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• Pregnant women, cancer, diabetic, hypertensive patients, others badly hit

• Experts blame forex, diesel crises

…warn of looming increase in mortality, morbidity

By Chioma Obinna

These are not the best of times for Nigerians in need of drugs and other essential pharmaceutical products.

Reason: Soaring foreign exchange rate and inflation have caused an astronomical rise starting from the importation of Active Pharmaceutical Ingredients (APIs), to the point of manufacturing and finished products as well as at the consumer level.

Just like other essential commodities, at every point in the country today, the prices of drugs and other pharmaceutical products have skyrocketed.

For a nation, which depends on importation for about 70 per cent of its drug needs, the soaring foreign exchange rates (Naira free fall) and inflation rates have not only caused a sharp rise in the cost of products but also made prescription drugs inaccessible and unaffordable to most Nigerians.

As of last week, the dollar was exchanging at N429: 38 at the Investors and Importers window and over N680 to a dollar at the parallel market.

Sunday Vanguard reports that the cost of drugs and essential pharmaceutical products has risen by between 30 per cent and 500 per cent in the last six months.

Further findings reveal that prices of drugs, including infusions, orphan drugs, and particularly drugs used by cancer patients, pregnant women as well as other drugs for chronic illnesses, have risen to such levels that many patients can no longer afford them.

This survey was done before the Consumer Price Index (CPI) for July 2022 was released, last week, by the National Bureau of Statistics (NBS), showing inflation rate in the country rose to a 17-year high of 19.64%. This compares to 18.6% recorded in the previous month of June.

The last time Nigeria’s inflation was above 19.64% was in September 2005 when it rose to 24.32%.

Although specific mention was made about the rise in food inflation in the CPI, among others, there is no mention of the effect of the inflation increase on drugs even if medicine is as important as food in human lives because people must fall ill.

For instance, according to Sunday Vanguard findings, the prices of antibiotics, antihistamines, anti-hypertensives, anti-diabetics pregnacare, and blood tonic, among others, and depending on the brand name, increased by between 30 per cent and 85 per cent while the prices of syringes went up by between 50 per cent and 100 per cent during the period under review.

Infusions per unit, sold for N120 months back, now go for N700, which is about 500 per cent increase, in the last six to eight months.

Many Nigerians can no longer afford common analgesics. A sachet of paracetamol sold for N50 now goes for N100 depending on the area of purchase. Prices of anti-malarial have also gone up.

Nigerians treating different conditions are now failing to follow their drug regime as their brands of drugs are no longer available or the cost of alternatives has hit the roof.

Many diabetics and hypertensives, who are supposed to be on routine drugs, are on drug holidays. Some routine drugs used in pregnancy are not spared, no thanks to the rise in prices. Worst hit are Nigerians treating chronic conditions like cancer.

According to Sunday Vanguard investigations, arranging importation for anti-cancer and other chronic conditions’ medications that require special treatments have become more difficult due to soaring foreign exchange and the inability to secure it through the Central Bank of Nigeria (CBN) official rate.

These drug pharmacists tag orphan drugs are mostly not stored in the pharmacy due to their storage condition and the fact that they are more expensive and needed by fewer patients.

Apart from the finished products’ challenge which is mostly borne by consumers, manufacturers of drugs in Nigeria are facing hard times as 80 per cent of APIs used in manufacturing drugs locally are imported. Unfortunately, there are very few or no alternatives for these millions of Nigerians.

Fold up

Stakeholders in the pharmaceutical industry fear that many drug companies may fold up due to the inability to access foreign exchange and the cost of diesel among others.

Sunday Vanguard further investigations reveal that the situation portends danger to Nigerians and the economy at large. Some patients who spoke said their conditions are getting precarious due to their inability to afford routine drugs.

Mrs. Jaccinta Ekwe, who told Sunday Vanguard that she had been on diabetes drugs for over a decade now, said she could no longer afford the treatment.

“I am losing faith. My son lost his job a few months ago. Before now, with N3, 000, I could buy my two weeks routine drugs. These days I need nothing less than N7, 000 to do two weeks of treatment”, Ekwe said. “I have decided to ration it. I only take it when I notice any strange feeling.”

For Okoro Emmanuel, a Sales Representative at the EU Emmason Pharmacy in Lagos, the economic situation was becoming frustrating.

Emmanuel told Sunday Vanguard that drugs’ prices keep increasing on daily basis.

“Inflation is affecting our sales because people are no longer buying (medicines)”, he said.

