LAGOS, Nigeria — When Nana Nwachukwu, a lawyer and policy analyst based in Abuja, Nigeria, purchased malaria drugs from a pharmacy last year, she used Nigeria’s mobile authentication service to make sure they were real. She scratched off a code on the drug pack and texted it to a number that would confirm whether the medication had been authenticated by the National Agency for Food and Drug Administration and Control.
The response: It had not. She tried three times. The drugs could not be accounted for.
“Thankfully none of us had taken [them],” she said.
More on the future of health partnerships:
Nwachukwu returned to the pharmacist, who blamed a network error with the authentication service. Even though Nwachukwu presented the text evidence, the pharmacist insisted the drugs were not fake.
Tens of thousands of Africans die from counterfeit anti-malarials alone each year, according to World Health Organization estimates. These products are ineffective at best, and often downright dangerous — low-dose counterfeits sold as anti-malarial pills can cause the malaria parasite to build drug resistance, for example.
NAFDAC says Nigeria is the largest market for fake drugs in developing countries, and began partnering with technology companies mPedigree, Sproxil and PharmaSecure in 2010 to use mobile authentication to protect the country’s most heavily counterfeited drugs — antibiotics, anti-malarials, and diabetes medications.
Eight years after the technology was introduced, NAFDAC says the program is a success.
“We did a study and from a figure of 19.6 percent counterfeit anti-malarial drugs in 2012, we have come down to 3.5 percent in 2015,” said NAFDAC spokesperson Abubakar Jimoh. Launched in 2014, the national survey was undertaken by jointly by NAFDAC, the National Malaria Control Programme and the Federal Ministry of Health, with funding from the United State Agency for International Development and implemented by USP.
At a press conference where he presented the survey, Paul Orhii, then-director general of NAFDAC, attributed the reversal to both the authentication service, and other NAFDAC strategies such as scanning drugs at ports with TruScan, a handheld Raman spectrometer that detects counterfeit drugs.
NAFDAC has aggressively fought counterfeit drugs since the early 2000s, when the late Dora Akunyili was director general. Akunyili closed fake drug markets, fired corrupt staff within the agency, and set up surveillance at ports and airports where many counterfeit drugs enter the country from India and China. She ruffled so many feathers that she received multiple death threats, and survived an assassination attempt in 2003.
Despite her efforts, counterfeit drugs remained prevalent, even finding their way into reputable pharmacies.
According to a 2013 paper published in the African Journal of Pharmacy and Pharmacology, Nigeria produces only 30 percent of its drugs, importing the rest. Demand for these foreign drugs often outweighs supply. Counterfeiters also exploit the fact that authentic drugs can be too expensive for consumers, who seek out cheaper options instead.
Drugs must be analyzed and tested for safety before being approved for distribution. But as the journal reports, “Unfortunately, the forensic laboratory, which is the major public laboratory for the purpose of quality control analysis, is not adequately equipped to cope with the volume of requests, particularly for analysis of imported drugs.”
The mobile authentication service intends to mitigate these issues.
Pioneered on the African continent by mPedigree in 2007, the technology is straightforward: Sproxil, mPedigree, and PharmaSecure provide NAFDAC-approved pharmaceutical producers with a unique set of codes for their products. The 12-digit codes are concealed on each pack of medicine by tamper-evident, coated labels. The codes contain product information such as manufacturer, active ingredients, and expiration date. After purchasing the product, a consumer can text the code to a toll-free number and receive a reply within seconds that verifies whether the drug is authenticated and safe to use. There is also an option to verify via a mobile app.
If there’s a problem with authentication, the text reply provides a number to report the problem.
The companies log the verification results, and collate and parse the data for “suspicious activity patterns,” according to Chinedum Chijioke, managing director of Sproxil. This information is sent to NAFDAC to investigate.
Still, not everyone is convinced the mobile authentication strategy is a lasting solution.
“If someone can counterfeit a drug, they can counter its [protection] mechanisms,” said Adaeze Ezenwa, a pharmacist in Lagos. He explained that because Nigerians have developed such a mistrust of drugs over the years, they may not bother to authenticate their medications, believing they are compromised either way.
According to all three companies, however, even the most sophisticated counterfeiter cannot subvert their technology.
“It’s simply impossible to clone a used PIN and receive a genuine response on the PIN upon verification,” said Chijioke.
While Jimoh says pharmaceutical companies have benefited from the reduction in counterfeits, the authentication service will remain a requirement for only antibiotics, anti-malarials and diabetes drugs. He said protecting all drugs would be too costly for the companies.
Femi Adereti, a pharmacist with Greenlife Pharmaceuticals, agreed. Greenlife manufactures about 100 different medical products, including its flagship drug, an anti-malarial called Lonart.
“But for other products we barely get cost price on, you wouldn’t want to spend so much on that,” Adereti said.
Update, July 11, 2018: This article has been updated to clarify that Nigeria did not have plans to expand the authentication service to drugs beyond antibiotics, anti-malarials, and diabetes medications, and that USP was an implementing partner to USAID, not a funder of the national survey on counterfeit anti-malarials.
Devex, with financial support from our partner MSD for Mothers, is exploring how the private sector is driving innovations in global health. Visit the Focus on: Future of Health Partnerships page for more.