Big Pharmaceutical: Africa Fake Drugs

?

Is War Against Bad Medicine Paying Off?

2009-08-01
Roger Bate & Thompson Ayodele*

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 to 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.

*Bate is the Legatum Fellow in Global Prosperity at the American Enterprise Institute, a Washington DC think-tank. Ayodele is the Executive Director of the Initiative for Public Policy Analysis in Lagos, a Nigeria public policy think-tank.
www.thisdayonline.com/nview.php?id=150420

+Recent Paper, Drug Use In Nigeria can be downloaded at:
http://www.fightingmalaria.org/pdfs/nigeria_drug_project_august2009.pdf

---

NEWS RELEASE: IPPA Study Indicates Counterfeit Medicines still Prevalence but on Decline

August 3rd, 2009

Lagos, Nigeria: The Initiative for Public Policy Analysis, a Nigeria public policy think tank, Africa Fighting Malaria and American Enterprise Institute, a Washington DC think tank, has published a working paper: Drug Use In Nigeria.

The paper indicates there is prevalence of sub-standard and fake drugs in Nigeria but this is on decline. The paper also discovered irrational drug use and healthcare personnel acknowledged patients purchasing medicines from unregistered channels, and without valid prescriptions.

For decades, Nigeria has been plagued by counterfeit and poor-quality medicines, yet little information exists on the extent to which healthcare personnel are aware of counterfeit and substandard medicine, and how this influences their behavior.

Field researchers administered informal questionnaires to 211 healthcare personnel in Lagos, Ondo, and Ogun states of Nigeria about patient behavior and their own awareness of, and exposure to counterfeit and substandard medicines.

Respondents frequently cited the high cost of medicine as explanation for the proliferation of poor-quality drugs. Most healthcare personnel were aware of the problem, but their ability to identify and respond to poor-quality medicines differed widely.

Researchers 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, including earlier research by some of the authors, that the prevalence of poor-quality medicines may be decreasing in Nigeria—possibly because of improved policing and prosecution of counterfeiters by the National Agency for Food and Drug Administration and Control. Government, industry, and the public health community can work together to improve consumer and healthcare worker awareness, and increase access to low-cost, high-quality pharmaceuticals.

And while Nigeria still has problems to overcome it is well ahead of other African nations in combating the scourge of substandard drugs. Indeed it could be viewed as a model for other countries in Africa – as such the bar should be set high for combating poor-quality drugs in Nigeria.

Media Contact: +234.80. 2302.5079 and +234.1.791.0959
Full paper can be viewed at:
http://www.fightingmalaria.org/pdfs/nigeria_drug_project_august2009.pdf

---

FOR IMMEDIATE RELEASE
21st? May 2009

Fake drugs kill over 700,000 people every year – new report

(Lagos, Nigeria): A new report co-sponsored by International Policy Network (London) and Initiative for Public Policy Analysis (Nigeria) details the shocking burden of fake drugs in less developed countries.

The report notes that fake tuberculosis and malaria drugs alone are estimated to kill 700,000 people a year. That’s equivalent to four fully laden jumbo jets crashing every day.

The report lays bare the ballooning problem of counterfeit and substandard drugs, which can constitute one third of the drug supply in certain African countries. These dodgy drugs result in unnecessary death and increased levels of drug resistance.

The report highlights more shocking evidence, such as:

•Nearly half the drugs sold in Nigeria, Ghana Angola, Burundi, and the Congo are substandard •About two thirds of artesunate (anti-malaria) drugs in Nigeria, Laos, Myanmar Cambodia and Vietnam contain insufficient active ingredient •Most fake drugs originate from China and India

Current attempts to deal with the problem through tougher regulation and criminal penalties do not address the root causes of counterfeiting.
Worse, many countries have corrupt regulatory and legal systems that are easily exploited by criminal counterfeiters, so additional rules will only increase corruption.

Governments also exacerbate the problem by making legitimate drugs more expensive through taxes and tariffs.

The report stresses that what is needed are effective mechanisms to enable purchasers of drugs to be assured that what they are buying is the real thing. Identity preservation systems using unique codes verifiable through a simple text message are one possible solution. More effective trademark systems would also help.

Co-sponsor and Executive Director of IPPA Nigeria, Thompson Ayodele, said:
?”Substandard drugs thrive in Africa because many people who are victims do not have the courage to divulge the culprits to authorities because of fear of being attacked by the counterfeiters. This happens because of the weak penal system that gives light sentences to the perpetrators. Unless African countries begin to institutionalize respect for trademark laws, ensure that the judicial systems is strengthened and government reduces tariffs, taxes and VAT on drugs, fake or substandard drugs will continue to pose challenge in healthcare delivery”

*The entire report can be viewed at:
http://policynetwork.net/uploaded/pdf/Keeping%20it%20Real%20low-res.pdf

* *For more information contact Thompson Ayodele? +234 80 2302 5079 or thompson@ippanigeria.org

Initiative for Public Policy Analysis (IPPA) is a non-profit, non-partisan, non-government public policy think-tank working to promote institutions that enhance development. This year IPPA Nigeria is named among most influential think tanks in the world.