When pharmacies sell death for a penny

Irish poet and one of the foremost figures of 20th-century literature, William Butler Yeats, aptly put it in his famous ‘The Second Coming’. “When things fall apart,” wrote Yeats, “not only can’t the centre hold, even the falcon cannot hear the falconer”. I find a corollary in this cause-and-effect thesis offered by Yeats in the narration of Reverend Richard Henry Stone. Stone was one of the earliest American missionaries to come to Africa during the 19th century. He was a representative of the Southern Baptist Convention and spent quality time among the people of Western Nigeria. Stone lived in Ijaye, Abeokuta, and Lagos and, in the process, travelling to places he called Ibadan, “Lahlookpon (Lalupon), Ewo (Iwo), Ogbomishaw (Ogbomoso), and Oyo,” located in today’s Osun and Oyo states.

Rev Stone observed firsthand the destructive Ijaye war of 1860-62, alongside his wife, Susan Broadus Stone, helping to care for wounded soldiers. He also conveyed these brutal war orphans to Abeokuta. More tellingly, Stone met Aare Kurumi of Ijaye, the generalissimo of the war and the ruler of the place he called “Ejahyay” – Ijaye. He had a very condescending impression of the war general, a man he called a “notorious free-booter and slave hunter”. Kurumi was also a despot who beheaded his subjects for even small infractions. So one day, Stone was speaking with one of his aides in his own house. Having heard that Kurumi was mortally ill, he asked the aide if he was not afraid that Kurumi could die of his illness. The aide looked across his shoulders and whispered, excited, in Stone’s own words, “Be kawlaw bah koo, adieh ko sookoon,” a corrupted version of the Yoruba wise-saying, “Bi kolokolo ba ku, adiye o le sunkun.” In English, this translates to mean, if the fox dies, the chicken will rejoice.

In the jungle, when the fox dies, the chicken is happy. The death of the fox is an opportunity for the chicken to engage in its ancient vagabond walks. In Nigeria today, the fox is dead, long live the vagabond walk of the chicken. This seems to sound true for any hope of sanity or anything good in so many aspects of Nigerian life. The moment sanity died in virtually all aspects of our lives in Nigeria, impunity and impudence took over. They strut with peacock pride, everywhere. The one that seems most frightening is the epidemic of counterfeiting in Nigeria. There is virtually nothing in Nigeria, today, that is impenetrable to the magic wand of fakery. It is so bad that if you want a human being faked, you would get the dross in a twinkle of an eye.

Drug cloning is the most lamentable brand of this Nigerian fakery. Almost every minute, a Nigerian kisses the canvas after consuming fake drugs. Last week, the Nigeria Customs Service area comptroller, Oyo/Osun Command, Dr Ben Oramalugo, announced that the command had intercepted fake pharmaceuticals which included Augmentin tablets, Ampiclox and Amoxycillin capsules. These faked drugs were concealed in 53 sacks which had a Duty Paid Value of N1,739,000,000.00. A few months ago, police officers from the Okokomaiko Division of the Lagos State Police Command also intercepted a Volkswagen LT bus loaded with 70 cartons of expired drugs. Command’s Public Relations Officer, Benjamin Hundeyin, disclosed this. The cartons contained Feed Fine Cyproheptadine Caplets 4g, with an expiry date of 2016. When quizzed, one of the suspects confessed that the expired drugs were being carted to an individual in Alaba who had been contracted to change the expiry dates of the drugs so that they could be freighted to Port Harcourt for sale. In August 2023, the Kano State Police Command similarly confiscated 820 cartons of suspected fake and expired drugs at the Mallam Kato Market, Fagge local government area of the state.

Long before now, in 2009, a shipment of counterfeited anti-malarial drugs was intercepted in Lagos. A Nigerian businessman had colluded with a Chinese drug exporter who outsourced the job to an employee of a Chinese drug manufacturing company. The drug ring included a team of packaging experts, as well as another man with the assignment of shipping the drugs into Nigeria from China. In some instances, drugs are made up of chalk which unsuspecting consumers swallow as drugs.

