Health - Recently, there has been rising concern over Nigeria's over-reliance on foreign countries for its medicine needs. A conservative estimate put the drugs import consumed by Nigerians at about 70 per cent, which in the words of stakeholders, is dangerous as Nigeria has more than 150 million people. At a workshop held recently in Kano State for patent drug sellers on adulterated and substandard regulated products, the director-general, National Agency for Food and Drugs Administration and Control (NAFDAC), Dr Paul Orhii raised alarm over the dangers posed by fake and counterfeit drugs to healthcare delivery in the country. He disclosed that apart from the obvious health hazards associated with counterfeit medicines, their proliferation also endangers the economy.

According to him, fake drugs lead to treatment failure and development of drug resistance which, in turn, make people lose hope in the healthcare system, as they also undermine the efforts of manufacturers and importers of drugs which has a draining effect on the nation's economy.

Gone are the days when anyone can easily detect whether a drug is fake or genuine simply by looking at it.

In the words of Orhii, the average man in the village cannot simply identify fake drugs, not even the average person in an urban setting; not even him as the DG of NAFDAC.

He blamed the situation on the current sophistication in printing technology. "It used to be that the counterfeiter would just write something and you know that their English will be wrong, everything will be wrong and when you look at it, you know that something is wrong with the medicine. At that time, we used to tell people that if they want to buy a product, they should look for the NAFDAC registration number and when they see it, it's good. But I cannot say that today, because these people are sophisticated now in printing technology. If somebody can go to the extent of making a fake tablet, to look exactly like the genuine one with all the minute details, what stops that person from maybe writing the NAFDAC registration on the packaging?

It's so easy. In fact, NAFDAC registration number is the easiest thing to make by any printer in Nigeria now. They even improve on the original. We intercepted medicines, we tried to use holograms to show the authenticity of products that we approved. We intercepted medicines that were counterfeits but that had holograms where the original did not have a hologram yet. So you can see the counterfeiters are ahead of the game."

Realising the overwhelming need to tackle this hydra-headed monster, the DG NAFDAC, noted that the indigenous production of drugs would reduce the country's over-reliance on Chinese and Indian products, adding that if Nigeria produces its own drugs locally, it would be able to ensure the safety of the drugs.

The federal government, through the Bank of Industry, set up a N200 billion intervention fund for indigenous pharmaceutical manufacturing firms to take off, so that Nigeria can become self-sufficient in the supply of essential medicines and also become a main exporter of medicine, instead of the current situation where it is the main importer of medicines from other countries.

Orhii explained that as a first step, what the agency did was to invite the World Health Organisation (WHO), because for the country to be able to become a net exporter of medicine, it had to be WHO prequalified, and have facilities that are WHO prequalified.

WHO prequalification is needed, according to him, because international donors buy medicines only from WHO prequalified companies.

He explained, "For example, the other year, Global Fund expended $4.7m acquiring medicines for donation to developing countries. Nigeria with a population of 150 million people is a major recipient of these donations and yet no single dollar was spent here, simply because we do not have any company that is WHO prequalified. The only countries on the African continent that are prequalified are one in South Africa, one in Morocco and one in Uganda. In Nigeria or West Africa, there are no companies that have WHO prequalification. And so when we looked at the matter and when we looked at the fact that we import 70 per cent of medicines that are needed in this country, we did that analysis and came to the inescapable conclusion that the availability of these pharmaceutical products for Nigerians at affordable prices is a national security issue."

The DG said about 11 companies were selected and taken to Geneva for a workshop at the WHO so that they would be trained and the prequalification programme extended to them.

"Surprisingly," he said, "When we arrived Geneva, we found that India and China had been there for the past six years as a deliberate policy of their governments, to support the pharmaceutical industries in these countries. We were going there for the first time. The WHO experts have done the workshop for our pharmaceutical industries, looked at where we are and they have designated some experts to come to Nigeria this month, audit their factories and look at where we are, and what they need to do to get to where they need to be, so that we can begin to work on them."

Speaking more on the intervention loan, Orhii disclosed that, "We realised that with the banking system currently, the loans are not favourable for industrialisation. There are no long term loans; even the interest rate is too high. So we needed to come up with a pharmaceutical intervention fund that is a deliberate effort by the government to encourage mad-in-Nigeria medicine. That is why the minister of health got us to have a document with the Bank of Industry, worked us one with the Central Bank of Nigeria and we came out with a document. In the document, we are requesting N200 billion pharmaceutical intervention fund, so that the loans will be made available at single digit cost to pharmaceutical industries to help them and then there will be long term loans to help them develop. The minister of health led the delegation to the president, along with the then minister of finance, the minister of state for commerce and industry and the managing director of the Bank of Industry.

The president received the proposal very well, but the problem right now is that we are to source the resources, the money. That is what we are working on currently. The money has not yet been made available and the programme has not taken off, even though some industries are investing their own resources. Last year, Juhel Pharmaceuticals built a state-of-the-art infusion manufacturing company, the biggest on the African continent, using German technology. It satisfies even WHO requirements and the president commissioned it last year. This year, May and Baker similarly invested about N4 billion of their own money to build a giant manufacturing company that is of world standard and the president just commissioned it this month."

However, the director-general, Nigerian Institute of Pharmaceutical Research and Development (NIPRD), Prof K. Gamaniel said that though there are over 100 indigenous pharmaceutical companies, the issue is their capacity in terms of infrastructure and funding.

He observed that it is cheaper to import drugs than to manufacture locally, because of the running costs. "For instance," he explained, "The running costs for a company is higher here than what it is abroad. So if you include transport, you can still get drugs cheaper when imported than when produced here. It's not as if our companies are incompetent. Most of our companies now are indigenous; we have Juhel, which just opened a new complex and May and Baker.

The problem, he said, lies in the fact that companies operate their business for profit. "They use the opportunity of need to also make profit while they satisfy need, which is the principle behind manufacturing companies and in some private institutions. So the situation we are in is that it's not profitable if you produce, as compared to when you import. Once we solve infrastructural problems like power, especially, these companies will produce at their best. So this funding will go a long way in solving the problem. But I think the greatest problem is power, water supply and local transportion."

He added that these are the things needed to boost local drugs production and bring the prices of locally manufactured drugs down. "So it's not an issue of lack of capacity. Nigerians are competent people. After all, they are also producing drugs for manufacturing companies like Pfizer outside the country."

Nevertheless, Orhii disclosed that another way to rid the country of fake drugs is to sanitise the chaotic drug distribution market.

According to him, Nigeria is one of the only few places on earth where there are places like Idumota Market and Onitsha Bridge Head Market, where drugs are sold just like any other product.

He said, "We tried to close these places down in 2007; it didn't work because we did not have alternative channels of distribution of medicine. Right now, we are working with the private sector and we are quietly opening up this drugs distribution huts. They are built to world standard, to WHO specifications. The temperature is right, humidity is right and the people who man them are qualified pharmacists who know about drugs. We have encouraged the private sector to build this kind of hut in all the states all over the country, so that by the time they finish and we have a way of distributing drugs, we will require that all medicines have to be in that and we can close down the open drug market. We will require that every drug or medicine has to be in that hut and before medicines go in there, all these huts will have the Truscan equipment, to be able to scan the medicines before they are stocked, so that we are very sure of the quality of the medicines going into these huts. From there, we know that as they come in, we'll scan them; when they go out, we'll know where they are going and people who are purchasing them will scan them."

Winifred Ogbebo

Leadership/08/08/2011