The prevalence of fake drugs is a menace to over 200 million people in Nigeria. The need to look at the effects of substandard products on the nation’s economy
Earlier this year, the National Primary Healthcare Development Agency, NPHDA, said that over 70 per cent of medicines being dispensed in Nigeria were substandard. The agency noted that the majority of Nigerians did not have access to quality health services.
Similarly, officers of the Nigeria Customs Service in collaboration with other sister agencies like the National Drug Law Enforcement Agency and the National Agency for Food and Drug Administration and Control recently destroyed 48 containers of substandard drugs coming into the country. This could be said to be a confirmation of what NPHDA had said.
A lot of Nigerians have been hard hit by this menace. According to medical experts, some of the health issues ranging from loss of sight and hearing defects as well as kidney and liver issues are caused by substandard drugs or abuse thereof.
Nigeria is the most counterfeit market in the developing world, according to Bloomberg, occupying a top seat among African countries losing thousands of citizens annually to fake drugs. About 120,000 Africans die annually, according to Brazzaville Foundation.
The negative effects of substandard drugs in Nigeria can only be imagined as peddlers of these products disguise in several forms just to carry on with their illegal business.
Most streets in Nigeria have medicine merchants, popularly known as chemists, in various corners dispensing drugs at will – even without certification.
Some hawk them, while a few have backyard factories where they manufacture these products and dish them to vulnerable Nigerians. These products are attractive to the vast majority of Nigerians because they are relatively cheaper compared to medicines from genuine pharmacies. And with 95 million people poor in Nigeria, according to the World Bank, it is easier to see why the counterfeit market is booming, say experts.
Some of these merchants of substandard drugs leave the buyer with no traceable address, making it hard to arrest and prosecute them.
The pharmaceutical industry is hard hit by the prevalence of these drugs. Pharmacists complain that a lot of Nigerians now tar everybody in the drug value chain with the same brush. Also, counterfeit drugs are threatening over N500 billion investments made by local pharma players in the country. Currently, a number of local industries complain of low patronage, resulting from Nigerians finding cheaper alternatives in unapproved medicines.
Effects on health
The National Chairman of the Association of Community Pharmacists of Nigeria, Wale Oladigbolu, described fake and substandard as a waste of resources.
He also said that the prevalence of substandard drugs in the system had led to distrust in the nation’s health system.
“There is a spectrum for that effect. It ranges from economic effect, social impact and also has health implications. Let me talk about the economic impact of substandard medicines. It is a waste of resources and energy when these drugs circulate within our system. The social impact is that there is a distrust of the health system in Nigeria once the prevalence of fake drugs is on the high rise.
“The most important impact of substandard medicine is that the person who takes the medicines won’t have the positive effect that he or she desires. So, the goal of taking the medicine will not be achieved.”
Oladigbolu stated that consumption of substandard drugs could lead to other damages in the system.
“Some of the substances that they use in making these falsified medicines are outrightly dangerous to the health and could lead to damages. When people are sick, they go to get well, but when they take substandard medicines they stay longer in hospitals. It can also lead to some other dangerous diseases. Imagine if a drug is to assist a pregnant woman and that drug is substandard. The implication is that there won’t be safe delivery and there would be surgery. Imagine somebody who is supposed to leave the hospital now but has to go through surgery and all that. So, it is dangerous to the system.”
Also speaking, the Secretary of the Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria, Frank Muonemeh, lamented that substandard drugs now competed with the genuine manufacturers in the market.
He added that most substandard drugs were being flown or imported into the country. “Those falsified medicines flow into the country; they are imported. They compete with the originally manufactured medicines and the patient cannot get what he or she wants. The patient will also end up spending more money and you know we make a lot of out of pocket expenses to buy drugs. Almost 70 per cent of Nigerians still spend money out of their pockets because they don’t have health insurance, so you’re gambling.”
The Chief Executive Officer, of Neimeth International Pharmaceuticals Plc, Matthew Azoji, said, “First of all, the effect of substandard medicines on the health of Nigerians is not only that there would be failure in the treatment – some of those substandard also have the tendency of destroying the health of the individual who is taking them. They may not be able to know what they are taking and at the end of the day, the health of the person is worsened. So, it has the tendency of destroying the health of the individual because they are always cheaper.”
Meanwhile, a Public Health and Infectious Diseases Physician, Dr. Maclawrence Famuyiwa, said, “The health implications of those substandard can essentially be said to be poison since their compositions are uncertain and may be at concentrations that are dangerous for human health when consumed. They end up not treating the diseases they are meant to treat. So, they can lead to early death of those using the drugs to treat their diseases and can also result in treatment failure.
Also, those drugs can cause organ damages, for example, kidney failure which will essentially require more money to be spent for the person to survive.”
Famuyiwa was of the view that substandard drugs could lead to extra expenses. “The person being treated will end up spending more to achieve a cure because when those substandard fail to work, patients will still have to spend more money again to buy genuine drugs to be able to achieve a cure.”
On his part, Azoji said that by patronising substandard drugs, taxes going to the Federal Government would be reduced.
“Not only are they damaging the health of the individuals, they are taking the market from genuine companies, thereby affecting the economy of the country. The genuine companies that pay taxes and support the employment structure will have their market taken away. If their markets are taken away, their businesses will go down, and the more their businesses go down, the more their contribution to the GDP of the country is reduced significantly.
“And when this happens, the revenue that comes to the government in terms of taxes is reduced and the employment that they generate will reduce.
Why counterfeit drugs?
Pharmaceutical practitioners believe that the influx of substandard drugs into Nigeria may not go soon due to the low purchasing power of Nigerians.
According to the PMGMAN scribe, Muonemeh, “For me, these things are bound to happen because we know the purchasing power. You are very aware of the current dollar rate, that the purchasing power of people is no more strong.”
He added that local manufacturers were preventing the prices of these drugs from rising.
“It’s tough for manufacturers. We are the ones holding forth so that prices of products won’t escalate and the reason we do that is to ensure we do not leave the patient to choose between buying substandard and original medicines So, the same patient is left with the same choice of choosing between the original drug and the substandard medicine.”
The experts opined that the Federal Government must come up with strong policies to ensure that these drugs would not find their ways into the country.
According to Oladigbolu, “All the regulatory authorities have to stand up to these. It is something that the Federal Government has to stand up to, to ensure that we don’t have substandard drugs in our system. These are outrightly dangerous to the health of Nigerians. It means that people will have to spend more and stay longer in the hospitals because the medicines are substandard. It also means that the health industry will be discredited because people will be concerned about the quality of medicine they take. If the medicines are not trusted, then the health system cannot be said to be trusted.”
The ACPN chairman also said that the players might have lost 25 per cent of revenue to the influx of substandard drugs.
“I can’t really say the amount the sector may be losing. I am a scientist and we don’t quote figures out of context, but the sector may be losing up to 25 per cent of its revenue to the influx of substandard medicines. It means that substandard will be cheaper and people may want to patronise that one over established companies’ products, which might be slightly more expensive. And when people take such medicines without results, they have to go back to the hospital. As a matter of fact, the National Health Insurance once said there was perceived low quality of medicines in Nigeria.”