Nigeria’s marathon struggle against counterfeit medicines

In a large warehouse in the northern Nigerian city of Jos, people are repackaging medicines—including painkillers, antiretrovirals, and erectile dysfunction drugs—smuggled from South East Asia into the capital, Lagos, before being transported to Jos. The counterfeiters place the medicines in new packages labelled in English, with Nigerian registration numbers and false manufacturing dates. Often these convincingly mimic the logos of trusted brands.

Such counterfeits are on the more visible side of “fake medicine” in Nigeria. Cyril Usifoh, president of the Pharmaceutical Society of Nigeria, says that in some cases a batch of falsified drugs are mixed with a small quantity of the legitimate product. This can pass quality controls. “What we [really] struggle with is adulteration of products,” says Nelly Okpako, a pharmacist in Lagos. These are not deliberately falsified products but are substandard medicines with substantially different quantities of the active ingredients than advertised.1

Overall, there’s a consensus that in Nigeria the fake medicine problem is far less severe than it was. Data are patchy, but one estimate is that in 2001 substandard and falsified medicines made up at least two thirds of medicines in Nigeria.2 These were largely basic, quick selling medicines such as antibiotics and antimalarials. “There was a time in Nigeria when you just couldn’t buy a [real] drug,” reflects Bisi Bright, a pharmacist who leads the non-profit LiveWell Initiative.

Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC) claims that at least 85% of medicines sold today are legitimate, but others dispute this.3 (NAFDAC did not respond to a list of questions from The BMJ.) The actual figure …