With more than 90 percent of Nigeria’s population at risk of malaria infection, it seems we all have a story to tell about the disease. When I was younger, my sister had a close shave with malaria. She developed a high fever and received several antimalarial ‘treatments’ from unlicensed chemists, which did not help. Her case became quite severe before she finally received proper treatment just in time to fully recover.
As a physician, I am all too aware that her story is sadly not unusual. Malaria is preventable and treatable, yet millions of Nigerians suffer from it every year – and far too many die from the disease. Tragically, many of these deaths are due to incorrect diagnoses and use of poor quality drugs. These failures do not merely prevent patients like my sister from recovering. They also challenge the world’s ability to fight malaria.
Counterfeit and substandard drugs are a bigger problem than many realise. A review by the Worldwide Antimalarial Resistance Network – based at the University of Oxford, where I studied as an ExxonMobil Global Health Scholar last year – found that almost one-third of all malaria drugs tested globally failed quality tests, and nearly 40 percent of those were entirely fake. A person who takes fake drugs will not be cured from malaria. In some cases, those drugs may even make the person sicker, since they can contain toxic chemical compounds.
The issue does not end there. A person who takes substandard drugs, which contain insufficient doses of antimalarial compounds, may begin to recover. However, the parasite will not be completely eliminated from the blood and the patient may relapse. What’s more, over time, the use of poor quality medicines can decrease the effectiveness of our best drugs. If the malaria parasite survives treatment, it can adapt and build resistance to future drug interventions.
Resistance to artemisinin, the current preferred malaria treatment, has already emerged in Southeast Asia – in part due to improper diagnoses and misuse of drugs. Scientists monitoring drug resistance fear that it could soon spread to South Asia and then to Africa. Allowing substandard drugs to flood our markets could hasten the rise of drug resistance within our own borders and cause malaria deaths to surge.
This does not have to be our future. Ending malaria is complex and will involve solving many challenges, but we have tools that are proven to stop the disease – including bed nets, insecticide spraying, and diagnostics, as well as medications. If we use these tools the right way, we could eventually reduce the burden of malaria to zero.
Adequate drug regulation must be central to the fight against malaria in Nigeria and we’ve taken important steps forward. For example, the Nigerian National Agency for Food and Drug Administration and Control has deployed several technologies to fight fake and substandard malaria drugs, including an SMS system to verify the serial numbers on malaria drug packets. We now need to reach more of our population with systems to remove poor quality drugs from the market, as well as improve screening at our ports and borders to prevent the importation of fake medicines.
We also need better data on the prevalence of substandard and counterfeit drugs, and systems to monitor the quality of diagnosis and treatment our citizens receive. We can take inspiration from groups like the Worldwide Antimalarial Resistance Network, which provides a platform to share expertise and coordinate detection of poor quality drugs around the world. This is especially critical in Nigeria, where the lack of quality data makes it difficult to deploy the right interventions and develop effective strategies to combat the disease.
Finally, we need to generate public awareness about the dangers of poor quality malaria drugs. Education campaigns have been successful in helping our citizens make more informed choices about preventive measures like insecticide-treated bed nets and residual indoor spraying. We need similar programmes to help at-risk populations understand the threat of substandard medicines and the need for better care.
On this World Malaria Day, I am encouraged that Nigeria has taken many of the right steps to improve access to quality medicines and malaria prevention tools. But we need sustained involvement from all sectors to continue on this path of progress. If our leaders and our people step up our commitment to health, I am hopeful we can achieve a malaria-free Nigeria.
Tochukwu Abadom is a physician from Anambra State and currently practices at St George’s Hospital in London, United Kingdom. He is a 2014 graduate of the University of Oxford’s MSc in Global Health Sciences program, where he was an ExxonMobil Global Health Scholar.
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