Mr Adewale Aderemi Oladigbolu, a fellow of the Pharmaceutical Society of Nigeria and the National Chairman for the Association of Community Pharmacists of Nigeria, says in this interview with Sade Oguntola that Nigeria’s regulation on drugs is to ensure professionals self-compliance; however, it should be applied to all groups and institutions that handle and store medicines to ensure safe and quality drugs for all.
Why, much more than before, do you pharmacy practitioners need to work more closely with NAFDAC to improve Nigeria’s access to quality and affordable prices?
A: NAFDAC is in charge of regulating products, and in Nigeria, so many products have been registered. But there are a few products needed by the people in small quantities, and we are having problems ensuring their access. These include what we call service medicines, which are needed in small quantities, and orphan drugs, which are needed for very rare diseases. Service medicines are brought in to serve a very small niche of people. If these drugs are not available, people will die. But the guidelines from NAFDAC for import services and orphan drugs are not satisfactory to us, the practitioners.
The guideline says pharmacists will import it only for their pharmacies, and we are saying that this is not satisfactory because not every premise that needs those drugs can begin to approach NAFDAC to pay the registration fee, contact the manufacturer, and import them into Nigeria. At that point, it will drive the trade of this group of medicines into the black market. So, we are saying to open up the space and include retail pharmacies in their importation for distribution on a particular website that is traceable down the line so that is not abused.
NAFDAC is saying that if retail pharmacies want two packets of a particular product that is not available or that is not registered in Nigeria, we will give you a permit to import those two packets. How practicable is that? How economical will that be? Other big companies could import these products and then service retailers all over the country, including the surgical theatres in hospitals. But NAFDAC will go ahead and seal our premises when we have these products. If they want to stop pharmacy retailers from stocking these products, there is no problem, but let’s agree that people are going to die from lack of access to these medications.
Even though you don’t stock these medicines because community pharmacies are closely regulated by NAFDAC, these drugs are out there for sale in the open drug markets across the nation. What is your perspective on this?
NAFDAC does not have the capacity or the interest of Nigerians to close the open drug market. It is not good. In Onitsha, the open drug market was closed down for over a year, but that did not stop the pharmaceutical business in Nigeria. Close down the open drug market; let us face the same thing. NAFDAC will not regulate hospitals. The same law that permits them to step into pharmacies permits NAFDAC to step into any place where drugs are stored or sold to check whether those products are correct or not.
They have the effrontery to come to pharmacies—the same NAFDAC that cannot close down the open drug market. That is not agreeable to us, and all we are asking them to do is the minimum that any private association is asking. As our regulators, they must know our pains as people who have direct contact with those needing drugs every day. For instance, patients suffering from cancer need a particular strong analgesic for their pain. It is not registered because the number of people who need it is small and therefore not enough to justify its importation. So do you want every pharmacy that wants it to apply to NAFDAC? It is very complex; the time lag from registration to getting the permit to import is so long, people will die. Sometimes it takes more than a month before a permit to import is given. It is high time we sat down, looked at it together, and came up with a policy that meets the needs of the people. Every obnoxious policy that does not take the interests of Nigerians to heart is killing them in installments. Two, NAFDAC is underfunded and understaffed, and their regulatory effort does not extend to the open drug market. If it extends to the open drug market, there should be no open drug market in Nigeria.
The open drug markets are responsible for the hike in drug prices. The people in the open drug market are so financially big, so they mop up pharmaceutical products and hoard them. They then dispense it in small amounts while putting the price they like on it. They are equally responsible for substandard and falsified medicines. When people import fake and substandard products, they drop them in the open drug market, where they eventually reach the length and breadth of Nigeria. Really, there are regulations on medicines in Nigeria, but the intent to implement and regulate them is not there. If the intent to regulate is there, there should be no open drug market in Nigeria today.
Even now, we have people putting drugs in the tray for display in the sun. These last-mile retailers are not regulators; the big wholesalers who are in the open market give them all sorts of medicines for sales. Where I get my products as a pharmacist, if you don’t give them your annual licence to practice, they will not sell to you. But you can go to any drug market in Nigeria and get your products, and nobody will disturb you.
Will buying medicines from these markets not make them cheaper for the generality of Nigerians rather than patronizing community pharmacies?
The consumers are the ones to suffer if they patronise open drug markets because they are properly stored and illegal drug markets; they are avenues for the distribution of fake and substandard medicines. That is why we, as the regulated market, want to sit down with NAFDAC to see how we can work together for their regulation. Regulation does not mean that you want to kill professionals. It is that professionals must comply with the regulations on the handling of medicines.
In all of these, our leaders need to stabilise the naira because the pharmaceutical sector is highly forex-dependent. Over 70% of drugs in Nigeria are imported. Also, all the active pharmaceutical ingredients (API) and excipients required for the manufacturing of the drugs made in Nigeria are equally imported. Only water and packaging materials are made in Nigeria. Manufacturers and importers would overestimate the foreign exchange rate and, based on it, give a prize to the medicines they deal in. In fact, a weaker naira will also push some manufacturers out of the market.
For example, I might have been importing a container of anti-malarial before the naira worsened, but now I can’t do more than half of a container. The price is higher because it is dependent on the volume that you are buying. Even the logistics of imports will increase, as will the logistics of distribution locally, which will more than triple due to the price of fuel. All these things are factored in, and that accounts for the hike in drug prices. So, President Bola Tinubu’s intervention in the pharmaceutical sector that was mentioned should be implemented for the benefit of Nigerians because of the importance of drugs.
What will be some of your expectations from such an intervention in the pharmaceutical sector?
One, we want the tariff on raw materials and even finished products in pharmaceuticals to be removed because this directly will go to the patient. Two, we want the pharmaceutical industry to have access to special funds from the federal government. It was done for petroleum products, so why can’t we do it for the pharma sector, one that touches the life of every Nigerian because we all have the need for drugs regardless of where we live? Third, we also need a special adviser to the president on pharmaceutical matters who can give suitable advice to ensure a revolution in the pharmaceutical sector. It is a very sensitive area. If any country decides to wage war against Nigeria, all they need to do is cut the medicine supply or lace their products with substances that can kill Nigerians. The pharmaceutical sector is one of the highest employers of labour in Nigeria. The more pharmaceutical industries that we have, the better the nation’s economy will be and the less reliant we will become on forex.
Why should people patronise registered pharmacies for their medications given the importance of efficacious drugs?
It is so important to patronise registered pharmacies. When you step into a pharmacy, it is not just because of the drug alone. It also affords them the opportunity for proper health education and information from the pharmacists. The second one is about the medicine itself. Pharmacy is a perfection science; it is in the sense that you don’t want your product to deteriorate, so you want to store it appropriately. Also, it ensures that you are buying it from trustworthy, monitored, and regulated premises. Also, because the drug has not deteriorated, people will get well and won’t stay longer in the hospital. Actually, when drugs deteriorate because of poor storage, they can be toxic to the body.
Also, when individuals patronise non-professionals, how are we sure that what they need is what they were given and that they were not exploited?
But people say you sell at higher prices?
No, we don’t sell at a higher price. It is a perception. When I was in school, one of my lecturers said somebody opens a pharmacy in a rural setting, puts in an air conditioner, and paints the place well. Many will pass without patronising it because they perceive that the prices of their drugs are going to be higher. It is just a perception. In Nigeria, I can boldly tell you that is not the case. In fact, a study that corroborates this also said that drugs are three times cheaper in pharmacies compared to hospitals.