Drug prices soar after pharma giants GSK and Sanofi exit Nigeria

Last October, Idoma Prince visited a pharmacy in Nigeria’s capital city of Abuja to replace his old inhaler but he returned home empty-handed. The 24-year-old user interface designer was shocked after he was told the cost of a Ventolin inhaler, which he uses for his asthma, was now 8,500 Nigerian naira ($5.34). He returned home with the thoughts of the shocking price looming in his mind. Just a few months before, he had bought the same product for 3,500 naira ($2.46). “I wasn’t prepared for that [price] at all so I had to delay getting it till I had enough money on me. This January I went to get [it] again and I saw that the price had gone up to 10,000 naira ($7.02) for one inhaler,” he told Devex. Prince is just one of millions of Nigerians unable to get their prescribed medicines due to a continuous price jump caused by the country’s high inflation rate, weak naira, high import duties, and a deluge of exits by multinationals such as pharmaceuticals GlaxoSmithKline, or GSK, and Sanofi due to an acute foreign currency shortage plaguing the country and an unfavorable business climate. This has caused a serious upshoot in the price of medications, some increasing by as much as 1000%, and has inconvenienced many sick people — especially low-income earners grappling with the crippling realities of Nigeria’s economic woes. Consumers are having to settle for cheaper alternatives or native herbal concoctions, which experts say may not achieve the best results or are harmful, in a country where life expectancy is 56.05 years. Big pharma exits In August 2023, GSK, the producer of Prince’s inhaler brand, announced that it would be exiting Nigeria and pivoting to a third-party direct distribution model. GSK, which started its Nigerian operation in 1971, appointed a local middleman, World Wide Commercial Ventures Limited, to import and distribute its products in Nigeria from January. Before this, GSK imported, packaged, and distributed its products throughout the country with the help of more than 290 staffers. “In common with many companies operating in Nigeria, the significant challenge in accessing foreign currency in recent years impacted our local operations and has affected our ability to maintain consistent supply of medicines and vaccines in the market. This was a factor in our decision to move to a third-party distribution model, which we believe will enable more sustainable future supply,” the company said in a press statement. French pharmaceutical company Sanofi also halted its operations late last year and is also transitioning to a third-party model that will see a local company taking over the distribution of its products in Africa’s largest economy. Now Prince, who needs a new inhaler every month, hardly steps out of his house, he stays mostly indoors to reduce the chances of meeting his triggers, such as cold and perfume, which will necessitate him to use the inhaler. He has had to move back in with his family to cushion the impact of the economic hit and allow him to save money for food, health care, and other essentials. “Before now, I used to stay alone and I have a budget for what to spend every month but I can’t match up with the budget again. I recently had to move back to stay with my family,” he said. Prince’s inhaler currently sells for 18,500 naira ($13.09). The prices of locally produced drugs have also shot up due to the high cost of materials and production, said Tanimola Akande, a professor of public health and consultant community health physician at the University of Ilorin Teaching Hospital. Some of the local pharmaceuticals are struggling. This has given way to an influx of counterfeit drugs which is detrimental to health care. “[Local pharmaceutical companies] are facing challenges like high energy costs, low technical capacity. Many have shut down because they believe it is cheaper to produce abroad and just import it into Nigeria” said Seun Onigbinde, the director of BudgIT, a civic organization leveraging technology for citizen engagement. Presently, local drug manufacturing companies have 25% of the national market, while the remaining 75% is catered by imports from other countries. A change in consumer habit Lagos-based online drug store Famasi has noticed a drastic change in the purchasing habits of customers, some changing drug brands, not buying some of their essentials, or summarily not buying so they can buy other essentials like food. “Some people can't afford important medicines like Ventolin inhalers anymore. They are forced to settle for less effective options like Salbutamol tablets. Imagine dealing with asthma, one of the leading causes of death in Nigeria, and not being able to get the right inhaler,” said Oluwakemi Ebire, the company’s care specialist, who added that they’ve tried to keep the prices of drugs consistent despite the economic volatility. This is causing a headache for doctors, as drug compliance for those with chronic diseases like hypertension and diabetes is now a big challenge. “Drugs that will normally treat infections can no longer easily kill the germs causing the infection. In this scenario, a higher level of antibiotics will be used, which are even a lot costlier to the patients,” Akande said. “These days, doctors