By The Guardian
Fifty-Nine-year-Old Evelyn Imo was a constant in the Lawanson area of Surulere, Lagos State, where she lived on Cole Street. Like her distraught relatives, she never imagined that a simple visit to a local pharmacy would lead to her untimely death. But that is precisely what happened.
After Imo came down with an intense fever that left her weak and worried, she walked into a nearby pharmacy, where the pharmacist prescribed some anti-malarial tablets to ease her fever, along with some supplements to support her recovery. Unknown to Imo, the drugs she was handed were no longer safe for consumption as they had expired (some for over a year).
Consequently, the pharmacy’s negligence, rather than helping Imo to recover, worsened her condition with the expired medication poisoning her body. Before anyone knew what was happening, Imo’s system was too compromised to fight back. She died.
Shortly after her untimely demise, the unused medication/supplements were packed up by her children and sent to her frail elder sister, since they believed that the medicines could still be of use. But to her sister’s children’s shock, the drugs were all expired, some even for more than two years.
Horrified as they were, the discovery set in motion an investigation into Evelyn’s death, with experts confirming that the expired medications had become poisonous, contributing directly to Imo’s untimely passage.
With what was initially thought to be a case of an illness gone untreated, looking like a case of preventable death, Imo’s grieving family sought justice by suing the pharmacy for negligence in dispensing expired medication.
Onyinyechi Akabalu, who resides in the Okota area of Lagos State, found it pocket-friendly to purchase medication in bulk from Aba, Abia State, for her mother, who is both diabetic and asthmatic.
For long, a relative who resides in the bustling city of Aba handled that process with religious zeal, and all was well until things took a terrifying turn.
The bulk of medications that arrived one day, which were supposed to ease her mother’s chronic conditions, instead nearly cost her mother her life. “When this offending consignment arrived,” Akabalu recalled, “It was supposed to be just another consignment order, but soon after my mother began taking the medication, things just started to go wrong. My mother’s legs began to swell, and she was unable to walk. As the days passed by, I watched in fear as my mother experienced a series of asthma attacks that did not respond to her usual asthma medication. She struggled to breathe, and no matter how much we tried, nothing seemed to work until she suddenly lost consciousness,” Akabalu recalled.
At the hospital, where the family rushed her, doctors confirmed the worst. “The medications were fake and had no active pharmaceutical ingredient in them.” Mrs Akabalu spent five weeks in the hospital before regaining consciousness and another three weeks to recover. “It was terrifying to see her so sick. Knowing that something as simple as the medicine that was meant to help her nearly killed her still feels unreal. The hospital visits, the endless tests, and the mounting bills are another story…Now, every time I think about buying her medication, I’m filled with fear. I never thought I’d be so scared of buying drugs. All I just wanted ab initio was to make sure that she had what she needed. At this point, I don’t know what to trust,” she lamented.
When her four-month-old baby’s temperature suddenly spiked very late in the night, with accompanying stuffy nose and sundry signs of a fever, Lagos-based mother, Funmi Adebayo, alongside her husband, scurried to a nearby pharmacy/convenience store, where they explained their plight to the pharmacist, who sold them a bottle of Neofylin, a cough medicine, to relieve the child’s discomfort.
“After I gave my baby the medicine, it didn’t seem to be working, but I wasn’t alarmed until my husband took the same medicine. He started having a headache and some reactions. The headache became chronic,” she recounted.
Deeply shaken that a medicine meant for her infant was affecting her husband in such a manner, Mrs Adebayo said: “If we had continued giving that cough medicine to my child, only God knows what would have happened to him. It was clear the drug was fake,” she said.
Containing fake, counterfeit drugs still a long way to go
HEART-RENDING as these accounts by relatives of victims appear, they only represent an infinitesimal percentage of the millions of Nigerians that are either killed, deformed, or rendered partly useless because of fake and counterfeit drug usage.
The sheer scope of what the country is trying to contend with regarding fake and counterfeit drugs can be gleaned from the outcome of fresh raids carried out by the National Agency for Food and Drug Administration and Control (NAFDAC) in parts of the country.
For instance, precisely 17 years 11 months after NAFDAC, under the leadership of the late Dr Dora Nkem Akunyili, in a pre-dawn operation involving a combined detachment of soldiers and policemen in March 2007, raided the popular Onitsha Drug Market “Ọgbọ Ọgwụ,” Bridge Head, Onitsha, in Anambra State.