On the surface, this epidemic of drug counterfeiting may look benign to any non-perspective person. But, drug fakery has reached such a frighteningly alarming rate in Nigeria and harvests deaths into its pouch. Almost daily, scores of our fellow countrymen kiss the canvas for ailments which, with genuine and affordable drugs, they could live on earth for almost an eternity more. A couple of years ago, a diabetic uncle of mine who once lived in the United States and whose drugs were sent to Nigeria periodically had run out of his American drug supply. So he hopped into one of the most famous pharmacies around to procure diabetics drugs. He took them for about three weeks. Feeling somehow unwell, he decided to check his blood sugar rate. What he recorded was a figure almost in a handshake with the sky, immediately requiring an emergency insulin injection. This was what rescued him from death.

The pestilence called counterfeit drugs has led international organizations to observe how this lethal trade works in Nigeria. In 2006, the World Health Organisation (WHO) had to put together a global programme on poor-quality drugs, with particular focus on Africa. Similarly in 2010, the UN Office on Drugs and Crime, (UNODC) in its Global Crime Threat Assessment stated that drug fakery had become a major global threat, in concert with cocaine trafficking and allied crimes. So also did Interpol which signed, for the first time, agreement with pharmaceutical corporations to criminalize what it called ‘pharmaceutical crimes’.

Fake pharmaceuticals reveal the underbelly of a porous and ineffective regulation process and laws. While drug fakery history in Nigeria can be traced to as far back as the colonial times, its expansion is driven by the country’s hydra-headed economic crises, the crisis in the pharmaceutical industry and the collapse of Nigeria’s healthcare system which began in the 1980s. Scholars who study this malaise have discovered that unless Nigeria solves her economic and political problems, no matter how policies are made to regulate fake drugs, they would forever encounter failures. Such efforts can be compared to a Babalawo who abandons a more bothersome ailment of leprosy to treat eczema. Nigerian governments have been addressing symptoms of the crisis, leaving untouched the nexus between drug faking and a more fundamental political and economic problem that the country faces.

The history of drug counterfeiting in Nigeria is synonymous with the history of Nigeria. Indeed, drug clone precedes the existence of Nigeria as an independent country. The roots of unregulated trade in drugs can be clearly linked to colonial times when the trade was not particularly law-abiding. Colonial archives are replete with evidence that trade in medicine in Nigeria was grossly unregulated. From Richard Bailey, who became the first licensed African pharmacist to operate chemist shop in Lagos in 1887, the number of pharmacy shops began to increase into early post-colonial period. It was not until 1990 however that Nigeria first had its comprehensive drug policy. In the 1940s, drug counterfeiting and illegal sale of drugs were so widespread that a 1946 colonial archive said the streets were full of “innumerable market women and itinerant vendors selling small quantities of the common brands of medicine and to attempt to enforce a licensing system against such persons would require a special staff and inspectorate”.

An April 18, 1976 Punch newspaper report with the title “Drugs Shortage: Federal Military Gvmt orders probe,” said that the bid to look outside of hospitals for drugs was necessitated by drug shortages in the mid-1970s onwards. During this time, doctors were forced to ask their patients to find drugs outside the hospitals. This gave birth to government licensing more patent medicine dealers, a system that first came up in the late colonial period. The dealers were empowered to sell first-aid drugs on the counter, especially in rural areas where hospitals were absent. However, the greatest calamity that befell the Nigerian healthcare system came in the 1980s during the military government of Gen Ibrahim Babangida and his Structural Adjustment Programme (SAP) policy. With a colossal and sudden reduction in public spending on healthcare, as well as devaluation of Naira, importing drugs became a herculean task. To keep the drug trade running, counterfeiting of imported western drugs became rife, and an unheard of practice of in-hospital mixing of Paracetamol began, according to Gernot Klantschnig and Huang Chieh in their Fake Drugs: Health, Wealth and Regulation in Nigeria, (2018). It manifested in scant adherence to quality control.

Though the 1970s witnessed an upsurge in domestic manufacture of pharmaceuticals, local companies couldn’t survive without imported raw materials which Naira devaluation made unapproachable. As it is now under the Bola Tinubu government, foreign Nigeria-based drug manufacturing companies began to divest and relocate out of the country. By the mid-1990s, they had almost totally vacated Nigeria. This left local drug manufacturers who not only operated at low capacity, but had to make do with the lowering of standards. This resulted in poor quality. In the late 1980s, the press reported two high-profile cases of the result of Babangida’s asinine policy. The first was in Ibadan where Paracetamol poisoned more than 100 children, as well as in Jos of 1990 where falsely labeled poisonous ingredient in a drug’s manufacture became a health scandal. It was linked to a leading drug wholesale market with its roots in the Netherlands. Yet another was the national scandal which erupted in 2008 and 2009 as a result of a Nigeria-manufactured teething syrup named My Pikin where children were recorded to have suffered poisoning.

