ONITSHA, 6 April 2007 (IRIN) - ONITSHA, 6 April 2007 (IRIN) - For the past month armed soldiers and police have guarded all entrances onto the Bridge Head Market in the southeastern city of Onitsha as teams of food and drug control experts move from shop to shop in search of counterfeit and substandard medicines.

The market, a warren of lock-up shops and passageways, is considered by the National Agency for Food and Drug Administration and Control (NAFDAC) to be the soul of the counterfeit drug business in Nigeria.

On 6 March NAFDAC shut down the market with the backing of hundreds of troops and police – one of the toughest measures yet undertaken by the agency in its fight to eradicate a deadly but booming trade in fake medicines in Nigeria, said Dora Akunyili, the 52-year-old pharmacy professor who heads NAFDAC.

In the four weeks of the siege more than 80 truckloads of counterfeit drugs have been hauled away, officials said.

"The Onitsha market is responsible for distributing most fake drugs in Nigeria," she told IRIN. "If there is no Onitsha market Nigeria will record less than five percent of fake drugs" on the market.

Currently the national average stands at 15 percent, with Onitsha, a city of more than one million people, recording 30 percent, said Akunyili, citing a joint study by her agency and the World Health Organisation (WHO).

Undermining health

The United Nations is marking World Health Day on Saturday with the theme of international health security to urge governments, organisations and businesses to invest in health. WHO says the counterfeit drug trade is an increasing problem throughout the world, especially in developing countries, claiming thousands of lives every year.

WHO estimates that the incidence of counterfeit medicines ranges from 1 percent in developed countries to more than 10 percent in the poorer regions of the world, with prevalence higher where regulatory control is weakest. But the organisation notes that many countries in Africa, as well as parts of Asia and Latin America, have recorded more than a 30 percent rate of counterfeit medicines.

At the time Akunyili was appointed by Nigerian President Olusegun Obasanjo to head the drug agency in 2001, about 68 percent of all drugs circulating in Nigeria were unregistered and more than 41 percent were fake or substandard, she recalls. In tackling the problem she met tough challenges in a chaotic drugs market and a powerful and highly organised criminal cartel of counterfeiters.

Entrenched network

In Nigeria the distribution of pharmaceuticals evolved as part of a market system controlled by traders in traditional markets. While these traders are not trained in the dispensing and storage of medicines, the major pharmaceutical companies came to rely on them as distribution channels because of their effectiveness, said Akunyili.

"Their distribution system is fantastic in that they can distribute any drug throughout this country in three days," she said.

The fake drug trade used this same system to push its goods, she said. NAFDAC has found a trail that stretches from India, Pakistan and China, from where Nigerian counterfeiters order most of their drugs. The distribution chain covers much of west and central Africa. Ghana had in the past banned drug imports from Nigeria over fears medicines coming from its regional neighbour were substandard.

Under Akunyili NAFDAC launched a programme to register and certify all drugs on sale in Nigeria in 2002. This resulted in the closure of major pharmaceutical markets in the southern city of Aba and the northern city of Kano. The pressure worked and temporarily won compliance from other markets, including the Onitsha Bridge Head Market.

The campaign netted several convictions against counterfeit drug traffickers and oversaw the destruction of substandard medicines that would have cost buyers more than US $60 million, according to NAFDAC.

Traffickers fight back

But the campaign's success also triggered reprisals from the powerful criminal rings controlling the trade.

Several of NAFDAC's offices across the country were set on fire and vandalised, including its main office and laboratory in the economic capital, Lagos. Akunyili herself narrowly escaped death when suspected assassins opened fire on her official car in 2003. A bullet grazed her head.

Police soon arrested several Ontisha-based suspected drug counterfeiters, who were charged with the attempted assassination. After a two-year trial they were freed on legal technicalities, which emboldened drug traffickers, NAFDAC officials said.

In June last year when food and drug officials went to the Bridge Head Market on a routine inspection with a team of policemen, traders traders attacked them and drove them from the market. Six of their vehicles were burned.

"After this incident we realised that any time we wanted to sanitise the Onitsha market we would need to mobilise the army and the police," said Akunyili. That is what it did last month when it closed the market.

New system

NAFDAC aims to audit all traders at the market to determine which drugs are fake, substandard or unregistered and eliminate them. But the agency acknowledges that in the long-term the war against counterfeit drugs will be hard to win unless the current system of marketing drugs in Nigeria is reformed.

"The [drugs] markets have been so entrenched that they are difficult to eliminate without an alternative," said Akunyili. "But we want to phase them out."

Plans are now underway to build drug marts run by licensed professionals that will probably borrow from the skills shown by the drug traders in order to set up an alternative national drug distribution system.

"The difference will be that the proper environment for the storage of drugs will be created, it will be run by professionals and they will be subject to easier regulation," said Akunyili.

dm/cs

IRIN news