At the time of closing the market, which had over 2,500 drug shops, the agency described it as a “den of criminals”. The then Director of Enforcement, Dioka Ejionueme, who led the operation, said the closure became inevitable to check the market’s increasing danger to public health.
Nothing supports the fact that Nigeria is increasingly solidifying itself as a fake drugs haven like the worrisome scenarios, where tonnes of fake and counterfeit drugs are unearthed in diverse locations across the country as the agency screened and sealed over 3,000 drug shops in Lagos.
The agency’s renewed assault on counterfeiters also led to the seizure of 87 truckloads of banned, expired, and substandard medical products. Among these confiscated are USAID- and UNFPA-donated antiretroviral drugs, male and female condoms, and other compromised medical supplies.
The Director-General (DG) of NAFDAC, Prof. Mojisola Adeyeye, who made this disclosure recently, warned illicit businessmen that “enough is enough” after massive warehouses stocked with fake and expired medicines were discovered in Ariaria and Eziukwu Markets (Aba, Abia State), Bridge Head Market (Onitsha, Anambra State) and Idumota Drug Market (Lagos State).
Aware of the magnitude of war that must be waged against drug counterfeiters, fakers, and sundry peddlers, the agency earlier this month, proposed the death penalty for drug peddlers.
The DG, while appearing on a Channels Television magazine programme, The Morning Brief, argued that only strict penalties would deter drug peddlers, especially when their actions result in the deaths of children.
“Somebody bought children’s medicine for about N13,000, while another person sold it for around N3,000 in the same mall. That raised an alarm. Guess what? When we tested the medicine in our Kaduna lab, there was nothing inside. So, I want the death penalty. You don’t need to put a gun to a child’s head to kill them. Just give them bad medicine,” Adeyeye said.
In calling for the judiciary and the National Assembly’s cooperation to boost the onslaught, she stressed: “You cannot fight substandard and falsified medicines in isolation. The agency can only do so much, but if there is no deterrent, there will be a problem.
“Someone brought in 225mg of Tramadol, which can kill a person or fry their brain, and the punishment is just five years in prison or a fine of N250,000. Who doesn’t know that a person can simply withdraw N250,000 from an ATM?
“That is part of our problem. There are no strict measures to stop offenders from repeating the same crime. We can only do so much, but if our laws are not strong enough or the judiciary is not firm in its stance, we will continue to face this challenge. So, our judicial system must be strong enough. We are working with the National Assembly to make our penalties much stiffer. But if you kill a child with bad medicine, you deserve to die,” Adeyeye emphasised.
Cartel pushback: A reminiscence of old
FOR years, Akunyili, the deceased DG of NAFDAC, waged a long-standing war against agents of death masquerading as drug sellers/businessmen. Peeved by the death of her sister upon receiving doses of fake insulin, Akunyili, between 2001 and 2009, put her life on the line by targeting drug cartels that operated in different parts of the country.
Her departure from office saw the agency go into something akin to a long, deep slumber while the merchants of death had a field day breaking new grounds and expanding their coasts. This latest round of raids is one of the first times that NAFDAC is burrowing its fangs deep into the flesh of drug fakers and counterfeiters in a long while.
Expectedly, the outcry is loud, with the cartel fighting back while deploying every trick in the books. As Akunyili did, Prof. Adeyeye has also raised the alarm over threats to her life and the safety of her staff as they continue the hazardous assignment of cleaning the Augean’s stables.
Speaking at a State House briefing at the Presidential Villa, Abuja, on Wednesday, Adeyeye reiterated her call for the death penalty for those involved in the production and sale of fake and counterfeit drugs in the country while also disclosing that NAFDAC recently seized illicit drugs are worth over N1 trillion.
Further painting a complex and disturbing picture of the drug situation in the country is official data retrieved from the Nigerian Customs Service (NCS) detailing the interception of illicit drugs, including cough syrup, tramadol, and Indian hemp (Cannabis sativa), over four years.
In 2021, the NCS intercepted 16,722 kilogrammes of illicit drugs with a duty-paid value (DPV) of N885,063,379. 30, while 2022 saw seizures of 133,424 kilogrammes valued at N676,305,411.91.
By 2023, the service confiscated 46,682 kilogrammes of illicit substances, with a duty-paid value of N851,884,010. 52, while last year, 28,434 kilograms were seized, with a duty-paid value of N2,178,283,214.29.
