One woman's war with fake drugs

By Olenka Frenkiel BBC reporter, Bad Medicine

Counterfeit drugs are flooding the international marketplace, but Nigeria's Dr Dora Akunyili fights day and night to stop it.

Dr Dora Akunyili is passionate in her bid to end the fake drug trade

Dora is angry.

Angry because her diabetic sister died from what she is convinced were fake insulin and fake antibiotics.

And angry because so many of her countrymen and women are fighting killer diseases like malaria and tuberculosis with little more than sugar syrup and chalk tablets, cynically packaged to look like the real thing.

When she started her job as director general of Nigeria's National Agency for Drug and Food Administration (Nafdac), she trawled drugs markets, hospitals and clinics and was horrified at what she discovered.

A survey conducted with the World Health Organisation found more than half the drugs on sale in Nigeria were fake or sub-standard.

Nigeria's hospitals were using fake and contaminated drips, surgeons were using fake adrenalin to re-start the heart, anaesthetists were giving sub-strength muscle relaxant to patients in their operating theatres.

"Counterfeit drugs are murder," says Dora. "It is the highest form of terrorism against public health because it kills a mass."

Death threats

Counterfeit drugs are murder Dr Dora Akunyili

Until her arrival, Nafdac, like many other government organisations in Nigeria, had functioned little better than a toll gate. Importers simply paid a bribe to get their products into the market.

That changed.

Last year she closed down the vast open-air medicine market in Kano for three months, after her officers confiscated £140,000 worth of fake drugs.

But in a culture steeped in corruption, she has not had an easy ride.

She built a new team of female inspectors and pharmacists (she believes most men are too easily tempted by bribes) and started to prosecute importers of fake drugs.

When the public saw the dragons she was slaying, she may have become Nigeria's uncrowned queen, but the counterfeiters fought back.

They burnt down Nafdac's offices and threatened to kill her and her children.

When she stood firm, they shot her in her car. The bullet grazed her skull but she survived.

'Injecting water'

Dora tells the medicine dealers at Kano market to reject fake drugs

Direct proof that a fake drug has killed is hard to find.

However, one particular tragedy in July 2003, is probably as close as it gets.

The International Children's Heart Foundation visited Nigeria to operate on sick children at a teaching hospital in Enugu.

The operations should have been straightforward. The patients' prognosis was good. But when the operations began, things went wrong.

Cardiac nurse Joanne Price recalls: "You give them adrenalin to restart the heart and that normally works. But this time nothing came back. It was water. I felt we were basically injecting water instead of adrenalin."

Four children died as their parents watched and prayed.

Despite being confronted with what seemed to be a hospital cover-up, Dora confiscated supplies and found fake adrenalin, fake muscle relaxant and infected intravenous drips.

The hospital maintain there is no proof to link the deaths of the patients with the drugs used.

International effort

Imperfect holograms on packets can indicate that drugs are fake

But the problem of fake drugs is not confined to Nigeria, or even the developing world.

In the UK in November 2004, Allan Valentine was imprisoned for manufacturing fake Diazepam and Viagra in his Wembley warehouse where Indian tablet presses and chemicals were found.

In the US, where patented drugs are the most expensive in the world, fakes have penetrated the pharmaceutical chain from drug manufacturers, through wholesalers, to high street pharmacies.

The American Food and Drugs Administration prosecutions have tripled in the last year.

At a conference in Paris about counterfeit medicines, Dora demands concerted global action. "Eradication of counterfeit drugs should be treated as an international health emergency," she says.

She believes that raising public awareness has produced dramatic results in Nigeria and urges other nations to be more open.

Unsurprisingly, drug companies around the world are fearful that their brand will be shunned if news of a fake gets out.

But no matter how tough the situation gets for pharmaceutical industry, Dora will not be leaving any stone unturned.

Bad Medicine was broadcast on Tuesday 12 July 2005 at 2100 BST on BBC Two.