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Counterfeit Drugs

Paul Obi writes on the giant strides recently made by the National Agency for Food and Drug Administration Control (NAFDAC) to wipe out counterfeit drugs from our shelves
With Nigeria’s fight against drug counterfeit spanning more than two decades, the hope of curtailing the illicit trade has been ongoing for a while. This recent resuscitation of the fighting power of the National Agency for Food and Drug Administration Control (NAFDAC) has brought some sanity and as many would say, a ray of hope that the country will soon confront the menace.
Thus, with the recent clampdown, a recent survey on drugs counterfeit has elicited some confidence on Nigeria’s leap on the fight against fictitious drug. From the hey days of late Prof. Dora Akunyili to the current tenure of Dr Paul Orhii,  Nigeria’s commitment in ridding fake drugs has never been in doubt, a feat highly recognised within the World Health Organization (WHO) and the international community.
A recent national survey indicates that the fight against drug counterfeiting seems to be yielding positive results . The survey was conducted by the National Agency for Food and Drug Administration (NAFDAC) in collaboration with the National Malaria Elimination Programme with funding provided by the USAID through Promoting the Quality of Medicines (PQM) programme of the United States Pharmacopoeia convention showed that substandard antimalarial medicines in Nigeria is now 3.6 per cent.
The Director General of NAFDAC, Dr Orhii disclosed that the report underscores the total commitment of the Nigerian goverment in putting a stop to the illicit trade. The DG explained that counterfeiting is more prevalent among malaria drugs. He said, “The scourge of malaria remains a huge health threat to countries in sub-saharan Africa including Nigeria.
In Nigeria, malaria contributes an estimated 11 per cent of maternal mortality and accounts for 60 per cent of out-patient visits, 42 per cent of hospitalization among children under the age of five with a prevalence of 50 per cent in the 6-59 month age group.”
This approach appears to have reflected on the survey. More so, the survey came at a time when malaria constitutes one of the dreaded anf tropical diseases in Africa. According to Orhii, “Malaria is highly endemic with a burden estimated at 100 million cases per year with over 300,000 deaths. This figure represents more than 50 per cent of the total deaths caused by malaria worldwide.”
The survey also brings to the fore the response mechanism within the pharmaceutical industry needed to stem the tide of fake and counterfeit drug business in the country. But Prior to 2001, it was reported that 40 per cent of medicines circulating in the Nigerian pharmaceutical supply chain were either susbstandard, fake or counterfeited.
According to the survey and several other studies conducted by NAFDAC from 2001-2014, there has been a positive trend which shows progressive decrease in the incidence of counterfeit medicines in Nigeria.
A study conducted in 2005 by NAFDAC in collaboration with WHO and DFID also indicated  a remarkable decrease in circulation of counterfeit medicines from 40 per cent in 2001 to 16.7 per cent.
The report observed that “the quality of selected antimalarial medicines circulating in sub-Saharan Africa study of 2008 had a failure rate of 64 per cent whilst 36 per cent passed
The National Survey of Quality of medicines using Truscan device was conducted by NAFDAC across 29 states including FCT, Abuja from January 2010 to April, 2012 in which 5,790 samples were tested, 5,419 samples passed and 371 samples failed. The percentage of samples that passed was 93.6 per cent while the per centage failure was 6.4 per cent.
Of the 5,790 samples tested, 910 were anti malarials, 732 samples passed and 178 of the samples failed. The per centage of the antimalarial samples that passed was 80.4 per cent, while the per centage failure was 19.6 per cent. This is an improvement in the figures ob tained from the study on the quality of anti-malarials in Sub-Saharan Africa in 2008. The Affordable Medicines Facility-malaria (AMFm) study conducted in 2012 revealed that substandard antimalarial medicines was 20 per cent.
Also, a study conducted by Professor Obinna Onwujekwe of University of Nigeria (UNN) involving 3000 samples of antimalarial medicines reported also revealed that 9 out of every 100 samples of anti malarial medicines were of poor quality.
NAFDAC in collaboration with the NMEP (Federal Ministry of Health) and USP with funding with USAID conducted a survey on the quality of antimalarial medicines circulating in Nigeria in 2014. The report of this survey, which will be presented today revealed that the substandard antimalarial medicines in Nigeria is 3.6 per cent. The NAFDAC DG attributed the reduction in the incidence of substandard medicines to “key strategies adopted by NAFDAC which include sustained public enlightenment campaigns; deployment of cutting-edge technologies, for example, Truscan, Minilab, RFID, Black Eye, Mobile Authentication service. Other strategies include WHO prequalification of antimalarial, capacity building and local and international collaborations amongst others.”
Permanent Secretary, Federal Ministry of Health, Mr Linus Awute said the report is critical in providing the push for government to do more with regards to the fight against fictitious drugs.  He explained that the survey came  “At a time when the health sector has recorded a lot of successes and now focusing on elimination of malaria in the country. Awute stated that “poor medicines quality either through counterfeit or substandard medicines can lead not only to protracted illness or adverse drug events, but can also contribute to the emergence of multi-drug resistant infectious pathogens.
“We are therefore here today to share the report of the survey conducted by National Malaria Elimination Programme (NMEP) in collaboration with NAFDAC which will provide insight into the quality of antimalaria medicines in circulation in the country.”
The permanent secretary was of the opinion that “These efforts will most certainly help to provide useful information in the fight against the circulation of substandard and falsified medicines in Nigeria.” 
Awute also maintained that government will “Ensure the availability of quality medicines in Nigeria, not just antimalarials but other medicines other disease programmes like HIV/AIDS, Tuberculosis,  Representative and Child Health issues among others.”
He said, “This objective has been augmented to enhance standards and quality of pharmaceutical products in Nigeria by alignment of international recognised criteria and standards. It is our expectation that the barriers to trade will be minimized while strengthening public health protection and ensuring beter quality of pharmaceutical products in the country.”
He maintained that the Nigerian drug regulatory authorities will continue to work in partnership with the pharmaceutical industry to ensure the smooth implementation of policies and government initiatives. This, Awute said,  will enable government strenthened regulatory mechanisms through Medicines Quality Monitoring (MQM) Alert system to identify substandard, falsified and adultrated products.  The innovation will also enable timely sharing of alerts of such products among stakeholders to find innovative and effective ways to overcome the challenges of substandard and falsified products in Nigeria.
With figures from the survey indicating some improvement in the fight against counterfeit drugs, there is also the need to strengthen surveillance and monitoring mechanisms that completely checkmate new avenues for illicit drug trade.
This calls for more public awareness and sensitization. NAFDAC also need to liase with security agencies at border posts like Customs, Immigration Service and Civil Defence to come out with better and modern ways of tracking drug traffickers and those caught in the web of selling fake drugs. But beyond the reduction of counterfeit drugs in the country, more still lies ahead and from all indications, complacency is not one of them.
NAFDAG DG,Dr Paul Orhii
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