All seizures by the NCS were handed over to the National Drug Law Enforcement Agency (NDLEA).
Counterfeiters driven by pecuniary gains, enabled by lax oversight at seaports
A cocktail of regulatory agencies such as the Nigeria Customs Service (NCS), the National Drug Law Enforcement Agency (NDLEA), the National Agency for Food and Drug Administration and Control (NAFDAC), and the Standards Organisation of Nigeria (SON) among others, straddle every inch of the country’s seaports to ensure that substandard goods, including drugs are shut out, but the reverse is the reality as tonnes of illicit drugs flood the country daily.
The President of the Pharmaceutical Society of Nigeria (PSN), Ayuba Tanko, while sharing his perspectives on the phenomenon, established a nexus between the growing issue of counterfeit drugs, and the departure of international drug companies like GSK and Sanofi from Nigeria.
Tanko, who noted that counterfeiters tend to target high-value products, particularly when genuine products become scarce, explained: “When a desired item suddenly becomes scarce, they will fake it to make money. Fakers are all over the world. The moment an item goes out of place, they will fake it.”
Speaking on local manufacturing, Tanko expressed optimism that if local Nigerian manufacturers start producing high-quality drugs, it will significantly deter counterfeiters. “If many companies in Nigeria are producing good drugs, and the economy improves and the drugs are not that expensive, people will buy the genuine ones,” Tanko stated.
While deploring dire economic challenges facing the country, he emphasised that poverty and the allure of lower prices are some factors that drive consumers to purchase counterfeit drugs, urging them to be more cautious by buying from trusted pharmacies, even if it means paying slightly more.
The National Secretary of PSN, Gafar Madehin, maintained that fake drug dealers are driven by profit, as the focus on anti-malarial, anti-diabetes, and paediatric medications is worrisome.
He elaborated that malaria, being endemic in Nigeria, “counterfeiters’ interest is to make money; a lot of money for that matter. So, that is why they will invest in medications with higher demand. These fakers are in this business for one reason: to make money.” He also noted that children’s medications are another major concern, given the clear and high demand for such products.
On how the issue can be addressed, Madehin cautioned that a sustainable approach is needed to stem the menace, urging the government to prioritise funding and provide other necessary resources for regulatory agencies in the fight against fake drugs.
“The government created this agency, and the reason is clear — drugs and medicines are essential to human life, from cradle to grave. So, we are all exposed to the danger of fake drugs, regardless of our status, but a knee-jerk approach cannot solve the problem,” he stated.
“Nigeria is a vast country, so regulatory agencies need sufficient manpower and resources to tackle this menace,” Madehin added. The Secretary General of the Merchant Seafarers Association of Nigeria, Captain Alfred Oniye, said: “While an agency like NAFDAC has implemented measures to improve quality control at ports of entry such as screening import documents before issuing pre-release stamps and conducting inspections of imported goods, the complexity of global supply chains, corruption, and porous ports and borders continue to pose significant obstacles.”
Oniye said the sheer volume of goods passing through ports can overwhelm inspection systems as limited resources and manpower make it challenging to inspect every shipment thoroughly.
He said counterfeiters use advanced methods to mimic legitimate products, making it difficult for inspectors to detect fake drugs. At the same time, corruption among customs officials and other regulatory agencies’ personnel can undermine efforts to enforce quality control measures.
“Corruption among law enforcement and regulatory officials can facilitate the entry of counterfeit drugs from the ports into the market. Weak enforcement of regulations allows counterfeiters to operate with impunity,” he stated. Oniye also pointed out that the complexity of global supply chains can obscure the origins of goods, making it harder to trace and verify their quality.
The seafarer scribe added that counterfeit drugs enter the Nigerian market through various channels, often exploiting weaknesses in the supply chain and regulatory systems, such as porous seaports and borders, making it difficult to monitor and control the flow of goods as smugglers often use these routes to bring in counterfeit drugs.
He also stated that counterfeiters often repackage expired drugs and alter expiry dates to make them appear legitimate to deceive regulatory agencies at the ports.
To clear terminal operators of complicity in the circulation of fake and counterfeit drugs, the General Secretary of the Association of Bonded Terminal Operators of Nigeria (ABTON), Haruna Omolajomo, emphasised that bonded terminal operators are not aware of the actual contents of containers until the Customs examine them.
