FAKE PHARMACEUTICALS

FAKE PHARMACEUTICALS

Nigeria's Drug Czarina Risks Death to Take on Counterfeiters

By Samiha Shafy

Part 2: Drug Resistance

Akunyili announced to her staff that from then on, every drug would be analyzed in the agency's internal laboratory before it could be approved, and that the initial approval would be limited to five years. All packaged food products -- toothpaste, bottled drinking water, baby food, chocolate bars -- would have to be tested to ensure that they satisfied hygiene standards and that they contained the correct ingredients. Factories that produced drugs or food products, the agency's new director announced, would also be inspected regularly from then on. But the most important change Akunyili brought to NAFDAC was that anyone who was caught taking bribes would be fired.

A short time later, Akunyili proved that she meant business. "I had to fire my husband's younger brother because he had accepted money," she says. "The family hasn't forgiven me to this day." She bites her lower lip. Then she says, defiantly: "But I had to. Otherwise I would have lost control."

The results of Akunyili's efforts are in full view in Nigeria's big outdoor markets. In a country where pharmacies are practically nonexistent, the outdoor markets are where most drugs are sold.

The drive to the Idumota Market leads through Lagos's constantly clogged streets, where men and women with dusty faces balancing baskets of water bags, fruit and nuts on their heads maneuver between the tightly packed cars in the sweltering heat. One vendor is selling dead rats dangling from a stick. Legless beggars in rags crawl through the garbage on the side of the street. No one pays any attention to them.

Declan Ugwu, a NAFDAC employee, has come to the market to try to buy a counterfeit allergy drug. The fake drug was once hawked on every street corner, but vendors have become more cautious -- and violent. In a raid a few days earlier, a policeman came away with head wounds serious enough to land him in the hospital.

Ugwu, a rotund man with a soft face wearing a traditional brown-and-yellow robe, balances on wooden walkways that run through claustrophobically narrow alleys. The ground is muddy, and on both sides of the alley vendors in small huts are hawking a broad array of drugs: pills to treat AIDS, antibiotics, insulin, sedatives, even a cough syrup made by a company called Nigerian-German Chemicals. The vendors sit in groups of three or four in their shops, chewing on toothpicks and sizing up their customers.

The first three vendors tell Ugwu that they don't sell the allergy drug, and that that sort of thing isn't available here. The fourth vendor, a young man with a shaved head and a soiled T-shirt, asks Ugwu to come into his shack. He says that he'll have to look into the matter, and disappears. Two other men sit there in silence, one of them entering numbers into a pocket calculator.

The vendor returns after fifteen minutes. Perhaps he could provide the drug Ugwu has asked for, he says, but it will be expensive and risky. He writes a name and a mobile phone number on a piece of paper and tells Ugwu to call him later. The man calls himself "Chosen." Ugwu leaves the shop and disappears back into the crowd. There is another raid at the Idumota Market a week later.

Ugwu, his boss and other NAFDAC employees use posters, brochures and television ads to alert the public to the dangers of counterfeit drugs. Agency officials travel the country, giving presentations. When the campaign began producing results, a counter-movement began.

Their adversaries tried a soft approach at first. "They sent middlemen who offered me bribes in the millions," says Akunyili. A few dealers felt so invincible that they didn't even try to conceal their criminal dealings. Complicating the issue is the fact that Nigeria has weak laws against drug counterfeiters. Those who are caught can expect to pay a fine of no more than 500,000 Naira -- about €3,000.

Akunyili can't change the law or do anything about corrupt judges. "But I use loopholes," she says, smiling. She has the authority to have shops and markets closed. She can create a spectacle by publicly burning counterfeit goods. And she can also publicly humiliate offenders, like Marcel Nnakwe, the leader of a gang of counterfeit drug dealers in Onitsha, who she paraded before the public on live television. Nnakwe was forced to apologize and swear that he would never pursue "this illegal business" again. He complied, albeit sullenly, and after the appearance he vowed to exact his revenge.

That was when the attacks began. Six armed men forced their way into Akunyili's house in Abuja, overpowered the staff and searched the rooms -- and left a bundle of bank notes lying on the desk untouched. A year later, in August 2002, a fire destroyed one of the agency's new laboratories in Lagos. In March 2004, NAFDAC offices in different federal states went up in flames at the same time.

Who is behind the attacks? There are indications that Nnakwe has sent paid killers to do away with Akunyili. A court case against him has been dragging on for more than three years. The other incidents were not investigated.

"I don't want to think about why the government isn't doing anything," Akunyili says. "It makes me afraid." She hesitates, weighing her words carefully. "If I were to ask for 10 additional police officers, I know I'd get them. I'm sure of that." Then she adds, now very cautiously: "Even if some people are chummy with the criminals, they value public opinion. That's why they want me to remain in my position."

On this afternoon, Akunyili meets with two Indians and their Nigerian escort. She sits regally on a black leather sofa in her enormous third-floor office, the wall behind her lined to the ceiling with prizes and awards. Her bodyguards usher in the visitors, who hurry forward and bow. Akunyili nods graciously, puts on her gold-rimmed reading glasses and motions to them to sit down. "Please excuse me for making you wait since early this morning," she says, smiling softly. "I had a lot to do."

