manufacturers. These drugs are bought by people who either cannot identify fake medical products or are seeking cheaper alternatives to genuine products.
A United Nations, UN study on drugs and crime revealed that about 500,000 people die annually from counterfeit drugs in Sub – Sahara Africa countries Also trafficking drugs is also taking a direct economic toll on affected countries.
International operations saw more than 605 tons of medical products seized in West Africa, between January 2017 and December 2021. Typically, these products travel through mainstream international trade channels, mainly by sea. Some of the drugs were diverted from the legal supply chain. Those with inside knowledge say the products often come from major exporting countries to the Sahel region, including China, Belgium, France and India. Others are manufactured in neighbouring countries. Once in West Africa, smugglers move the drugs or medical products by bus, cars and trucks to the Sahel, following existing trafficking routes, to avoid border controls.
Investigations revealed that terrorist groups and non-State armed groups are commonly associated with medical product trafficking in the Sahel, but their involvement is limited. These groups levy “taxes” in areas they control or they abuse the drugs themselves.
UNODC report states that investigations have uncovered a variety of actors involved in the illicit medical product trade. Traffickers include pharmaceutical company employees, public officials, law enforcement officers, health agency workers and street vendors.
Report says that high prevalence of infectious diseases coupled with challenges in access to health care, including affordability, means “demand for medical products and services is not fully met through formal channels” creating an opening for organized criminals involved in trafficking and sales of fake drugs.
The Pharmacy Council of Nigeria (PCN) in trying to sanitize the drug industry in its efforts to reduce the deaths rate in the nation resulting from fake, expired or substandard drugs, began crack down on illegal medicine stores in the country and sealed 1,409 of them in six months, from April to September 2024.Out of the 1,409 sealed stores 1,115 were patent medicine shops while 294 were pharmacies.
The PCN, a Federal Agency responsible for overseeing pharmacy practice in Nigeria which was established by the pharmacy council of Nigeria Act 2022 with the primary goal of ensuring that pharmaceutical practices in the country meet the required standards, lamented the lack of mobilization as the reason why they can not efficiently carry out their duties.
Beyond that analyst and health experts argued that the National Agency for Food and Drug Administration and Control, NAFDAC, needs to fix its system. They equally expressed concern over the waning power of NAFDAC especially during the era of former Director- General, Dora Akunyuili, however when NAFDAC was contacted for comments they did not respond to the magazine’s request for comments.
These Revelations have left a lot of concerned citizens worried as to how so much deaths could be happening as a result of fake and substandard drugs in countries where there are supposed to be bodies that ought to check these menaces of fake drugs especially in Nigeria.
Somehow, the supply and sales of fake drugs have triggered deadly results. For example, there are 267,000 deaths resulting from substandard malaria drugs and about about 169,000 deaths as a result of fake antibiotics used to treat severe pneumonia in children.
Recent alerts from the National Agency for Food and Drug Administration and Control, NAFDAC, also warn of adulterated cough syrups, antibiotics and other children’s remedies in the market.
Counterfeit drugs are a deadly and growing problem globally, particularly in developing nations where supply chain security is limited, undermining progress towards meeting the UN’s Sustainable Development Goals. Nigeria’s case is even worse according to health workers.
Investigations revealed that, in 2022 alone, across Nigeria amid the reported surge of multiple counterfeit drugs in circulation, the National Primary Healthcare Development Agency, which is charged with primary health welfare delivery under the Federal Ministry of Health, stated that about 70 percent drugs distributed in the country are either sub standard or counterfeit. Also, a United Nations Office on Drugs and Crime (UNODC) states in its new threat assessment report that trafficked medical products kill almost half a million sub-Saharan Africans every year.
Furthermore, the magazine investigation shows that the statistics on deaths caused by fake, expired and substandard drugs in Nigeria is indeed alarming. For instance, between November 2008 and February 2009; 84 Nigerian children died from acute kidney failure due to contaminated teething syrup containing the industrial solvent diethylene, glycol etc. Experts say the incident highlights the severity of fake, expired and substandard drugs in Nigeria.
This explains why experts warned that the first 28 days of life – the neonatal period – is the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life at an average global rate of 17 deaths per 1,000 live births in 2022, down by 53 per cent from 37 deaths per 1,000 live births in 1990. In comparison, the probability of dying after the first month and before reaching age 1 was estimated at 11 deaths per 1,000 and the probability of dying after reaching age 1 and before reaching age 5 was estimated at 9 deaths per 1,000 in 2022. Globally, 2.3 million children died in the first month of life in 2022 – approximately 6,300 neonatal deaths every year.
Curiously, the World Health Organization, WHO, estimates that caring for people who have used falsified or substandard medical products for malaria treatment in sub-Saharan Africa costs between $12 million to $44.7 million every year.
Beside, a medical practitioner who pleaded anonymity because of fear of stigma from the health authority said fake and substandard drugs not only causes harm but also lead to treatment failure and more disease progressions.
This was corroborated by a Matron (name withheld) at University Teaching Hospital, Benin who noted that counterfeit and substandard drugs are one of the factors responsible for increase in mortality rate. She further noted that widespread circulation or fake low quality medicines often containing incorrect or harmful ingredients are common occurrences in the drug industry. A development she says lead to increase in mortality rate in Nigeria. She also identified improper and poor storage of drugs as another reason for increase in mortality rate in the country.
Furthermore, the magazine’s Reporter gathered that lack of adequate regulation; inadequate oversight and enforcement by regulatory agencies that allow unapproved or unsafe drugs to enter the market contributes in no small measure to increase mortality rate.
Another Health Worker at the Lagos State Teaching hospital who did not want her name in print noted that self-medication and misuse of drugs often without proper medical guidance, increases mortality rate.
Furthermore, a Pharmacist based in Ikeja, Lagos averred that high costs of drugs makes it unaffordable; a development which he said could lead to delayed or foregone treatment.
Hence he advocated for subsidisng of drugs to Nigerians in order to tackle
the problem of in affordability. He also advocated for a capacity-building programme for healthcare professionals on pharmacovigilance and drug safety.
Accordingly to Mr David Ochuko a health Care practitioner expressed concern that the recent move by two giants pharmaceuticals; Glaxosmith Kline (GSK) and Sanofi to end operations in the country has made legitimate Medical products more scarce thereby giving room for fake drug peddlers to operate ,he further said that Nigeria health sector along with all her health enforcement agencies must deliberately filter and regulate the global supply chain of the medical products that find their way through the nation’s borders.
Curiously he complained that a lot of the victims of fake, substandard and expired drugs are people who either cannot identify these drugs or are seeking cheaper alternatives to pricey genuine products due to the economy situation of Nigeria.
Meanwhile, the magazine’s Reporter discovered that inadequate training for healthcare workers especially the ones that handle administration of drugs is a factor in the drugs industry. There is also corruption and inefficiency within the healthcare system.
This may be why a health and drug administration expert, while addressing the issues noted that the country requires a multifaceted approach. The drug industry; he further explained, needs to strengthen the drugs regulatory framework in order to enhance the operations of the drug industry in Nigeria.
He also called on the African Union which established the African Medicines Regulatory Harmonization initiative in 2009 to improve access to safe and affordable medicine through the various heads of the African countries.
Accordingly, he stated that Nigeria with the highest black population needs a public awareness campaigns to educate the citizens on proper drug use and the risk involved as part of the measures to reduce the increasing high mortality rate in the country.