Last week Dora Akunyili, Director General of Nigeriaâ€™s National Agency for Food and Drug Administration (NAFDAC) called on faith based organizations to join the fight against counterfeit malaria drugs in Nigeria. She explained that with the faded efficacy of chloroquine and sulfadoxine-pyrimethamine (SP) Nigeria must be vigilant in protecting the efficacy of ACTs.
NAFDAC does take action as seen in a recent newspaper notice seen in part here that warns the public about unregistered and potentially dangerous drugs. NAFDAC has taken other recent helpful actions. For example, the Agency has asked producers of SP to remove the warning that this drug is contraindicated in pregnancy so that SP can be used for IPTp during the second and third trimesters (but still not the first).
Some challenges remain. Many monotherapy artesunate drugs had been registered over the past 5 years, and although NAFDAC agrees with WHO that such drugs can lead to resistance and should not be sold, NAFDAC has taken a more conservative approach and is simply allowing the licenses on those products to expire. The monotherapy drugs are still in abundance in the medicine and pharmacy shops, particularly in urban areas, and some state pharmacy stores do stock them. While it would mean financial loss to companies, businesses and clinics if monotherapy artemisinin drugs were abruptly withdrawn, the longer term costs of developing resistance to artemisinin-based drugs would be enormous both in terms of lives and finance.
Nigeria is not the only country that should pay attention to its malaria drug supply. Recently I purchased an artesunate-SP combination in a registered pharmacy shop in Entebbe, Uganda as seen in the photo. Again, combinations of artesunate and drugs like chloroquine and SP that have reduced efficacy is dangerous in terms of speeding up development of parasite resistance to the artesunates. WHO expects that this combination â€œwill fail rapidly.â€
The time to act to protect ACTs in Africa in now.
[Note that photos of pharmaceutical products do NOT constitute an endorsement.]