A year after British pharmaceutical giant, GlaxoSmithKline exited Nigeria and asthmatic patients who depended on its inhalers faced significant distress due to the medication’s scarcity, investigations showed that fake and unregistered inhalers have flooded Nigerian markets.
For a 28-year-old marketer, Rose Daniel, having to deal with the side effects of an anti-asthmatic tablet, was an experience she never wanted to have anymore.
Every time she took the medicines, uncontrollable tremors sent shivers down her spine, making her lead a less productive life.
But succour came when her consultant, eight years ago, prescribed an asthma preventer, Seretide Diskus inhaler, with zero side effects.
However, following the exit of GSK last year, and the scarcity of the inhalers, the fear of a return to the daily tremors gripped Daniel’s mind.
Determined to spare no cost, the Cross River indigene reached out to notable pharmacies across the country and eventually bought three packs to last her for many months, pending when normalcy would return and the drugs become available.
Once the inhalers became available, Daniel said that she ensured she got her inhalers at a registered pharmacy she was sure sold genuine and approved drugs.
But one day, while at work, she saw the pack of a Seretide inhaler with a colleague and wondered why the pack looked different from hers.
After a quick perusal of the pack, the truth hit her in the face.
“It had no NAFDAC (National Agency for Food and Drug Administration and Control) Registration Number!” she said.
Daniel said she was grateful that she had ensured she had only bought her inhalers and other drugs from a trusted pharmacy store.
On a journey to discovery
Following a tip-off from an asthmatic patient that fake and unregistered inhalers, Seretide inhalers, had flooded the market, PUNCH Healthwise embarked on a fact-finding mission to pharmacies and the drug market in Church Street, Idumota, Lagos State.
Entering into Church Street, the popular hub for wholesale and retail medicines, the tearing sounds of semitransparent adhesive tape (cellotapes) filled the atmosphere.
Human load carriers bore several cartons of purchased medicines and hospital consumables on their back to deliver them to their respective buyers.
After a brief observation of the market nuances, this correspondent inquired at some shops about where to get Seretide Diskus. Then, the referrals began.
A tall, dark-complexioned middle-aged man enthusiastically greeted another man and boldly said in the Yoruba language, “We’ve been in this market since the 1980s.”
This man would later become a guide as he led this correspondent to the prescription shops where the inhaler could be bought.
“If I take you to the place where the other woman described, the price there is expensive, I’ll take you to this shop,” the guide responded.
Unfortunately, the woman at the shop did not sell such a product, leading to another round of referrals.
At last, a young man garbed in native attire, called Nosa, was recommended.
This correspondent then showed him a picture of an unregistered Seretide inhaler, with the pack content written in English and Urdu, a language mostly spoken in Pakistan and India.
After a perusal of the picture, Nosa responded in the affirmative and led us to his ‘second shop’.
Nosa, this correspondent would later learn, sells wholesale and retail prescription medicines.
Curious as to why his name rang through like an anthem on the lips of other sellers, this correspondent asked whether he was the main distributor of Seretide Diskus.
“I am not the only one, I sell prescription medicines,” Nosa opined, as he led us through the noisy market to another shop.
Once we got there, he asked his ‘brother’, Lucky, if the inhaler was available and he responded in the affirmative.
This correspondent was offered a seat on the bench placed by the narrow entrance to the shop to await the return of the salesperson assigned to ‘bring’ the inhaler from an undisclosed location.
Undoubtedly, the unregistered medicines were not to be displayed on the shelves. Only a specific request from a ready-to-pay buyer was the criterion for the inhalers to be brought out.
After about 30 minutes of waiting accompanied by several pleas to be patient, the Seretide Diskus arrived wrapped in a medium-sized black nylon bag.
After checking the content of the bag to be sure “what I ordered was what I got,” this correspondent discovered that the name of the drug was written in Urdu language unlike the one presented.
Throwing further questions at Lucky, he responded, “Every batch comes with a new package but it is from the same producer as the one you showed me. This batch came in English. The one in Urdu was produced last year.”
However, an analysis of the packet showed that it was manufactured by “Glaxo Wellcome Production, France and the Batch Releasing Site: Glaxo Wellcome United Kingdom Limited, Brentford, Middlesex, UK and imported by Modern Pharma Trading Company.”
While the production and expiry dates read January 2024 and January 2026, respectively, the glaring absence of the National Agency for Food and Drug Administration and Control Registration Number rang the alarm bell.
What makes them fake?
In this context, a counterfeit and fake drug is defined by NAFDAC as any drug or drug product which is not registered by the Agency by the provisions of the Food, Drugs and Related Products.
Furthermore, the NAFDAC Drug and Related Product Labelling Regulations, 2019, prohibits the manufacture, import, export, distribution, advertisement and display for sale or use of any drug or drug product that is not labelled by the regulation.
It further reads, “The outer and inner labels of a drug shall clearly show the registration number of the Agency (NAFDAC REG. NO.) assigned to it as indicated on the Certificate of Registration in a manner prescribed by the Agency.”
Any conviction of contravention of the Regulations prescribes the guilty individual to one-year imprisonment or a fine of N50,000 or both and the corporate body to a fine of N100,000.
Providing further insights, the former president of the Pharmaceutical Society of Nigeria, Olumide Akintayo, stated that having fake drugs was a serious offence that violated sections 1.1 and 2.1 of the Fake Drug Acts.
Aside from the violation of the law, Akintayo explained that the influx of fake drugs portends a high incidence of morbidity and mortality rates.
He further discouraged the sale and handling of unregistered drugs and food substances and urged government agencies that have oversight responsibilities to move into action to stem the tide of fake drugs.
The battle for ‘breath’
PUNCH Healthwise had in November 2023, reported the travails of asthmatics, who after GSK’s exit, could no longer find the inhalers.
For those who found them, the astronomical price increase was a burden too heavy to bear, as some of them resorted to using little dosages of the medications for them to last longer, while others bought other brands with cheaper prices.
Lifelong treatment
Although asthma is not curable, inhaled medication, oral and injectable medications can control asthma symptoms, allowing people with asthma to lead normal, productive and active lives.
This made asthmatics use their preventive inhalers daily and go about with the reliever inhalers.
According to the World Health Organisation, asthma is a major non-communicable disease affecting both children and adults but is the most common chronic disease among children.
Asthma symptoms are caused by the inflammation and narrowing of the small airways in the lungs, which can lead to a combination of cough, wheezing, shortness of breath and chest tightness.
As of 2019, the Nigerian Thoracic Society stated that 15 million people were asthmatics. This implies that 15 million out of the over 213 million Nigerians, have asthma.
Many asthmatics use Seretide
The president of the Nigerian Thoracic Society, Professor Musa Babashani, confirmed to PUNCH Healthwise that although alternative controller inhalers were available, many asthmatics in Nigeria rely on Seretide.
With over 13 million Nigerians living with asthma, the NTS president warned that the influx of fake controller inhalers would make it even more difficult for patients to manage their symptoms, potentially leading to higher morbidity and mortality rates.
Curled from PUNCH
