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The Nigerian pharmacologist Dora Nkem Akunyili knows all about the dangers of counterfeit drugs: in 1988 her sister was killed by them.
The Nigerian pharmacologist Dora Nkem Akunyili knows all about the dangers of counterfeit drugs: in 1988 her sister was killed by them. Thirteen years later the Nigerian president, Olusegun Obasanjo, appointed her head of the country's National Agency for Food and Drug Administration and Control (NAFDAC). One of her main tasks is to take on the manufacturers of fake drugs that have caused huge damage in her country. She has found that more than two-thirds of drugs sold in markets, and a high proportion of those used in clinics and hospitals, come from rogue producers. The drugs have no active ingredient or a fraction of what they should, or have passed their expiry date and been relabelled, or were poorly made. Encouraged by the lack of regulation, the counterfeiters have overwhelmed Nigeria's pharmaceuticals industry. Western manufacturers have pulled out – though some have been implicated in schemes to resell expired medicines. Tens of thousands of Nigerians have been injured or killed after taking fake drugs, which either fail to treat the condition or make it worse. Since taking over, Akunyili's organisation has confiscated and destroyed counterfeit drugs worth $16 million. But her job carries a high personal risk: two years ago she came within millimetres of losing her life to an assassin's bullet. Curtis Abraham talks to one of Africa's bravest campaigners about life on the front line of the drugs war
BYLINE: Curtis Abraham
SECTION: INTERVIEW; Talking Point; Pg. 56
LENGTH: 1026 words
When did you first become aware of the dangers of counterfeit drugs?
My sister, Vivian Edemobi, became diabetic in 1986 and was started on insulin injections, which controlled the diabetes initially. But then she stopped responding to insulin. The doctors and family were confused: insulin brings down blood sugar, if it is genuine. At the time fake drugs were not a well-known issue, and it did not occur to us that she was being given fake insulin. Her health continued to deteriorate until she got an injection abscess. She was prescribed antibiotics but did not respond to them. She died in January 1988. When we learned that she died from the use of fake insulin, we were all devastated. The pain of her loss will remain with me all my life. She was the best in my family.
How big was the fake drug problem when you took over as director-general of NAFDAC in 2001?
We discovered that almost 70 per cent of the drugs sold in the markets were fake or counterfeit. We also found appreciable quantities of fake drugs in clinics and hospitals. At that time there was no effective regulation for food and drugs in Nigeria. This allowed all these fake and counterfeit drugs, as well as unwholesome foods and other sub-standard products, onto the market. Everyone, Nigerians and non-Nigerians alike, was at the mercy of counterfeit drug dealers.
As a result of this, other West African countries with better regulations, such as Ghana and Sierra Leone, refused to accept drugs that were made in Nigeria. Our local drug manufacturers were closing shop, and multinationals such as Merck, Boots and Sandoz left the country out of frustration. Manufacturers and importers could not compete with people who would either not add any active ingredient or add just a fraction, or who would relabel expired products, or produce ineffective drugs because they lacked the know-how. Fake drugs also embarrassed our healthcare providers and eroded public confidence in our healthcare system.
What did you do?
We were faced with the enormous task of reactivating a two-decade-old failed regulatory environment. The failure was largely due to corruption on the part of staff, manufacturers and importers. My first step was to change the mindset of the NAFDAC staff. It was a cultural revolution. We mapped out strategies to fight drug counterfeiting and other product faking. I made sure that our laws and operating procedures could not be compromised.
We have also taken on multinational companies. We took on Nestlé, which had imported expired skimmed milk and affixed new dates. We set Coca-Cola a time frame within which to improve the quality of its drinks. We confronted Cadbury, which imported expired chocolate.
Why have fake drugs become such a major issue?
The main reason is corruption. Regulators who refuse to be compromised suffer intimidation, harassment, threats and physical attacks. Another major problem is the lack of awareness by both health practitioners and the public. Furthermore, some exporting countries pay little attention to the screening of drugs for export. Some drug importers make false declarations about the products in their containers, or they wrap drugs in textiles or whatever. Plus, clandestine drug manufacturers are sophisticated: it has been difficult even for brand owners to tell the difference between their drugs and counterfeits.
There are also problems with the lack of adequate legislation. Laws against drug counterfeiters in most countries are very weak. Consequently, criminals are shifting from smuggling narcotics and weapons to drug counterfeiting because it is financially lucrative and relatively low-risk.
Who is behind it?
The fake drug cartel in Nigeria has partners in different parts of the world, especially in India and China. We have blacklisted 30 Indian and Chinese companies and one Pakistani company involved in fake drug production from exporting their drugs into Nigeria.
What sort of things do these drugs do to people, besides killing them?
Fake drugs can make a condition worse, and even cause organ failures. A fake antibiotic, as well as not curing a disease, can induce bacterial resistance against a genuine antibiotic. In the same way, fake chloroquine has contributed to the new strains of malaria parasites that are resistant to chloroquine, and this has stopped many people from using it as a first-line drug for the treatment of malaria.
You nearly lost your life in the battle against fake drugs. Tell me about that.
During the Christmas festival of 2003 I was visiting my mother-in-law in my home town of Agulu. We were suddenly inundated with noise, which we thought was Christmas fireworks until the back window of the car shattered. By God's grace the bullet only pierced my headscarf and brushed my scalp, burning my head, and went out through the front windscreen. I later learned that some of the bullets meant for my car hit a commercial bus in the pandemonium, and the driver of the bus was hit by the bullets and died as a result.
How is your family affected by the risk of your job?
My family lives under tension, fear and uncertainty about their lives and more especially about me. My youngest son, Obumneme, was so harassed and threatened in high school that he decided for fear of his life to tell the other students that I am not his mother but his aunt. My husband, who is a medical doctor, is also living in fear for his life. He has security around him 24 hours a day. As for me, I do not have a social life. I am surrounded by police and other security personnel round the clock. I'm very careful wherever I go because the criminals are always trailing me. My husband handles stress through tennis. I deal with mine with constant prayer.
Dora Nkem Akunyili was a senior lecturer and consultant pharmacologist at the College of Medicine, University of Nigeria, Nsukka. She was appointed director-general and chief executive officer of the National Agency for Food and Drug Administration and Control (NAFDAC) in 2001, and is due to hold the post until April 2006. In 2003 she was awarded a Transparency International Integrity Award for her efforts in fighting corruption.