The advent of Dora Akunyili, Director General of the drugs regulatory agency, NAFDAC however helped to substantially regain Nigeria’s pride. Hitherto, Nigeria was held as haven of counterfeited drugs. Importers of faked drugs, whose main attention is always riveted to drugs that are the most consumed among drugs, regarded as drugs that ‘sell fast’ in the Nigerian market, were fiercely combated by Akunyili at personal cost. The Obasanjo government also funded the huge publicity given by Akunyili to falsified drugs.

Things have since worsened ever since. The twin policies of fuel subsidy removal and unification of exchange rates of the Tinubu government, like the Babangida SAP, have sapped life out of original drugs in Nigeria. Like the dead fox, they have let loose the chicken of counterfeit drugs on the prowl. Unbearable costs of drugs have returned Nigerians to their primordial conception of sickness and return of herbs as potent healing pharmaceutical drugs. Its effects are kidney diseases being battled on a large scale in Nigeria. In Yorubaland for instance, prior to the advent of the white man, it was held that illness was as a result of attack by either enemies (ota), whcih can be further classified into witches (aje), sorcery (oso) or to a god (orisa) and deity (ebora). Europeans’ understanding, on the converse, which gave birth to the philosophy of drugs and hospitals, is based on the belief in the germ theory. This holds that physiological and anatomical disorders show up in man due to activities of germs and viruses inside the body system. Unable to afford drugs’ exorbitant prices, Nigerians are today forced to patronize a litany of counterfeited drugs on the prowl. They are cheaper and affordable but have, regrettably, led to a spike in deaths.

In saner societies, drug regulation is a matter of life and death. America’s Food and Drug Administration (FDA) jealously protects the people’s public health through ensuring the safety, efficacy and security of human and veterinary drugs, biological products and medical devices. Like the proverbial dog that guides the home of Eledumare, it scrutinizes America’s drug supply. More often than not, the FDA provides accurate, science-based health information to the public. It is assisted by an American health system that prioritizes the health of its people.

I was moved to tears a couple of weeks ago as I witnessed the American health system in action. My host in New Jersey had taken ill, nearly collapsing in the bathroom. He and I were all alone. We managed to call 911 and in about five minutes, three full-kitted men, in an ambulance and another vehicle, emerged by my friend’s Old Bridge apartment. They were kitted in emergency equipment. In a stretcher, they carried my friend down the building and into the ambulance. We were at the Hackensack Meridian Medical Centre, Piscataway in a jiffy. This hospital is strictly dedicated to emergencies. Though I was told this was miniature in America’s investment in her citizens’ healthcare, any Nigerian who manages to be at Hackensack would weep if drawn into comparison between what it is and, for instance, Nigeria’s rich in fossils Ibadan-based UCH. The equipment available were the latest. In four days, Hackensack drilled into probable causes of my friend’s collapse. One of the doctors on ground was a young Nigerian lady said to be a top-notch doctor in America. Hackensack never demanded a dime from my friend. The cost of this first class treatment was borne by insurance, his place of work and a tiny fraction shipped to the patient.

The cause of Nigeria’s healthcare palaver is complex to decipher. Her economic and leadership crises seem to be at the core of its lifelong disease. Other ancillary issues like the greed of the Nigerian and the perception of healthcare as business, rather than a life-saving venture, also rank high. The Tinubu government must stem the daily deaths of our productive countrymen through counterfeited drugs enveloped by a collapsed healthcare system. In the words of the Muhammadu Buhari junta when it struck on December 30, 1983, hospitals had become “mere consulting clinics.” Today, they have become slaughter slabs and pharmacies, dispensers of death. While government’s proposed Executive Order to reduce identified barriers to local drug manufacturing, to enable the industry to thrive, is a necessary immediate remedy, the problem is beyond skyrocketing cost of essential medicines. Nigeria’s healthcare system is an emergency which needs a holistic and immediate intervention.