Is NAFDAC really winning the war against fake drugs?

Recently, the Minister of Health, Prof. Onyebuchi Chukwu, was interviewed on 90 Minutes, a current affairs programme on the African Independent Television. The minister used the opportunity to shed light on the achievements and challenges of Nigeria’s health sector. Among the giant strides that he claimed the country has made include the extermination of guinea worm and Type 3 polio; significant reduction in maternal and infant mortality; improvement in the condition of service of health workers – nurses can now go on internship likewise, other professionals in the health sector can now get to Level 17, which is the highest in the civil service cadre. He also claimed that some states in Nigeria had met health-related MDG goals.

The minister tried to distinguish between health and health care and that he was only in charge of health care and not the health of the citizens. He asserted that while efforts were being made to improve health care delivery in the country, there are other things that contribute to people’s well-being like their lifestyle which is totally independent of the health care. For instance, reckless driving, indiscipline, lack of hygiene can cut short people’s lives.   The minister nonetheless agreed with the panel of interviewers that there are still significant challenges with Nigeria’s health care delivery system and that he and his lieutenants are doing their level best to overcome them. Prof Chukwu also strongly advocated for Nigerians to embrace health insurance.

Be thaqt as it may, a critical aspect of any health care system is drug production, distribution and administration. Patients are normally examined and diagnosed by doctors and laboratory scientists followed by prescriptions to the pharmacy for drug purchase while nurses, among other services, ensure proper usage of prescribed drugs. For decades, Nigerians have been under the siege of substandard, adulterated and counterfeit drugs. Charlatans and unqualified personnel have taken over the production, distribution and administration of drugs all over the country. There is also the sale of expired drugs.  This has been the stock in trade of local chemist shops or itinerant medicine sellers; unfortunately, some General Hospitals were recently alleged to have dispensed about-to-expire drugs to some patients. Mention must also be made of genuine drugs that have lost their potency as a result of improper storage. All these have resulted in thousands of premature deaths while some others end up being permanently disabled as a result of being administered counterfeit drugs. This phenomenon is most flourishing at our rural communities and urban slums where the prying eyes of regulatory agencies are less vigilant.

Aside administration of fake and substandard drugs, there is also the largely unregulated activities of herbalists and local medicine sellers. Here, I mean those selling herbal concoctions at motor parks, inside buses and at village markets. There is a popular medicine in Yorubaland known as aporo-epa-ijebu, a much-touted cure-all or antidote to all-known human sickness. This patently dangerous drug is still very much on sale in open market in all nooks and cranny of Yorubaland.

The National Agency for Food and Drug  Administration and Control was established  to safeguard public health by ensuring that only the right quality drugs, food and other regulated products are manufactured, imported, exported, advertised, distributed, sold and used. The agency specifically has the mandate to do the following: Regulate and control the importation, exportation, manufacture, advertisement, distribution, sale and use of regulated products; conduct appropriate tests and ensure compliance with standard specifications; undertake appropriate investigation of the production premises and raw materials of regulated products; and compile standard specifications, regulations, and guidelines for the production, importation, exportation, sale and distribution of regulated products.

NAFDAC also controls  the exportation and issues quality certification of regulated products intended for export;  establishes and maintains relevant laboratories for the performance of its functions;  ensures that the use of narcotic drugs and psychotropic substances are limited to medical and scientific use only;  undertakes the registration of food, drugs, medical devices, bottled water and chemicals;  undertakes inspection of imported regulated products; and,  pronounces on the quality and safety of regulated products after appropriate analysis

In a recent interview in Thisday, August 31, 2013, the Director-General of NAFDAC, Dr. Paul Orhii, said: “…counterfeit drugs were first detected in 1968. By 2001, more than 40 per cent of the drugs in the country were counterfeit or substandard. Due to the effort of my predecessor, by 2005, counterfeit drugs were reduced to 16.7 per cent.”  That should be cheering news, isn’t it? However, Orhii went on to say something scary, which is that narcotic drug barons are now divesting from hard drugs to manufacturing of adulterated and counterfeit drugs. According to him: “With the recent crackdown on illicit narcotic trade, most of the drug barons have now diverted their resources to manufacturing counterfeit medicines. Globally, the business is worth about $75bn annually. That is the quantity of fake drugs circulating internationally; it is more globalised and with the former hard drug barons now entering the business, it has become more militarised. It is now more dangerous fighting counterfeit drugs. Now, they are more sophisticated.” That, indeed, is scary and disturbing.

Orhii is not done, there is another challenge. It’s increasingly difficult to identify fake drugs, he declared aloud. He voiced his frustration when he said: “Before, once you looked at the packaging of a medicine, you knew that they were counterfeit, maybe from the printing. But now, with the sophistication in printing technology, when you see the packaging, it is copied exactly and sometimes they even copy more than the original. We attempted to put holograms on medicines but the counterfeiters got the hologram before us. Nigeria is a good market that attracts drug counterfeiters. We have a huge market; we have a good buying power; so when they bring their counterfeit drugs here, they sell.”  Even though the NAFDAC DG ended the interview on a positive note that his agency had brought the incidence of fake drug to a single digit, I doubt the sincerity of that statement.

Nevertheless, I commend NAFDAC and the Pharmaceutical Council of Nigeria for raiding drugstores with fake, adulterated and expired drugs. However, a lot more needs to be done to safeguard the health on Nigerians.  Preventive medicine and measures are the only foolproof option. After all, if one is healthy, there won’t be any need to use drugs, whether fake or genuine.