FAKE PHARMACEUTICALS

Nigeria's Drug Czarina Risks Death to Take on Counterfeiters

By Samiha Shafy

Pharmacologist Dora Akunyili is a remarkably honest woman. The trait earned her a job as Nigeria's pharmaceutical industry enforcer. Her campaign against the country's counterfeiters has put her life in danger, but she has no plans to back down.

Dora Akunyili and her brother were sitting in the back seat of a dark limousine, chatting and laughing. They had no idea that killers were tailing the car.

A police officer was sitting in the front passenger seat and other bodyguards were in cars ahead of the limousine. It was a sunny winter afternoon. Akunyili had just come from a festival and was on her way to visit relatives in her native village.

She felt the pain at the top of her skull and heard the rear window shattering at the same time. When she reached up to touch the silver scarf she had wrapped around her head, she realized that there was a hole in it. Only then did she comprehend what had happened. "Officer, help me, I have a bullet in my head!" she cried. The police officer turned around and yelled back: "Be quiet, madam. If you had a bullet in your head, you wouldn't be speaking!"

Nowadays Akunyili has to laugh when she thinks about the incident. "The bullet grazed my head. It singed the skin on my skull and a few hairs, and the spot where it had hit me was swollen for a few days," she says, opening her eyes wide and wrinkling her nose. It wasn't until later that she learned that a bus driver had been mortally wounded in the assassination attempt. "We simply took off as fast as we could to the next police station."

Akunyili, 53, a pharmacologist and the mother of six children, has a round face and a fondness for colorful traditional robes. As the Director General of Nigeria's National Agency for Food and Drug Administration and Control (NAFDAC), she is constantly in danger of attack.

She is fighting a battle for the health of 140 million people. Globally, the trade in counterfeit drugs costs hundreds of thousands of human lives, and few countries are more affected than Nigeria. A toxic mix of oil dollars, violence and corruption has turned the country into a major hub in a multi-billion dollar business.

Counterfeit drugs consist of pills, drops and ointments containing either incorrect active ingredients or none at all. Sometimes the active ingredients are so diluted that the drugs are completely ineffective. In their least harmful form, the fake drugs are vitamin tablets made of chalk or erectile dysfunction drugs made of cornstarch. All too often, though, they are ineffective or even toxic copies of brand-name drugs used to treat cancer, hypertension, diabetes, malaria and AIDS.

Most fake drugs come from India and China. An international network of dealers distributes them, usually in developing countries. Nigeria, considered one of the most important centers in the pirated drug trade, set a sad record a few years ago when, according to studies, up to 70 percent of all drugs in the country were found to be fake.

That number has apparently dropped to just below 20 percent today. The decrease is principally the achievement of this plump woman in a blue-and-gold outfit. Sinking her exhausted body onto the sofa in her hotel room in Lagos, Akunyili removes her shiny red pumps with a sigh.

It's almost midnight at the end of a long day in the Nigerian capital of Abuja, where NAFDAC has its headquarters. Akunyili has just flown back to Lagos, a chaotic city filled with mountains of garbage and millions upon millions of people, a foul-smelling hell and one of the world's most dangerous cities. More than 15 million people struggle to survive in Lagos, one of the world's most dangerous cities. Nigeria's government, meanwhile, decided to abandon the city long ago: In the early 1990s, the Nigerian government built Abuja, a smaller, more organized and more easily controlled capital in the country's interior.

In Lagos, Akunyili only feels relatively safe inside the walls of the heavily guarded Sheraton Hotel. Guards stand at the hotel's entrance manning the security doors. Patrols monitor the floors and the building's opulent gold-and-marble lobby. Thanks to the Sheraton's tight security, Akunyili's bodyguards can relax for a few hours while their boss tells the story of how she became the drug counterfeiters' worst nightmare.

It all began because of Akunyili's basic sense of honesty. Seven years ago, she was suffering from gastrointestinal complaints. Doctors were stumped. Her employer, the Petroleum Special Trust Fund, generously offered to give her a check for 17,000 pounds ($33,000) for treatment in London. But when she learned that the costly treatment wasn't necessary, and that all she needed was a specific drug, she thanked her supervisor and returned the money. "He was quite impressed," she recalls, giggling. In Nigeria, no one returns money.

Akunyili's boss related the story to an acquaintance, who in turn told the president. Two weeks later, on a Sunday afternoon, Akunyili received a call from the president, who told her that she would be just the right person for the job of running corruption-plagued NAFDAC.

It was a tough assignment. In 2001, when Akunyili was appointed Director General of the agency, other African countries had recently banned the importation of drugs from Nigeria for safety reasons. The country's honest drug merchants had given up when they were unable to compete with the counterfeiters' cut rates. Pharmaceutical corporations that produced genuine drugs had abandoned the country.

"People are dying all over the world because they take counterfeit drugs," says Akunyili. "But here in Nigeria, there is a victim in almost every family." She presses her lips together and stares down at her hands. "My sister Vivian died of diabetes when she was 21. She simply went into a coma and died." It turned out Akunyili's sister had been given fake insulin.

