Africa Facing Lethal Counterfeit Drugs
By DULUE MBACHU
.c The Associated Press
LAGOS, Nigeria (AP) - Wrenching stomach pains seized Johnson Olisa when he took antibiotics prescribed for an ear infection. Barely conscious, he was rushed to a hospital, where doctors said he was lucky to survive.
Taking pills, syrups, drops or shots is a game of Russian roulette in Nigeria, Africa's most populous country. Sloppy packaging and phony manufacturers' addresses are among the few tell-tale signs giving away potentially lethal counterfeits that account for more than half of all drugs produced and sold.
The deadly fakes often find their way across the continent, prompting neighboring Benin, Togo and Ghana to ban Nigerian imports. Western embassies warn their citizens to avoid all but a handful of Nigerian pharmacies that import their medicines from Europe and the United States.
Internationally, health experts, enforcement agencies and drug companies have called for tougher action - saying in part that greatly diluted drugs are fostering drug-resistant disease strains. ``It's a global problem and it needs global action,'' Lembit Rago of the World Health Organization said.
In Nigeria, Dora Akunyili, head of the country's food and drug control agency, believes the toll from decades of rampant, unregulated trade in counterfeit medicine could be in the hundreds of thousands.
``When I was told his pains started when he took the antibiotics, I asked to see the tablets and the pack,'' recalls Dr. Nwandu Emenike, the Lagos physician who prescribed the drugs to Olisa.
``I could tell right away it was fake.''
Yet few patients - and not all doctors - can tell the difference between the real thing and fakes sold for just a few naira, or pennies, by streetside vendors. For those who get it wrong, the consequences can range from prolonged illness to death.
Nigeria's drug control agency has seized blood-pressure medication containing chalk and insulin vials filled with sugar water. Analgesics have been passed off as anti-malarials. Medicines that have long expired are put back in the market, relabeled with new due dates.
Equally worrying are antibiotics with few or no active ingredients.
``If ampicillin is supposed to taken in 250 mg tablets, the fakers go to India and China and tell their fellow criminals to put in 20 mg,'' Akunyili said.
When antibiotics are used in such insignificant quantities, infectious organisms more readily develop immunity - leading to the emergence of drug-resistant strains of once-curable diseases. ``That kind of organism does not need a visa to travel,'' the Nigerian drug chief said. ``It can infect people outside this country.''
More than 60 percent of medicines on sale in Nigeria are either counterfeit, substandard or expired, Akunyili says.
Until her agency - assisted by the U.S. Department of Food and Drug Administration and the World Health Organization - started cracking down on the illegal industry a year ago, the figure was 80 percent.
Many of the frauds are cooked up in improvised factories, roadside stalls, rundown warehouses and homes in Nigeria's sprawling cities of Lagos, Onitsha and Aba. A den of counterfeiters was recently uncovered in a street market within the Ojo military barracks on the outskirts of Lagos.
Other counterfeits are imported, mainly from India and China.
Behind the deadly trade are criminal rings with international links.
``When I took over in early 2001, it was a totally disorganized system,'' Akunyili said. ``It was so chaotic that our markets became the main wholesale outlets for drugs. Even commercial buses became a way to (spread) the drug trade.''
Law enforcement agents can only dole out weak penalties that fail to deter kingpins of the trade. Many of its leaders have become fabulously wealthy. Marcel Nnakwe, a suspected Nigerian kingpin arrested last year and released on bond, is still awaiting trial after being charged with distributing counterfeit drugs for decades.
Until the early 1990s, the punishment for vending fake drugs was a fine of 100 naira - about 78 cents - or three months in jail. The penalties were later raised to $3,900 or five to 15 years in prison.
Nigerian lawmakers are considering a new bill to better regulate the trade and provide tougher punishment, said Emeka Orji, another drug agency officer.
In the meantime, major pharmaceutical companies have begun taking their own measures.
GlaxoSmithKline's Nigerian subsidiary recently begun adding holograms to medicine packaging and set up a special surveillance unit that works with enforcement agencies to identify counterfeits and their dealers.
The criminals appear to be fighting back.
Last year, armed bandits broke into the Nigerian drug agency's main investigative laboratory, built with international assistance and destroyed computers and drug-testing equipment.
02/22/03 07:00 EST