“They walk in and out due to the high cost of drugs without buying anything. “For instance, Acini we used to buy at N300 is now sold for N400, Ampiclox sold for N700 a week ago but today it is N800. Antimalarials like Amatem sold for less than N1, 000 but now goes for N1, 500 etc.”

Another pharmacist at Livefort Pharmacy in Lagos told our correspondent said that falling naira has contributed to the problem apart from the harsh economic situation the country is facing now.

“The worst part of it is that people are not patronizing us like before”, he lamented.

“Some of the drugs are even off the shelf because you can’t buy what you know you cannot sell. It is not good for business.

“The high dollar rate is affecting us because prices of drugs aren’t stable, you can buy at N1, 000 today and by tomorrow it has jumped to N1, 500. It is tiring and discouraging.”

Mrs. Chidima Okereke, of Safe Care Pharmacy, said the issue of foreign exchange has greatly affected her business as the prices of most drugs have gone up beyond the reach of many customers, thus making most of them go for dangerous alternatives.

“The prices of most malaria drugs have gone up tremendously”, Okereke said. “Amatem Forte that we used to sell for N1, 300 before now goes for N2, 000. Colart that we sold for N700 is now N1, 800 and Lonart sold for N1, 900 is now N2, 500. P-Alaxin which used to sell for N1, 000 is now N1, 500 per sachet.

“The increase in the price of diesel would have forced us to close down if not for the inverter that we are using. “The whole thing is beyond comprehension considering the situation of many health seekers.”

Mr. Emmanuel Charles, of Meditrust in the Surulere area of Lagos, expressed concern over the increased cost of some diabetic drugs, saying some of his regular customers on insulin injections are no longer coming.

“I have about three customers now that are diabetic patients who are on insulin but no longer come to patronise me”, Charles said.

“It is not as if they are buying from another place but they complained of the high cost of insulin.

“The cost of a vial insulin injection that used to cost between N2, 500 and N4, 000 is now sold for N5, 000 to N7, 000. The price of test strips is now about N7, 000 as against N4, 000 for a pack of 50 strips.”

Miss Idowu Dimeji, of Omega Pharmacy at Ojuelegba, Lagos, complained of the increasing price of pregnancy care drugs due to foreign exchange rate and the increased price of diesel. “Pregnacare Plus that we used to sell for N6, 000 is now N19, 000 while Pregnacare Max that sold for N7, 000 is now N18, 050”.

Toll

There is no gainsaying that, like every other sector of the economy, foreign exchange flight is taking a toll on the pharmaceutical sector.

Stakeholders, who fear that Nigeria remains an importing and consuming country, say the future does not look good for the sector and the challenges posed by scarce foreign exchange are multifarious.

According to the Chief Executive Officer, Engraced Pharmacy Ltd and former General Secretary, Association of Community Pharmacists of Nigeria, (ACPN), Lagos State Branch, Jonah Okotie, it is appalling to watch daily as medicines get out of the reach of the common man and many turning back due to the inability to afford the new prices, besides the hard fact that some medicines are out of circulation completely.

Okotie, who lamented that pharmaceutical companies in Nigeria are not left out of the out-of-stock menace, added that there has been a decline in patronage.

“Products we used to stock 10 or more packs in a week or two, now, we buy just one and it takes a longer time to dispense. And the cost of operation is increasing by the day”, he said.

“Rocephin injection per pack, an antibiotic for saving lives, was N3, 500 before now, but it is over N5,000 currently. Zinnat 500mg tab, another antibiotic, formerly sold for N3, 000 before, now sells for N5, 000 plus and the syrup not readily available anymore.

“Not only is Zinnat syrup not available anymore, so are other products like Epilim syrup which is an anti-epileptic medicine used in children and so are some other essential medicines.

“We fear the worst; unnecessary morbidity and mortality of our people as a result of the unavailability of essential medicines due to high cost beyond the reach of the average man, and outright non-availability of some medicines in Nigeria due to the high exchange rate beyond the reach of importers and local manufacturers.

“We are stoking a fire that might be difficult to quench if we don’t declare this a national emergency.”

3rd party

Also confirming the dire situation, the National Chairman, Pharmaceutical Wholesalers Association of Nigeria, PWDAN, Ernest Okafor, said third party sale of foreign exchange through BDCs (Bureaus de Change) before now contributed to the situation of the economy.

Okafor said importers are finding sourcing of foreign exchange difficult coupled with the Federal Government policies.