Akunyili's first move in her new position was to clean up the 3,000 person agency, promptly firing about a tenth of its staff. "Most of them weren't even aware that they were supposed to be performing a control function. Any merchant could bring drugs to NAFDAC, and they were simply registered, without further ado," she says, shaking her head. "Of course, the employees wanted money in return for the registrations. Most of them were corrupt."

FAKE PHARMACEUTICALS

Nigeria's Drug Czarina Risks Death to Take on Counterfeiters

By Samiha Shafy

Part 3: 'They're not Petty Criminals

The three visitors assure her that it isn't a problem at all. Then the younger of the two Indians, a gaunt man with a moustache wearing a black suit, speaks. He tells the director that his company deals in imported table salt and wants to build a production facility in the southeast. But the salt mine they want to use belongs to the state.

"Fantastic," Akunyili says slowly. "You want me to help you get the mine?" All three men nod enthusiastically. "Okay, I'll speak with the minister. More production in the country is good for everyone." She motions toward the door. "Next, please." The man with the moustache tries to hand her a gift wrapped in pink paper, but she turns him down.

There are also people in Lagos who prefer to work with Akunyili behind the scenes. "These drug counterfeiters, they're not petty criminals. If they found out that I'm harming their business, they could burn down the clinic and shoot me," says George Okpagu. He sits at his desk in a small hospital in Lagos. The air-conditioning isn't working. Okpagu, in a white doctor's coat, wears his hair cropped close to his head. He is barefoot. He has been in charge of the hospital for 22 years.

He often asks his patients to bring him the drugs they take. "If something looks like it's counterfeit, I ask the patient where he bought it. Then I call up the NAFDAC people and tell them that they should search this or that shop," he says. "This is the only way to support Dora Akunyili without putting myself in danger."

He laughs bitterly. Four years ago, he says, he almost died when he took counterfeit drugs to lower his blood pressure. "I bought the pills in a pharmacy when I was traveling. The package looked completely normal," he says. He says that he had been taking the drug for years and that he had always responded well to it. But a few weeks later he became dizzy at work. "The last thing I remember was another doctor taking my blood pressure: 200 over 110. Then I lost consciousness."

Okpagu had had a cerebral hemorrhage. He was unconscious for eight days. When he came to, he was temporarily paralyzed on one side of his body. In the meantime, his fellow doctors analyzed the pills -- and discovered that they contained no active ingredient. Today Okpagu blames himself, saying that as a doctor, he should have been monitoring his blood pressure. "But how many Nigerians have the money and the education they need to protect themselves against these murderers?"

But Nigerians do have Dora Akunyili. And for that they worship her. She is routinely showered with letters and poems, drawings, good luck charms and sweets. Strangers address her on the street, eager to touch her, but her bodyguards have to push them away. They call Akunyili "Mommy," a sign of respect in Nigeria.

Sometimes being a popular hero is exhausting. Akunyili plans to remain in office for another three years, until the end of her second term. She dreams of a more relaxing job -- perhaps as an ambassador in a faraway, peaceful country. She is convinced that she will have to leave Nigeria as soon as she gives up her position. "I wouldn't survive long without the bodyguards that the government provides for me."

Her children have been living in the United States for years. Her youngest son has just finished high school. His parents would have liked to keep him with them for a while longer, but after an attempted kidnapping four years ago they decided to send him away. "I thank God that neither my family nor I knew ahead of time how dangerous this job would be," Akunyili says quietly. "My husband lives in constant fear, and I'm worried about his health." But now is hardly the time to give up.

The green numbers on the television set in Akunyili's hotel room indicate that it's 2:00 a.m. She is exhausted, but she says that she still wants to make one thing clear. "What we are fighting here is not just an African problem," she says. "Resistant strains of bacteria, which are literally being cultured with poor copies of antibiotics, are spreading throughout the world." To address the problem, she plans to work more closely with health authorities in neighboring West African countries in the future.

Akunyili has already traveled to India and China to recruit inspectors and win over local authorities, with only moderate success. She is also the deputy chair of a special unit of the World Health Organization (WHO) established in late 2006 to improve international cooperation and encourage member states to enact tougher anti-counterfeiting laws.

Is she achieving anything? Can Akunyili truly change Nigeria? How does one measure success in a place like this?

The next day NAFDAC holds a public "destruction exercise" in Lagos. On a field outside the city, workers mound up boxes of drug packages and douse them in diesel. In the presence of TV cameras and journalists, a bald man in a black suit takes a torch and sets the pile of fake drugs on fire. The man's name is Dioka Ejionueme. He is the agency's director of enforcement. As the flames shoot up, he describes recent successes in a hoarse voice. This, he says, is the 116th public burning, and this time, once again, counterfeit drugs worth several million dollars have been destroyed!

But he only reveals the real news once the journalists have left. He seems slightly sheepish. Effective immediately, the director of enforcement whispers, the counterfeit drugs will no longer be burned publicly, but in state-of-the-art incinerators. It's Nigeria's contribution to protecting the environment.