By Obi Adigwe
This year marks the third consecutive year that I chair the National World Malaria Day Committee on behalf of Dr Okechukwu Akpa, the PMGMAN Chairman. Although some progress has been made, the situation remains dire.
Malaria continues to be a serious disease in our region and we still carry an inordinate share of the global disease burden. Findings from a recent study indicated that nine out of ten Malaria cases occurred in Sub-Saharan Africa. Similarly, nine out of ten people who died of the disease were from this part of the world.
In the three years that I have chaired the Committee, what I have found most interesting is the astonishingly wide range of stakeholders involved in this area. It is based on this experience that an important realisation dawned on me during the 2nd Planning Committee meeting on the 22nd of March this Year, at the Abia House in Abuja.
During that Eureka moment, I found that although the various relevant stakeholders had extremely incongruent motivations for their activities in the sector, only an ontology that incorporated these disparate perspectives would enable a timely achievement of the goal. Perhaps therefore, this is why this year’s theme is so apt “Ready to beat Malaria: together we can”. The emphasis on the ‘together’ bit stresses the importance of collaborative working, as well as individual responsibilities from various stakeholders.
As such, given how deadly malaria is, one of the most important tasks a stakeholder can carry out this year, is an introspective reflection of how they can contribute to beating this scourge. For the purposes of this discourse ‘stakeholder’, does not only refer to healthcare professionals and policy actors, but realistically, everyone who is at risk of the disease. The term also encompasses the millions of individuals, who although are not at risk, work in Malaria, or are passionate about beating the disease.
As the Executive Secretary of the PMGMAN, it was therefore natural that my reflection would throw up some of our initiatives (from the Pharma Manufacturers’ perspective) that could help beat malaria. At PMGMAN we conceptualised and have consistently advocated the concept of Medicines’ Security. Simply put, the Medicines’ Security Concept argues that unless a people exert sufficient control over how their medicines and healthcare commodities are produced, sustainable access to relevant, affordable, high quality products cannot be guaranteed in that setting.
When this concept is viewed against the incidence and prevalence of malaria, which remains one of the biggest killers in our context, the implications of its potential become clear.
In the main, building local capacity in Pharma Manufacturing would guarantee sustainable and predictable supply of safe, affordable and efficacious antimalarials for Nigerians. Adopting this approach would also ensure that the relevant local capacity is developed to match our contextual needs. As a nation, this will make us better ready to beat malaria.
We have also worked with Government to develop policies to which can further the Malaria fight. In the 2016 Fiscal Policy, Government instituted an import adjustment tax for Antimalarials together with three other categories of medicines, for which incontrovertible evidence indicated that local production outstripped national consumption.
This landmark policy is one of the most important measures undertaken by Government to support local production of medicines. However, when compared to other countries in our setting, Nigerian Medicines’ Manufacturing has so much more potential, both in terms of ensuring sustainable access to medicines, as well as contributing to national socioeconomic development.
Currently, Nigerian manufacturers represent more than a third of all pharma production plants on the continent, and also constitute the biggest cluster of internationally certified manufacturers in the whole of Africa. Against this backdrop, it is clear that there is a significant and urgent need to prioritise Local Pharma Manufacturing in Nigeria, so as to harness the current untapped potential. This is what will enable a contextual and comprehensive support framework for Nigerian companies that manufacture antimalarials and other lifesaving medicines.
One other policy with the potential to impact our goal to beat Malaria is the Executive Order – 003 (EO – 003) which came into force on May 18, 2017. In many developing country settings, one of the most effective means of supporting local production of specific commodities such as antimalarials, is by the development of policies that encourage patronage of such products. However, despite mandating all MDAs to ensure that least 40 per cent of their procurement spending is on locally made medicines, evidence suggests that the EO – 003 is not being faithfully implemented.
It is necessary for government to formulate a robust and comprehensive incentive package for the development of the pharmaceutical sector. Strategies that Government can use to stimulate FDI in this area include the granting of tax holidays for Pharma Manufacturers that have made capital investments towards establishing new plants and upgrading existing ones. Tax waivers will also facilitate investment in Pharma research and development.
Government must also improve the ease of doing business in the sector by working with Manufacturers to remove tedious and cumbersome regulatory and bureaucratic bottlenecks. Efforts must be made by all stakeholders to ensure a deliberate prioritisation of Local Pharma Manufacturing, as a means of achieving Medicines’ Security.
PMGMAN has done its own bit, but is far from resting on its oars. Currently, a significant proportion of Local Manufacturers produce Affordable, High Quality Antimalarials, including ACTs. Members of the Group are however continuously investing in improving various relevant indices. Currently, Local Manufacturers have more than enough capacity to satisfy National consumption, in fact, quite a few have even started exporting to the Continent.
The theme selected this year to underpin the World Malaria Day is “Ready to beat Malaria: together we can. This all-encompassing approach represents the most comprehensive and robust approach so far. Going forward, this approach can therefore ensure a widespread and robust engagement of all citizens and relevant stakeholders. This will in turn ensure that malaria receives a sound beating, and gets kicked out from Nigeria for good.
Dr Obi Peter Adigwe is Chairman of the National World Malaria Day Committee