“Scarcity of imported finished products and raw materials keep worsening daily. Scarcity breeds high prices which, in turn, affect affordability and unwholesome practices”, he said. “Wholesalers, hitherto operating with low margins, leveraging on turnover for sustenance are now having their margin and turnover depleted”.

According to him, the short-term implication is that importers, manufacturers and wholesalers will not be able to survive the business environment as many companies are folding up, downsizing and laying-off personnel.

“Many are not meeting up with their obligations set by tax masters who need more from them to meet the year’s revenue target set by the agency and on which government drew their budget”, he added.

According to him, the long-term implication is that medicine security and the general health system will be threatened.

“The capital flight has adversely affected all sectors of the economy including personnel management where staff are asking for pay raise from not doing well companies”, the PWDAN chief explained.

Okafor said the only way to boost the country’s foreign reserve was to engage in the export of goods and services to contribute to world trade, balancing Nigeria’s imports with exports, ‘in other words migrating from a consuming nation to a producing nation.

He stressed the need for government, as a matter of urgency, to prioritize the establishment of the petrochemical industry and encourage the manufacturing of APIs in the country to save foreign exchange and make raw materials available for local production.

“Government should give the health sector priority in forex allocation and sourcing as it did for educational tourism”, Okafor said.

Noting that all categories of pharmaceutical products are affected, both finished and raw materials, the PWDAN boss added, “If you talk about the ones that we can’t produce and are being imported, what of the raw materials that are imported for the production of local products?

“Something drastic needs to be done at the policy formulation level to mitigate the looming disaster.”

Regret

Okafor regretted that the 30 per cent of drug needs allegedly produced in the country have over 80 per cent of their components imported, adding that “head or tail, foreign exchange distortion will affect all strata of the economy.”

Also speaking with Sunday Vanguard, an industrialist and importer, Lolu Ojo, said there is a direct relationship between naira devaluation and high cost of medicines and explained that the official forex rate was unreliable as businesses don’t get it.

Ojo expressed worry that businesses may shut down if the situation continues for long, adding that there will be a possible surge in the circulation of fake or substandard drugs and other items.

He listed some of the implications of the present development to include increase in unemployment, spread of social issues and increase in untimely deaths.

According to him, Nigeria is running an import-dependent economy with no hope on the horizon.

“No one is talking to us. We need to reorder our priorities and let our leaders settle down to proper governance,” Ojo stated.

“There is already general inflation which is already evident in the prices of goods and services including staple food items. “There is the possibility of unnecessary deaths or prolonged illness due to drug and essential medical affordability.”

Also speaking, the National Publicity Secretary, Pharmaceutical Society of Nigeria, PSN, Felix Ndiukwu, told Sunday Vanguard he just received notice from some pharmaceutical companies on plans to review the prices of their products upward due to the inability to access forex at an acceptable rate.

Ndiukwu explained that in his facility, several patients can no longer afford their routine drugs and efforts to find alternatives are very slim.

“As we speak right now, I have been shopping for alternatives that will be cost-effective for these patients”, he said.

“There is a need to fix the economy because whatever affects other commodities also affects pharmaceuticals.”

He called for the urgent passage of the Pharmacy Bill that will revolutionalise the pharmaceutical industry in terms of access, affordability, security. and protection of the common man.

Meanwhile, a former Lagos State Chairman of ACPN, Abiola Paul–Ozieh, noted that prices are rising, saying the hike in foreign exchange rate has significantly impacted drug prices.

She said it was unfortunate that after over 60 years of independence, Nigeria is still not self-reliant on food, medicines and some critical materials for its wellbeing.

“Over 60-70 per cent of our drug use is based on importation. We import raw materials and packaging materials for the few drug products manufactured within the country”, Paul–Ozieh stated. “Our manufacturing companies are operating below-installed capacity.

“We import finished goods from Asian countries and European countries heavily. As a nation, we lack medicines security because we keep importing and importing.

“Drug prices are now going up daily, companies are changing prices daily. It’s pathetic we are in such a terrible state”.

The expert regretted that government, over the years, lacked the political will to create an enabling environment for drug production in Nigeria, adding that, the petrochemical industry to jumpstart the production of raw materials had not been facilitated by successive governments.

“This is shameful. But thank God for some private organisations like Emzor Group that is now into raw materials production”, she said.

“We have a long way to go to get to the point of self-reliance. The whole of the pharmaceutical value chain will be impacted negatively as the Naira slides against the dollar.”

She added that due to the skyrocketing prices, and scarcity of certain medicines, the increasing cost of funds to import was imminent and may limit certain operatives in the pharmaceutical distribution chain and result in the unavailability of medicines.