Nigeria is home to over 200 million people who are susceptible to a set of health problems that are linked and interact synergistically, contributing to its excess burden of disease: which includes the rising rates of non-communicable diseases, endemic diseases, and emerging and re-emerging infections. If Nigeria is to reduce its disease burden and forge a path towards sustainable economic development, it must invest heavily in science and innovation - investing and strengthening pharmaceutical manufacturing is a way to achieve this. With multinational companies like GSK and Sanofi exiting the country, this presents a unique opportunity for the Nigerian government.
Cost of healthcare and drug prices are major concerns in Nigeria and prices of pharmaceuticals (drugs/medicines) affect the healthcare cost accounting for a large part of healthcare expenditure. Unfortunately, public healthcare expenditure is minimal and coverage under health insurance is limited, as most people are engaged in informal and unorganised sectors with no social security, health expenditure is largely met with household out-of-pocket (OOP). OOP healthcare expenditure is one of the major causes for large number of households falling into poverty and with the exit of international pharmaceuticals from the country, cost of medicines rose tremendously creating more challenges for households. Nigeria has an opportunity to fill this gap and lead the continent. To achieve this, we must do three things: invest in R&D infrastructure, create low-cost manufacturing, and develop a skilled workforce.
Nigeria isn't unique with regard to underinvestment in science and innovation. The whole of African R&D and innovation suffers from chronic underinvestment and poor implementation. Africa contributes just 2 percent of world research output, accounts for only 1.3 percent of research spending, and produces 0.1 percent of all patents. Only 1% of global investment in R&D is spent in Africa, and the continent holds a tiny 0.1% of the world's patents. Nigeria has an opportunity to turn this around by prioritising investment in pharmaceutical manufacturing of drugs and vaccines, thereby reducing over-dependency and over-reliance on the consumption of medicines and therapeutics from foreign countries. To begin on this journey, Nigeria can invest in manufacturing generic medicines.
A generic drug is a medication created to be the same as an existing approved brand name drug in dosage form, safety, strength, route of administration, quality, and performance characteristics, but costs less. It is essentially the same medicine but with a different price and brand name and is formulated when the patent and other exclusivity rights of the innovator have expired. The medicines cost less because generic drug manufacturers do not have to spend extra money on drug discovery and preclinical and clinical trials. The low cost of generics provides an opportunity for savings in drug expenditure in Nigeria.
India, also a lower middle-income country with a large population has successfully shown that drug manufacturing can be successfully achieved. Medicines were not easily obtained by the public in India. The major source of these medicines was from foreign countries.
The lack of indigenous medicines and their huge demand led to very high prices and as a result, drug prices in India were amongst the highest in the world. In 1957, the Indian Government revised the patent law to comply with the then, industrial needs. The Indian Patent Act of 1970, shifted patent compliance from 'product to process patents' so that the medicines reach even the poor sections of society. This became a watershed moment in the turnaround of India's pharmaceutical industry. This revolutionized the economic system in India by providing medicine at a low price. The Indian pharmaceutical industry has grown remarkably, overhauling the country from import dependence in medicine (until the 1970s) to self-reliance by the 1980s, catering to a large extent of domestic market demand and to becoming a major exporter after 1990.
Today, India is known as the 'pharmacy of the world', exporting medicines to many countries including Nigeria. The Indian pharmaceutical industry employs nearly 700,000 people directly in manufacturing, contributes more than 5 per cent of the country's commodity exports and has enjoyed double-digit growth in the last few decades. Its growth rate was almost twice that of national GDP and its pharmaceutical industry has attracted large foreign direct investment (FDI). Most people in India don't have health insurance, and the salaries are low compared to the Western world, but their out-of-pocket payments for medicines have reduced significantly, reducing the burden on households.
Price regulation of pharmaceutical products is the policy instrument that has been used to address the affordability of medicines in India. Nigeria should follow this same path India took whilst leveraging on local pharmaceutical companies that already exist.
Lastly, we must develop our human capital. Nigeria is blessed with a large population which is an important resource needed for manufacturing products that can be used in-country and exported into other markets within the African region. The country's investment in the mostly young population would ensure we reap the benefits of our demographic dividends. This would involve investing in education in the sciences from secondary school through to universities, investments in the creation of grants that encourage the development of innovative solutions to local problems, investing in creating a research ecosystem, and investing in developing and preserving the science research culture. Most pharma companies operating in India, even the multinationals, employed exclusively Indian people. From the people in the warehouse to the board of directors. This created many jobs in the life science industry, in turn developing and strengthening the local pharma industry.
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Nigeria can truly become the 'pharmacy of Africa' if we prioritize investment in pharmaceutical manufacturing. India has shown this can be done and we have all it takes to achieve this. All that's missing is political will. With political will, Nigeria will not need to depend on foreign countries for drugs and vaccines its citizens need and will be well on its way to achieving health and economic resilience of the continent.
·Rhodes-Vivour, an associate professor of genetics and molecular biology, writes from Lagos.
