World’s largest counterfeit drug market ripe for disruption
Dec 4, 2019
Africa’s flourishing open market in medicine is costing money and lives.
Africa accounts for 42 per cent of all instances of fake and substandard medical products globally, more than any other continent, according to the WHO © AP
I had devoted nearly half my life to practising medicine when my father, who had sickle cell disease, died due to a lack of basic drugs.
On the night that he suffered a sudden pulmonary embolism my older brother, a doctor, and my mother, a nurse, had called the hospital before he arrived to check if they had the medicine. He needed some strong painkillers and a parenteral anticoagulant, such as heparin or warfarin, used to treat clots. It is a drug that should be available in all emergency rooms.
But a nightmare ensued to find out simply if it was available and if so where it was being stored. This is sadly all too common a scenario in Nigeria, Africa’s most populous country with about 190m people. It might sound strange, but the average healthcare provider doesn’t know where to go to get medicine. The country’s booming pharmaceutical industry is fragmented, with critical supply chain gaps.
Nigeria has made progress in the war against counterfeit drugs, with fake medicine reported to have decreased from 42 per cent thanks to strong public awareness measures. Still, between 10 per cent and 30 per cent of pharmaceutical products are fake and the figure is far higher for some of the most basic and essential drugs, according to the country’s National Agency for Food and Drug Administration and Control (NAFDAC). Up to Opinion beyondbrics Africa’s flourishing open market in medicine is costing money and lives 64 per cent of medicine for malaria, Africa’s biggest killer, could be counterfeit.
At outdoor markets, patients and healthcare facilities buy drugs like they would biscuits or tomatoes from unlicensed hagglers. Our flourishing trade in prescription drugs resembles a flea market. Private and public sector hospitals and health centres fork out anywhere between twice, and a staggering 64 times, the international reference price for medicine.
My friend Adham Yehia, who would later become my business partner, was at one stage managing a private hospital and primary care centres. He would watch shabbily dressed traders bringing in cartons from the market. “How can we be sure that we don’t receive counterfeit medicine?” Adham asked the doctors and owners. A typical answer would be: “It’s Nigeria; everyone sources medication through the open market. What choice do we have?”
This triggered a deep sense of disappointment in the health system. We were not prepared to accept a status quo where health providers don’t get the medication they need while patients suffer.
This chaotic system costs lives. Fake drugs cause at least 100,000 deaths on the continent annually. Africa accounts for 42 per cent of all instances of fake and substandard medical products globally, more than any other continent, according to the World Health Organization. Nigeria has the biggest counterfeit drug market of all developing countries, says the NAFDAC.
My father, a professor in surgery, died not from lack of medical expertise, but from lack of resources. If my family, who are working at the heart of the medical profession, can’t access the drugs they need, what hope is there for others?
Nigeria’s first National Drug Policy launched in 1990 with the goal of improving drug availability, supply and distribution. We have a national procurement policy for the public sector and a dedicated procurement department for health-related items. Yet every day, I receive calls from former colleagues at hospitals desperately searching for basic drugs.
The NAFDAC has tried to increase availability of safe drugs, but Nigeria severely lacks the licensed professionals to distribute them. There are 12,807 registered community pharmacists — or about one per 20,000 people — far below the global average of 10 per 20,000. Nigeria needs about 50,000 pharmacists within the next five years, according to the Pharmaceutical Society of Nigeria (PSN).
Government initiatives show a resolve to fix the problem, but this is too big for one agency alone. It requires co-ordination between the NAFDAC, the PSN, the Pharmacists Council of Nigeria, law enforcement, technology and the private sector to rationalise the distribution of quality products so hospitals no longer have to resort to whichever drugs are convenient.
The NAFDAC can set the rules, but it lacks the infrastructure and resources for enforcement across the country. Handheld spectrometers can detect fake drugs within 30 seconds. Their use should become routine at borders and strategic points in the supply chain.
The PCN can shut down illegal pharmacies, but these have grown beyond their reach. Suppliers of counterfeit drugs must be convicted not as petty swindlers but as what they truly are: killers.
In short, we urgently need to disrupt and change the system. We need a hassle-free procurement process for all licensed healthcare workers to source medication, consumables and small medical devices.
It might be too late for my father. But in my lifetime, we can change the fate of others.
Chibuzo Opara is, with Adham Yehia, the founder of DrugStoc