Is War against Bad Medicine Paying off?

Roger Bate & Thompson Ayodele | 01 Aug 2009
This Day
For at least three decades, Nigeria has been plagued by counterfeit and poor-quality medicines. In 2002, the World Health Organization reported that 70% of medicines in Nigeria were fake or substandard while the National Agency for Food and Drug Administration and Control (NAFDAC) estimated a full 41% were fake. Today, it offers a rare model of improvement. Like many other developing countries, corruption in the healthcare sector was rife: drugs, such as antimalarials, and supplements, especially vitamins, which are both in high demand, routinely "leaked" from public facilities into the private market. Plum healthcare positions were not awarded to the best candidate but the most politically connected, or the one willing to pay the largest bribe. Intellectual property rights remained among the world's most poorly enforced.

But in the past five years NAFDAC has fought back. Originally under the leadership of Dora Akunyili and now Paul Orhii, NAFDAC has arrested counterfeiters, closed down markets selling their drugs and banned dozens of Indian and Chinese companies from exporting to Nigeria. As a result the amount of fake drugs on the market has fallen drastically: NAFDAC estimates now it is less than 16% of the market. Our research group decided to sample drugs to see if rates had fallen from our own previous research. In 2007 we'd found a failure rate of 32% of antimalarials. We also decided to see how aware Nigerian healthcare personnel were of counterfeit and substandard medicine, and how this influences their behaviour.

Our team administered informal questionnaires to 211 healthcare personnel in Lagos, Ondo, and Ogun states about patient behaviour and their own awareness of, and exposure to counterfeit and substandard medicines. They reported that some patients acknowledged purchasing medicines from unregistered channels, and without valid prescriptions. Respondents frequently cited the high cost of medicine as explanation for the proliferation of poor-quality drugs. "Where people cannot afford the best medicines, they buy what they can, regardless of quality", a doctor told us in 2007 and little seems to have changed.

Most healthcare personnel were aware of the problem, although few realize that costs are driven up by imprecise and sometimes excessive regulation, but their ability to identify and respond to poor-quality medicines differed widely. Worryingly, healthcare personnel thought at least a third of their patients bought drugs from unsecured markets like commercial buses and roadside hawkers. They thought that the most faked drugs were those in high demand like antimalarials. Unfortunately, very few healthcare workers informed NAFDAC, and far fewer the police, when they encountered fake drugs. Far more destroyed the fake drugs they came across. Many admitted selling unregistered drugs. A key reason is that healthcare workers fear retribution from counterfeiters if they raise a stink or refuse to sell fakes. Even the former head of NAFDAC was shot at by counterfeiters so a lowly pharmacist has little protection from such threats.

Our team also procured a small sample of essential medicines from pharmacies in Lagos to assess basic drug quality within the city. 18% of drugs failed thin-layer chromatography and/or disintegration tests. These results support findings that the prevalence of poor-quality medicines may be decreasing in Nigeria, probably because of improved policing and prosecution of counterfeiters by NAFDAC. All in all, Nigeria still has a major problem with fake drugs. Healthcare workers are not well enough trained to identify fakes and 91% of those we surveyed expressed concern that substandard medicine still poses a threat to public health.

Nevertheless, the situation is improving. Government, industry, and the public health community are working together to improve consumer and healthcare worker awareness, and increase access to low-cost, high-quality pharmaceuticals. And while things are far from perfect, Nigeria is well ahead of other African nations in combating the scourge of substandard drugs: indeed others should follow its example.

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