Omolajomo explained that if an importer declares a container to carry “vital medication,” it is only when Customs officials open the shipment that the actual contents can be verified.
Omolajomo also highlighted the role of corrupt Customs officials and other regulatory officers in facilitating illegal shipments, asserting that bonded terminals receive only minimal fees as service charges compared to the large sums collected by complicit officials.
“Some corrupt Customs officers demand payments of up to N50 million to allow certain shipments through, while bonded terminals only receive a fraction of that amount in service fees. When illicit shipments are caught, these NCS officers often pretend to be unaware, shifting blame to the bonded terminals,” he revealed.
Addressing concerns about Customs oversight at bonded terminals, Omolajomo affirmed that these officers are mandated by law to conduct a 100 per cent examination of containers before they leave the port or upon arrival at bonded terminals, which he said are properly equipped to conduct these inspections. Any failure to do so should be attributed to NCS officials and other regulatory agencies stationed at the terminals.
The Chairman of the Lagos State Medicine Dealers Association, Island Zone, Mr Innocent Ezennaya, expressed his group’s full support for NAFDAC’s efforts to rid the country of fake and counterfeit drugs. He, however, raised concerns about the origins of fake drugs, questioning how they continue to enter the market despite the presence of agencies at borders, airports, and seaports.
He said: “Some of these fake drugs come through our borders and airports, and we have agencies at the airports and seaports. So, how come these drugs still find their way in? If you do not block the source where all these things are coming from, you will keep fighting the same battle.”
He stressed that without addressing the source of the problem, the fight against fake drugs would continue to be an uphill battle. Hinting at how compromised regulatory processes allow dangerous pharmaceutical products to bypass necessary inspections and ultimately reach consumers, a ship and port agent, Jeremiah Nuhu said: “Some officials take bribes and allow some containers to leave the ports unchecked,” he said.
In highlighting the role of bonded terminals (off-site storage facilities used to decongest the seaports) as a critical weak link in the system, Nuhu said: “Some containers are not opened at the ports. They are taken to bonded terminals where surveillance is much weaker. At these terminals, it is easier to compromise inspections. So, the problem lies with the authorities,” he stated.
Nuhu emphasised that criminal networks exploit this system by falsely declaring the contents of their shipments.
Delay in zero duty waiver on APIs fuel proliferation of fake, substandard drugs
WHEN President Bola Tinubu signed an executive order for a two-year zero tariffs, excise duties, and value-added tax (VAT) on imported pharmaceutical products, the Federal Government intended to score several vital points in this sub-sector, including aiding cheap drug production and enhancing affordability.
However, the failure to begin the implementation has made the situation business as usual even though the Federal Ministry of Health and Social Welfare announced some months ago that it had finalised the Executive Order, Harmonised Implementation Framework, and cleared it to be gazetted. The waiver covers active pharmaceutical ingredients (APIs), excipients, and other crucial materials for producing drugs, syringes, long-lasting insecticidal nets (LLINs), and rapid diagnostic kits. With the implementation of the Executive Order, the government expects a reduction in the prices of essential pharmaceutical products and medical consumables.
The 2023 National Health Facility Survey (NHFS) by the National Bureau of Statistics (NBS) revealed that the lack of affordable essential medications impacts public hospitals and primary healthcare centres nationwide.
The Managing Director of Merit Healthcare Limited and the Director of Programmes at the Nigeria Academy of Pharmacy, Lolu Ojo, who attributed the failure to implement the executive order, said that things are slow because “that’s the government system where things move slowly due to many layers of decision-making.”
Ojo highlighted the sector’s vulnerability to fluctuations in the foreign exchange market due to Nigeria’s import-dependent economy and added that manufacturers also feel the strain, resulting in reduced importation and higher costs for the few pharmaceutical products available. He explained that the high drug prices are the most common complaint among patients, with affordability becoming a significant challenge.
Ojo added that some patients are currently unable to fill their prescriptions due to costs or lack of availability, leaving them with limited options, such as turning to prayers or traditional medicine.
A former President of the Pharmaceutical Society of Nigeria (PSN), Ahmed Yakasai, stated that apart from high interest rates, forex, high electricity tariffs, and high cost of diesel, the major problem affecting local drug production in the country is the lack of access to active pharmaceutical ingredients.
“We don’t have the petrochemical component of the petroleum industry where we can have all the hydrocarbons converted to active pharmaceutical ingredients.”
