Tackling proliferation of fake antimalarial drugs in Nigeria

In the rural community of Yamu, located in Kwali Area Council, Federal Capital Territory, the fight against malaria rages with heightened urgency as families confront the peril of counterfeit antimalarial drugs.

For the Shekwonukpemishi family, the struggle extends beyond the disease itself, entangling them in the pervasive threat of counterfeit medication infiltrating their community.

Mrs. Ladi Shekwonukpemishi, a 33-year-old school teacher and mother of three, shoulders the burden of providing for her family’s well-being.

When her youngest son, Ishaku, had a fever and chills, she hurried to the chemist in search of relief. Unknown to her, the tablets she procured, purportedly antimalarial drugs, were counterfeit.

As her son’s condition worsened, Shekwonukpemishi’s desperation mounted. With scant access to healthcare facilities and resources, she turned to traditional remedies.

Yet, with each passing day and her son’s fever unabated, she grappled with the haunting fear that her actions may have endangered her son’s life.

Across Nigeria, experiences like that of Shekwonukpemishi echo with alarming frequency.

The proliferation of fake antimalarial drugs poses a pervasive threat, thwarting efforts to combat malaria and imperilling countless lives.

According to the latest World Malaria Report, globally, there were 249 million cases of malaria in 2022, compared to 244 million cases in 2021.

The estimated number of malaria deaths stood at 608 000 in 2022, compared to 610 000 in 2021.

The WHO says the African Region continues to carry a disproportionately high share of the global malaria burden.

In 2022, the region was home to about 94 percent of all malaria cases and 95 percent of deaths. Children under 5 years of age accounted for about 78 percent of all malaria deaths in the region.

Four African countries accounted for just over half of all malaria deaths worldwide: Nigeria (26.8%),  the Democratic Republic of the Congo (12.3%), Uganda (5.1%) and Mozambique (4.2%).

Meanwhile, a 2023 study by Statista says 29 percent of respondents in the North East of Nigeria reported treatment for malaria in the preceding three months, leaving 71 percent untreated.

Similarly, in the South-South, 63 percent received treatment, while 37 percent did not.

The economic toll of counterfeit drugs is profound, with Nigeria harbouring 13 percent to 15 percent of fake medicines, as per NAFDAC.

A study in the American Journal of Tropical Medicine and Hygiene estimates that up to 64 per cent of antimalarial drugs in Nigeria are counterfeit or substandard.

The United Nations Office on Drugs and Crime (UNODC) reports that counterfeit medicines in sub-Saharan Africa could cause nearly 500,000 deaths annually.

The WHO estimates that the cost of treating those affected by falsified or substandard malaria products in sub-Saharan Africa ranges from 12 million dollars to 45 million dollars annually.

Also Mr Obe Adebowale Richard from the University of Portsmouth, in his

Mr Obe Adebowale of University of Portsmouth found in a study that the global market for counterfeit drugs ranges between 75 billion dollars and 200 billion dollars annually.

His research is entitled “Fraud, Corruption and Counterfeits in the Nigerian Pharmaceutical Industry,”

In Nigeria, the economic burden of counterfeit drugs includes healthcare costs associated with treating illnesses caused by counterfeit drugs, loss of productivity due to illness or death, and the impact on tourism and foreign investment perception.

Amidst these challenges, Juliet Bernard, a Director at Toosie Pharmacy in Abuja, underscored the risks associated with counterfeit drugs.

Bernard, a pharmacist, highlighted the potential ineffectiveness and harm, leading to treatment failure and drug resistance.

She also underscored the economic burden incurred by families and healthcare systems due to ineffective treatment and loss of productivity.

She also expressed concern that the prevalence of fake medication erodes confidence in healthcare systems and regulatory authorities.

She said this was further complicated by challenges in enforcing laws against counterfeit medication, allowing criminal organizational to operate with impunity.

The challenge is surmountable with the right attitude, policies and enforcement approach.

Dr Simon Agwale, CEO of Innovative Biotech, suggested the need to address the concerns by strengthening the monitoring and enforcement of medication quality standards by regulatory agencies.

Agwale said the importance of educating healthcare professionals and the public about the risks of fake medication.

He advocated bilateral and trans-agency collaboration to address the challenge of fake drugs manufacturing and distribution, with emphasis on securing pharmaceutical supply chain.

Furthermore, he called for a review and update of relevant laws to strengthen penalties for counterfeiters and improve accountability in the pharmaceutical industry.

The National Agency of Food and Drug Administration and Control (NAFDAC) is the federal government institution responsible for regulating the quality of food and drugs in the country. It says combating fake antimalarial drugs remains a headache.

Prof. Moji Adeyeye, Director-General, NAFDAC, outlined the agency’s efforts, including stringent enforcement, to ensure pharmaceutical product quality and safety in Nigeria.

“These include stringent regulations, regular inspections, and collaboration with law enforcement to crack down on counterfeit drug manufacturers.

“NAFDAC conducts public awareness campaigns and collaborates with international organisations like WHO and Interpol to combat counterfeit medication.

“Leveraging technology, NAFDAC enhances product tracking and authentication to prevent counterfeit drugs from entering the market, aiming to protect public health and maintain pharmaceutical industry integrity in Nigeria,“ Adeyeye said.

The problem of counterfeit medication is not limited to Nigeria. It is a global concern.

India, as a major producer and exporter of generic drugs, contends with counterfeit drug production, especially in rural areas with limited regulatory oversight.

China also grapples with counterfeit drugs, both domestically and internationally, prompting the implementation of stricter regulations and enforcement actions.

Southeast Asian countries like Thailand, Cambodia, and Vietnam face significant challenges due to counterfeit drugs, particularly in rural areas with limited regulatory oversight.

In Sub-Saharan Africa, including Nigeria, weak regulatory frameworks and porous borders contribute to the production, distribution, and sale of counterfeit medications, especially in rural and underserved areas.

International efforts to combat counterfeit drugs involve collaboration between countries, regulatory authorities, and international organisations.

These efforts include strengthening regulatory oversight, public awareness campaigns by organisations.

Such institutions include WHO and Interpol, technological solutions like track-and-trace systems and international collaboration to share information and best practices.

Sourcing medication through the right channels remain essential and the federal government says it is mobilising the citizens to act along that line.

Dr Anyaike Chukwuma, Director Public Health, Federal Ministry of Health, advised Nigerians to obtain medications only from licensed sources and to avoid street vendors or online platforms with unverified products.

Chukwuma stressed the importance of checking medication packaging for authenticity markers and ensuring accurate labelling details.

For online purchases, he recommended using reputable pharmacies and avoiding suspiciously low-priced options.

If encountering suspected counterfeit drugs, he encourages immediate reporting to regulatory agencies such as NAFDAC and staying informed through reliable sources like WHO.

Prof. Babatunde Salako of Nigerian Institute of Medical Research (NIMR) emphasised the urgent need for government intervention to tackle counterfeit drugs.

Salako also suggested the strengthening of regulations, enhancing transparency in the pharmaceutical supply chain.

He said investing in healthcare infrastructure, fostering collaboration among stakeholders, and educating the public about counterfeit drugs were also vital in the fight against counterfeit antimalarial drugs.

“These measures aim to prevent counterfeit drugs from entering legitimate channels, improve access to quality medications, and empower individuals to make informed healthcare decisions,” he said.

In the landscape of health, families like the Shekwonukpemishis navigate treacherous waters. Their struggles serve as a clarion call for concerted action against the proliferation of fake medication.

By Abujah Racheal