Bulletin of the World Health Organization

Nigeria leads fight against “killer” counterfeit drugs

Nigeria has been at the forefront of global efforts to fight counterfeit drugs since Dora Akunyili took over the National Agency for Food and Drug Administration and Control (NAFDAC) in 2001. To crack down on counterfeits, her first move was to stamp out corruption within her own agency as

In five years Akunyili, a 52-year-old professor of pharmacology, has attained celebrity status in Nigeria because of her uncompromising stand against corruption. “We have been rebuilding NAFDAC from a moribund government agency to [one that meets] international standards,” she told the Bulletin.

Nigeria is ranked as one of the most corrupt countries in the world, according to Transparency International. Before Akunyili took over, staff abused their position to extort money from honest manufacturers at the same time as taking bribes from counterfeiters in return for access to the Nigerian medicines market. Akunyili fired the most corrupt of her officers. To encourage honesty among her remaining 3000 staff and to boost morale, she offered incentives such as training abroad, improved facilities and a better working environment.

Akunyili told the Bulletin: “The level of corruption we had in 2001 cannot in any way be compared to what we have now. It has decreased to almost zero. But it is still a problem. We cannot rule it out completely.”

The Nigerian agency is now a key player in reducing the manufacture and distribution of counterfeit medicines in West Africa. It has the support of the Food and Drug Administration and the Environmental and Occupational Health Science Institute at Rutgers University in the United States of America, among other regional and international agencies including WHO.

According to Akunyili, drug counterfeiting was first reported in Nigeria as early as 1968, “So people have been dying in this country from the effect of fake drugs since the early 1970s”. In 1995, Nigeria reportedly donated 88 000 doses of meningitis vaccine to its neighbour Niger, but before the authorities realized that these vaccines were fake, about 60 000 people had been “inoculated”. Akunyili said that when she took office in 2001, fake drugs were openly circulating in her country.

Her efforts have led to increased public awareness about counterfeit drugs and tougher surveillance at Nigerian customs. She says that the number of fake drugs in circulation in Nigeria has been substantially reduced, although she and everyone else involved in fighting the illegal trade admit how difficult it is to quantify the problem and therefore measure their success. Still, there is plenty of anecdotal evidence that her measures have had an impact: shopkeepers no longer dare to sell counterfeits openly for fear of being reported to the authorities. Criminals behind the trade have left Nigeria and set up business in other countries, she says. Now governments across West Africa are working closely with Nigeria to crack down on the illegal trade.

How did Akunyili do it? In 2001, most Nigerian consumers were oblivious to the danger of counterfeit drugs. “Fake drug dealers used to thrive mainly because of a lack of awareness”. The agency broadcast jingles on radio and television to make the public aware of the dangers and to encourage people to report suspicious drugs. It also regularly publishes lists of counterfeit products in the newspapers. Last year, fake drugs worth about two billion naira (US$ 16 million) were voluntarily handed over by counterfeiters or seized after tip-offs from the public.

Akunyili has hit back at the counterfeiters directly too. There is tough surveillance at ports and airports where medicines enter the country. The authorities inspect shops and markets where medicines are sold. As of June 2006, Akunyili said she had secured convictions for 45 counterfeiters with 56 cases pending. The Nigerian authorities recently opened a laboratory in Port Harcourt that analyses medicines for authenticity. Another is being set up in Calabar.

“Fake drugs were not only killing people [but] the drugs were also killing businesses. So millions of lives have been saved. Industries have been revived,” she said, referring to the damage counterfeiting does to public trust in companies and their products.

Despite Nigeria’s efforts, Akunyili said: “We are not there yet. Even 1% fake drugs is not good enough, because every life is important.” Akunyili said she has asked the Nigerian parliament to amend existing legislation to make penalties tougher, so far without success. “The penalty for a fake drug producer or importer ranges from 5000 to10 000 naira (US$ 40–80), or between three months and five years imprisonment.” The other problem is that the law is not always enforced properly: the counterfeiter may avoid jail, and fines can be insignificant compared with the huge profits from the illegal trade.

But Akunyili says that the biggest challenge her agency currently faces is the open-air drug market in the city of Onitsha in south-eastern Nigeria. She believes that the bulk of fake drugs distributed in Nigeria originate there. Police raids have been unsuccessful because market traders attacked law enforcement officers. “Our officers literally had to escape [to avoid] being lynched”. But Akunyili is determined. “If they defeat us, they have defeated Nigeria.”

Abiodun Raufu, Ibadan