tend to insist on a particular brand of drugs for treatment of their patients, and such drugs are usually very costly. This situation is a very big challenge to the Nigerian health system." Antimicrobial resistance, which affects humans and animals, has compromised the effective treatment of diseases and infections for decades, making medical treatments expensive, hard, and even impossible. Vulnerable patients, such as those in low-income countries, who may not have the money to pay increasing medical costs bear the brunt. Commonly used antibiotics like Penicillin and Cotrimozale now have resistance proportions of up to 80% to 100%. Saheed Adeleke was diagnosed with a chronic bilateral ear infection at the University College Hospital, Ibadan, in late 2020. At the time his medications were affordable. He remembers buying drugs used to fight the bacteria and soften the wax in his ears — Seromol for 2,500 naira, Augmentin for 3,500 naira, and Flucamed for 600 naira. “Seromol is now 16,000 or more depending on where you buy, Augmentin is now 20,000 naira, Flucamed is now 2,000 naira from 600 naira. I stopped using the drugs the way I used to because of the change in price,” the 30-year-old said. “The way it is, I now skip [using the drugs]. I want to be managing it because of the price.” For the past five days, he has not been taking his medication and has found an alternative for Seromol, which he uses to soften the wax in his ears. He uses warm Goya oil, which he bought for 2,500 naira, but it doesn’t treat the pain from the infection. At the heart of the struggle of Nigerians like Adeleke is the country’s ailing economy and high inflation currently at 31.70%. Yet the minimum wage has remained stunted at 30,000 naira per month since 2019 when it was last increased. Nigeria’s economic hardship is caused by several factors such as a high foreign currency deficit, inadequate infrastructure, poor naira value, and high unemployment. The situation has most recently been accentuated by the twin policies of currency floating and removal of petroleum subsidy introduced to transform the economy but which have worsened inflation, triggered currency value drop which is pushing the vulnerable over the edge. Risky alternatives Cheaper drugs should not mean reduced potency as long as they are the same generic drugs from different manufacturers but this is not the case in Nigeria where a large number of cheap drugs are sub-standard in quality and the amount of expected active ingredients, explained Akande. “It has further worsened the proliferation of fake and substandard drugs. This certainly has serious consequences on patients' healing or recovery. It increases complications and deaths,” he said. “In the case of antibiotics, fake and substandard drugs are major factors in antimicrobial drug resistance. This is currently a big problem globally and particularly in Nigeria.” Nigeria has a 15% fake drug prevalence, according to a 2022 report by the NAFDAC. Most patients, according to Akande, can no longer afford orthodox health care and this has caused them to use alternative medicine. Liquid herbal medicine, known locally as agbo, has been the option they turn to. But experts warn that agbo could be dangerous and counterproductive, it has been identified as the leading cause of kidney failure in Nigeria. Agbo hardly has a correct prescription, users sometimes use too much and it takes a toll on their kidneys in the long run. Currently, 1 in 7 Nigerians has kidney failure. “They eventually report back to health facilities with disease complications, and these worsen the health indices of our country,” he said. A more structured approach Ebire said the government should invest in local research and development, empower the health care sector down to the grassroot, and subsidize essential medications for vulnerable populations. “Government should implement policies around regulating medication prices, ensure fair competition among pharmaceutical companies. The government should get involved in negotiating better deals with manufacturers that sees bulk purchases done at lower costs,” she said. “They should also think of subsidizing essential medications for the vulnerable population, especially those with recurrent medication needs.” Akande said the government should address the economic situation by providing an economic environment that can improve the income of citizens to increase the affordability of drugs while improving health care. “Efforts should be made to increase health insurance coverage of citizens so that there will be higher level of financial protection of patients,” he said. “The only way to rein in this situation is for the government to be more structured in how it makes decisions for the consequences of removing the fuel subsidy and floating of Naira. The government needs to be strategic going forward,” Onigbinde said. In Abuja, Prince is frustrated by the Nigerian economic situation and he feels the government is unconcerned about the living conditions of its citizens due to the ballooning cost of governance. “It is a huge struggle, honestly. I feel bad, sometimes not for myself but for people in worse situations,” he said. “I think the government should provide a sort of subsidy for certain medications, especially life-threatening illnesses.”