The counterfeit drug market is booming in Nigeria, no thanks to an unregulated pharmaceutical industry and other factors that have sustained the illegal business for decades. The healthcare system is under siege and has been so for many years. Marketplaces are flooded with so many adulterated drugs that kill or aggravate people’s ill health. The healthcare industry has been destabilised and weakened by fake and counterfeit medical products that are pushed into the country by crooked officials, including unregistered businesses, unqualified touts operating as pharmacists, unregulated and/or improperly supervised pharmaceutical industry, unethical people operating pharmacies without approved licences, and couriers of hard drugs who want to make quick money from a disorganised industry.
All these must be attributed, in part, to an import-dependent economy. When a country relies on importation of medical products to service the healthcare needs of citizens, one immediate outcome is the infiltration of fake and counterfeit drugs that pose serious health hazards to citizens. This leads to increase in illnesses among the population and, in many instances, deaths.
Unfortunately, it is now too late to hold the outgoing government of Muhammadu Buhari accountable for abdicating its obligation to provide for the healthcare needs of Nigerian people, to tighten the regulations that guide the operation of pharmaceutical businesses, to prevent the importation of fake drugs into the country, and to make it harder for citizens to easily access dangerous drugs marketed in open spaces.
It is worthless to expect a government that is now focused on the May 29, 2023, handover deadline to do anything serious to uphold its duties to citizens. What the Buhari government could not achieve in eight years cannot now be accomplished in 27 days leading to the handover to a new government. The incoming government must take responsibility to develop an efficient plan that would protect civil society from possible outbreak of any health-related epidemic that could be caused by consumption of fake drugs.
The recent warning issued by the National Agency for Foods, Drug Administration and Control (NAFDAC) over the illegal marketing and circulation of adulterated cough syrups underscores the extent to which the country’s healthcare system has been compromised, damaged, and hijacked by merchants of adulterated drugs.
It is not only fake cough syrups and antibiotics that are readily accessible in open markets in Nigeria. There are also thousands of dodgy, dangerous, unsafe, and illegal medicaments circulating in the society. Former NAFDAC director-general, Dora Akunyili, lived and nearly lost her life because of her determination and commitment to rid the society of counterfeit drugs. Fighting the merchants of fake and adulterated drugs in Nigeria and overseas is as fierce and deadly as fighting crooked officials in Nigeria.
As former chairperson of the Economic and Financial Crimes Commission (EFCC), Farida Mzamber Waziri, said when you fight corruption in Nigeria, you can expect corruption to come back fighting vigorously and ferociously. This suggests that the war against marketing of fake drugs in Nigeria and in other countries is a dangerous occupation. We live in an environment in which the marketers of illegal products believe that anything that hinders the growth of their prosperity and illegal business must be stopped, even if it involves taking human lives.
To understand what it takes to fight fake drug merchants in Nigeria, you must listen to the former director-general of NAFDAC, Dora Akunyili, narrate her personal experience.
In an Australian television interview in 2009, Akunyili revealed how adversity and a death in her family compelled her to carry the war against fake and counterfeit drugs to the doorsteps of the manufacturers of those drugs. The TV reporter asked Akunyili pointedly: “Why are you willing to risk your life on this?” The reporter was referring to the personal sacrifices that Akunyili had to make and the dangers to which she had exposed herself and her family while carrying out her duties.
Akunyili deliberated on the question, sighed, looked directly at the wall of her kitchen, and continued to slice some onions and capsicums on her kitchen table as she prepared a meal. Finally, she responded:
“You see, most of us have suffered from the effects of fake drugs. The best of all my sisters died in the ’80s because she was taking fake insulin. And she was diabetic. Her blood sugar could not be controlled. She got very ill. She had an infection. She needed antibiotics. We bought some antibiotics and she never responded to it. And as a scientist, I knew that if the antibiotic was genuine she would have been fine. And Vivian would have been alive today.”
Moments later, Akunyili explained her personal commitment to fight the producers, distributors and marketers of fake and counterfeit drugs. She said: “The opportunity I have to deal with these criminals is a life opportunity that I should make the best use of. And I’m happy that I make the best of it. I am getting results. We are getting results.”
If anyone tried to measure the value of Akunyili to the Nigerian society and as the boss of NAFDAC at the time she lived, there was only one way to achieve that. You needed to glance at the tight security cordon that was thrown around her wherever she went and also at her residence. She was like a prized piece of gold bar. Everywhere she went, everything she did (except for matters of privacy), she was watched closely by a team of fully armed plainclothes and uniformed security team. The security ring was thrown around Akunyili because she had close encounters with assassins who tried to kill her on various occasions. On each occasion, Akunyili survived through divine intervention rather than by the quickness of her security team.
In her closest encounter with her enemies, Akunyili narrated to the television reporter how the most brazen attempt on her life occurred. “They shot me. And this bullet shattered the back windscreen of my car, entered through my scarf, burnt the base of my hair…It was a horrifying experience,” she recalled. That attempt on her life was made in December 2003, two years after her appointment as NAFDAC boss.
In Nigeria, the dangers of fake and sub-standard drugs circulating in the markets are real. The TV reporter articulated the problem flawlessly when she said fake drugs “kill by stealth, by failing to cure and by creating drug-resistant killer diseases – fake antibiotics, anti-malarials, drugs for tuberculosis, diabetes, heart disease, intravenous drips, injectables all expertly packaged to look real.”
Akunyili responded to the TV reporter’s analysis: “The biggest problem today in terms of counterfeiting is the difficulty in telling the difference between fake and genuine drug. Even the manufacturers of some drugs cannot tell the difference between counterfeit and their drugs.”
This difficult situation has persisted, years after Akunyili departed.
Another devastating effect of fake and counterfeit drugs on the health of average Nigerians (especially those who could not afford to travel overseas for medical treatment) was revealed in 2003 when a team from the International Heart Foundation visited Enugu to operate on children with heart defects. At the University of Nigeria Teaching Hospital (UNTH), Enugu, 12 children underwent surgical operations. One of the children was named Blessing. She was six years old at that time.
The Heart Foundation team was frustrated by the high incidence of fake drugs that circulated in Enugu and indeed in Nigeria. As the team leader noted, more than 75 per cent of the drugs used in treating the children they operated on lacked potency. It was a terrible experience for the international team but it also underlined the enormity of the problem of fake drugs in Nigeria. Four of the children reportedly died, including Blessing. How appalling.